I was in the gown.
That detail matters. I want you to have the full picture before anything else happens. I was already in the pre-operative bay at Utah Valley Regional Medical Center, already changed into a hospital gown, already lying on the gurney. Dr. Howard Reichman's team was preparing to fuse my spine — L4, L5, S1 — a surgery that had become urgent because of a severe spondylolisthesis compressing my cauda equina. That's the bundle of nerves at the base of the spinal cord. Leave it compressed long enough and you lose things you cannot get back. So this was not elective. This was necessary, and it was happening that day, and I was ready.
My wife Jen had stepped out with her sister Dee Dee to grab some lunch. She'd be back. There was nothing to do in a waiting room while the pre-op team ran through their checklist, and she had been sitting with me through every appointment, every scan, every conversation with every specialist for months. She deserved a sandwich.
The anesthesiologist came in.
He introduced himself, reviewed my chart, asked the standard questions. And then he looked up and asked one that wasn't standard. Not for me. Not that day.
"Who are you working with for your transplant?"
I didn't have an answer. I didn't have an answer because the question made no sense to me. I was there for my back. I had PKD — polycystic kidney disease — but I had known about that for years, the way you know about a lot of things that sit in the background of your life, noted and monitored and not yet urgent. I hadn't thought about it seriously in years. Nobody had told me it was urgent. Nobody had told me it was close.
Nobody had asked.
Until right now. In a paper gown. On a gurney. Alone.
I called Jen.
She was somewhere between the hospital and lunch, and I pulled her back with a phone call she wasn't expecting. I don't remember exactly what I said. What I remember is the quality of that moment — the surreal, slightly airless quality of trying to tell your wife, through a phone, that the thing you came to the hospital to fix is apparently not the thing that needs fixing most urgently. That the appointment you both prepared for has just become something else. That a question you had no answer to has just reorganized everything.
She came back.
They proceeded with the back surgery. The spine fusion went as planned. And somewhere in the recovery that followed, we began to understand what we were actually dealing with.
* * *
I had known about the PKD for years — since just before I married Jen in September 1993, when an alarming episode of brown urine sent me to get checked out. That's how I found out. Not through careful monitoring or proactive screening. Through a frightening symptom that turned out to have a name, and a prognosis that seemed manageable enough that I largely got on with my life.
For years that's exactly what I did. The PKD announced itself occasionally — a burst cyst that felt like the flu and came with blood in the urine, dramatic enough in the moment and then gone. In between those episodes I didn't think about it much. Life was happening. Work, family, faith, the ordinary accumulation of a life being lived. The kidneys were back there somewhere, doing whatever they were doing, and I was up here doing this.
That's the thing about PKD. It lets you forget about it. Right up until it doesn't.
The nephrologist who came to see me that day was Dr. Terry Hammond. We had never met before. He was direct. He gave me a timeline — two years before I would need a transplant. He was also direct about the back surgery: proceeding carried real risk. The stress of a major operation could accelerate the kidney decline. We both understood what we were agreeing to.
We proceeded anyway. The spine needed fixing. The cauda equina couldn't wait.
After the surgery, while I was still in the hospital recovering, Dr. Hammond came to visit me in my room. Jen was there. The kidney conversation picked up where it had left off — now from a hospital bed instead of a pre-op bay, but no less real. When the world shifted that day in the pre-op bay it shifted for both of us, and we had been carrying it together ever since.
Two months later, on October 7th — my birthday — I went in for a post-operative kidney follow-up with Dr. Hammond. He looked at my numbers and then looked at me with the expression doctors wear when they are about to say something they know you are not ready to hear.
"I know I said two years," he told me. "But it fell off a cliff."
My kidney function was at eight percent. He wanted me to start dialysis immediately. He wanted me to begin searching for a donor right away.
I didn't sit with that. I started asking questions.
He told me I had significant symptoms — fatigue, swelling, cognitive fog — the kind that accumulate so gradually you stop noticing them, the way you stop noticing background noise. I told him I didn't. I meant it. I knew my own body and I knew what I was feeling and I was not willing to accept a description of my experience that didn't match my experience. He was insistent. So was I.
