When 10-year-old Sean Menard's battle with kidney disease took a turn for the worse, his former kindergarten teacher's aide offered him one of her kidneys. When it turned out she was not a good match, her husband volunteered.

His act of kindness not only enabled Sean to get the kidney he desperately needed, but it became a vital link in a chain of four donors who would give their healthy kidneys to four people in need of new organs.

The University of Maryland Medical Center announced the series of donations Tuesday, which marked its first kidney exchange. Known as a four-way swap, the procedure took place at the Baltimore hospital over two days last week among unrelated living donors and recipients from four states, ranging in age from 10 to 74 years old. Surgeons used a single-incision technique in which the organs are removed through a patient's belly button.

Several of the patients spoke at Tuesday's news conference, including Emmet Davitt, 50, the husband of Sean's teacher's aide.

"I really do view it as an opportunity, not as a great heroic act," said Davitt. "I wish Sean the best and look forward to seeing him running around."

Such swaps have taken place for several years at a handful of medical institutions nationwide, including Johns Hopkins Hospital, the first to do the procedure in 2001. They use pairs of donors and recipients who might not be good matches for each other but would match other people.

This one started with Edward Behn, 59, of Westborough, Mass., who had watched a friend die of renal failure last year. He wondered if he could help save someone.

His kidney went to an anonymous man in Maryland. The man's wife donated her kidney to Sean Menard. Emmet Davitt, the husband of Menard's former teacher's aide, donated his kidney to Carl Lichtman, 64, of Lake Worth, Fla., who was facing the grim prospect of lifelong dialysis. Lichtman's wife, Stacey, 60, donated a kidney to Bob Loudermilk, a 74-year-old Vietnam veteran from Virginia Beach.

Kidney transplants in children are infrequent; the University of Maryland does just three or four a year, said Dr. Matthew Cooper, director of kidney transplantation at the medical center. Last year, of the 16,520 kidney recipients nationwide, 773 were children, according to the United Network for Organ Sharing.

Children are more likely to reject a kidney and suffer infections after transplant, Cooper said. And since the organs last an average of 20 years, children are more likely to need a second transplant later in life.

When Michael and Jeannie Menard of Catonsville adopted Sean at 7 weeks old, he had been diagnosed with polycystic kidney disease. At 6 months, he had one kidney removed, in the hopes that the other would grow and function better. After years of treatment at the University of Maryland, Sean reached a point where he was getting worse. He became lethargic and could play outside for only 10 minutes at a time.

His teacher's aide, Julie Davitt, had spent hours with him every day in class, helping him use the bathroom and perform other small tasks. She grew attached to Sean, who greeted her with a hug every morning.

When she offered her kidney, the Menards refused, taken aback at the gesture. But Davitt called the Menards back a few days later, saying she had already secured the paperwork to volunteer to be a donor. It turned out that Julie Davitt could not donate, but her husband offered to.

"I was just floored that they wanted to do this, that they wanted the best for my son," said Jeannie Menard. "I know we will always be close to them. He gave my son life."

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