Then I moved on to the part that mattered more. Why two operations? Why dialysis as a bridge? Was there a place that could do the nephrectomy and the transplant simultaneously — remove the diseased kidneys and implant the new one in a single procedure, with no gap, no dialysis, no staged recovery?
He hadn't expected that question. Most patients hadn't done that research.
I had.
That was October 7th. My birthday. I didn't think much about that part.
I had a transplant the following April.
And I never spent a single day on dialysis.
That's the part that takes some explaining.
When a doctor tells you that you need dialysis immediately, the reasonable response is to start dialysis immediately. That is what patients do. That is what the protocol says. That is what virtually everyone in my situation had done before me, and what virtually everyone in my situation has done since.
I didn't do it.
This wasn't recklessness. I want to be clear about that. I am not recommending that anyone ignore their doctor's advice. What I am saying is that I looked at my own situation with clear eyes and the logic did not add up.
I had spent years largely ignoring PKD — not out of negligence exactly, but because it had mostly let me. It sat in the background of my life, occasionally dramatic when a cyst burst and then quiet again. I had not been carefully managing anything. But I had been living, and I was not ready to let dialysis become part of that life now, at the exact moment when a transplant was within reach.
It made no sense to me.
I understood the medical rationale. Dialysis stabilizes patients. It manages the toxic buildup that failing kidneys can no longer clear. It buys time. I understood all of that. What I also understood was that every day on dialysis carries its own costs — to the cardiovascular system, to the overall health of a transplant candidate, to the body's readiness to receive a new organ. I had come too far without it to start now, weeks or months before a transplant I was actively pursuing.
I told Dr. Hammond I would not be starting dialysis.
He did not agree with this decision. He was clear about that. But I made him do something important before I left his office: I made him tell me exactly what to watch for. What symptoms would mean I needed to go to the emergency room. What numbers, if they reached certain thresholds, would change the calculation. I was not refusing medical guidance. I was negotiating a different kind of partnership with my own care — one where I remained an active participant in the decisions being made about my body.
He told me what I needed to know. And then I went home to find a donor and a surgical team capable of doing something that most hospitals wouldn't attempt.
* * *
The procedure I was looking for was unusual. Most end-stage PKD patients receive a transplant with their diseased kidneys left in place — removal is reserved for cases where the kidneys are causing specific problems severe enough to warrant the additional surgery. Size is often the issue. PKD kidneys can grow to many times their normal dimensions, pressing against adjacent organs, compromising breathing, causing pain and recurrent infection. Mine had reached that point. The nephrectomy was necessary.
What I was asking was whether it had to be a separate operation — whether there was a program willing to remove the diseased kidneys and implant the new one in a single procedure, with no gap, no dialysis bridge, no staged recovery.
But I had found something. There was a program at the University of Maryland Medical Center in Baltimore that was pioneering a simultaneous approach — bilateral nephrectomy and live donor transplant in a single operation. Remove the diseased kidneys and implant the new one in the same OR visit. No gap. No dialysis bridge. No staging.
The logic seemed obvious to me. Why put a body through two major surgeries when one could accomplish both? Why accept the risks and costs of the interval between them? Why introduce dialysis into an equation where dialysis could be avoided?
I called UMMC. I got an evaluation scheduled. Jen and I flew to Baltimore.
On January 18, 2010, a transplant coordinator named Jessica Wilson sent me an email. It began: "Dr. Cooper asked me to review your case, knowing that we are likely moving forward with a living donor transplant and B. nephrectomy simultaneously for you. Dr. Kramer was in communication with me also prior to your arrival."
We were moving forward.
Finding a living kidney donor is one of the most intimate and complicated things a person can be asked to do. You are not shopping. You are not recruiting. You are watching the people who love you consider whether they are willing to undergo major surgery, live the rest of their lives with one kidney, and give something irreplaceable — not a gift they can replace, not money they can earn back, but an organ — to keep you alive.
Most people who volunteer are eliminated. This is, in its strange way, a gift too.
We tested eight people. Eight individuals who cared enough about me and Jen to submit themselves to the scrutiny of a transplant evaluation team. And one by one, the screening process found things. Pre-diabetes. Fatty liver disease. Conditions that, had they gone undetected, could have caused serious problems down the road. The screening designed to protect me ended up protecting them too. Eight people walked away from that process knowing something important about their own health that they had not known before.
That is not nothing. That is, in fact, everything.
My daughter Caroline — Jen's daughter from her first marriage, part of our family in every way that matters — was identified as a match early in the process. We made a deliberate decision to keep her in reserve. She was young, and the future is long. If I ever needed another transplant years from now, I wanted that option to exist. Some decisions are not about the crisis in front of you. They are about the crises you cannot yet see.
We went through donors. Dave, my brother-in-law, withdrew because of family pressures that became insurmountable. Eric, young and healthy and completely committed, was disqualified when screening discovered he had early-stage liver failure he had not known about. He would never have found that without the transplant evaluation. The process that removed him from consideration may well have saved his life.
By March of 2010, I was at seven percent kidney function. Not dialysis yet — but close. Jen had sat me down one evening, and I had looked at the calendar and realized a month had passed with very little visible progress. I sent a frustrated email to Jessica. I was sick. I was tired. I was starting to wonder if I had made the right call going to Baltimore.
Then on March 7, Eric called to let us know he had been disqualified.
I called Craig that same night.
* * *
Craig was my neighbor. He was my friend. He was, at the time, the President of our Elders Quorum — a lay leadership position in our faith community that carries responsibility for the welfare of those in the congregation.
But what Craig did had nothing to do with a church calling. It had to do with who he was.
When I called him that night in March, he told me he had been waiting. That he had known, somehow, that it would be him. He had watched the other donors go through their testing one by one. He had waited quietly, without saying a word, carrying a private certainty that his turn was coming and that when it came he would be the one.
"I've been waiting," he said. "I've known I'll be it."
I don't know what to do with a sentence like that except receive it.
There is something else about Craig that matters here. His wife's father had received a kidney transplant decades earlier — before the medical community understood what was about to kill him. He died from BK virus. The virus itself had been identified in 1971, but it wasn't until the early 1990s that doctors recognized it as a cause of transplant failure. For anyone who received a kidney before that understanding existed, BK nephropathy was a death sentence with no name. It destroyed the graft and nobody knew why. That is what happened to Craig's father-in-law.
Craig's wife grew up with that loss. Craig knew that world — not as his own history, but as his family's. He understood, in a way most donors could not, the stakes of what he was stepping into.
And he still said yes.
When Craig was tested, the results came back. He was BK negative. I was BK negative. Both of us, simultaneously, carrying none of the dormant virus that had taken his father-in-law's life a generation earlier.
The virus that killed Craig's father-in-law could not touch either of us.
If you are looking for the hand of something larger than coincidence in this story, you will find it in that fact.
Jen and I are members of The Church of Jesus Christ of Latter-day Saints. Jen was born into the faith — a lifetime member. I came to it as a convert, by choice, as an adult, and have been a member for more than three decades. I say this not to proselytize but because it is true, and because the truth of this story cannot be told honestly without it.
There came a point in the donor process when we were uncertain about something. A family matter connected to the transplant — something separate from the medical decisions, something that required a different kind of discernment. Jen and I went to the temple together to seek that clarity.
We did not go to the temple to pray about the donor order. That was not the question we brought with us. We were there about something else entirely.
But in that quiet, in that space, we felt something. A prompting. Clear enough that we both recognized it. We were to move Craig ahead in line — to call him before others who were technically next in the sequence.
We acted on it.
Craig had been waiting. He already knew. And we had been directed toward him through a door we hadn't expected to walk through, carrying an answer to a question we hadn't quite asked.
I think about the precision of that. We went to the temple with one question and received an answer to another. The answer reorganized the donor sequence in a way that placed the right person — the one who had been quietly certain it would be him, the one whose own family history made his BK-negative status almost incomprehensibly meaningful — at exactly the right moment.
Whatever you believe about how inspiration works, I can only tell you what happened.
Craig wasn't just the next donor. Craig was the donor.
The surgery date was April 23, 2010.
Back home in Pleasant Grove, our thirteen-year-old daughter Ellie was staying with Jen's sister Dee Dee and her husband Floyd. Ellie is my baby — born April 28, 1996, which meant her fourteenth birthday was five days away. She had watched her parents prepare for this trip, had understood enough of what was happening to be frightened, and had said very little about it. That was Ellie. She held it in. She was terrified for her dad and she carried that terror quietly, the way kids do when they decide that the adults have enough to manage and they will not add to the weight.
She turned fourteen five days after her father's transplant. I have never forgotten that.
Jen and I had flown to Baltimore. Craig had flown separately. We ran through pre-admission testing, waited through the final days before surgery, and tried to be ordinary people in an extraordinary situation. Jessica Wilson had been our guide through every step of the logistics — fax machines and insurance calls and blizzards in Baltimore and donor changes and lab draws and a hundred small crises — and she had made an impossible process feel human.
On the morning of April 23 we all went in.
The team that assembled for that operation was extraordinary. Dr. Stephen Bartlett — who would later become Executive Vice President and Surgeon-in-Chief of the entire University of Maryland Medical System — was my primary surgeon. Dr. Matthew Cooper and Dr. Andrew Kramer were also part of the surgical team. These were not simply capable physicians. They were among the people who had pioneered this procedure. The paper documenting their outcomes on simultaneous bilateral nephrectomy with live donor transplantation in PKD patients had their names on it. I was not being treated by doctors who had read about this procedure. I was being operated on by doctors who had written about it.
In Craig's operating room, his surgical team removed his left kidney. In mine, Dr. Bartlett's team removed both of my kidneys simultaneously and then implanted Craig's kidney in their place. Three surgeries, coordinated across multiple operating rooms, timed with precision so that Craig's kidney spent as little time outside a body as possible.
Jen waited.
I don't know exactly how many hours she sat there, or precisely what she thought about in the silences between updates. What I know is that she had been present at every moment that led to that morning — the pre-op bay at UVMC where a phone call changed everything, the nephrologist's office, the flights to Baltimore, the weeks of testing and uncertainty and logistics, the temple. She had been my partner in every decision, every frustration, every pivot. She had felt what I had moved through on autopilot. She had been fully present when I had only been functional.
When I woke up, I had one kidney. It belonged to Craig. It was working.
* * *
They placed my two kidneys on a surgical drape and photographed them.
I have those photographs. I have looked at them many times.
What you see in those images is two organs that are almost unrecognizable as kidneys. The cysts have consumed everything. The surface is irregular, lumpy, dense with decades of relentless growth. Each kidney is roughly twice the normal size. Where there should be smooth, organized tissue doing the quiet work of filtration, there is almost nothing but cyst.
When those kidneys were later donated to research — as I had arranged — the researchers reported back that they could find no discernible kidney tissue. None. What was there was cyst, wall to wall, the whole way through.
And yet those organs had kept me alive. At one percent function. With nothing left to speak of. They had held on long enough for Craig to be tested, for the prompting to come, for the surgery to be scheduled, for April 23 to arrive.
I do not call them failed organs. I call them fighters. They were me, in the end — refusing to quit past the point where quitting would have been forgiven, holding the line until the right solution arrived.
They deserved better than I gave them credit for, for a long time.
The recovery was not simple. It never is.
Jen cared for me in Baltimore for weeks after discharge — far from home, far from Ellie, in an unfamiliar city, managing my medications and my exhaustion and the hundred small crises that follow major surgery. She did this without complaint and without drama, with the particular steadiness that is harder to sustain than any single act of courage. She had sent her thirteen-year-old daughter to stay with Dee Dee and Floyd so that she could be three thousand miles away taking care of me. She had reorganized her entire life around my survival, and she did it as though it were simply what you do.
When we finally came home to Pleasant Grove, the recovery continued. She was there for that too. The daily management of immunosuppressants, the lab draws, the monitoring, the slow return of strength and appetite and something resembling normal life. And Ellie was there — quiet, watchful, her dad finally home, her fourteenth birthday behind her now. I don't know everything she felt during those weeks. What I know is that she had held it in and she had waited, and her dad had come home.
By July 2010, I was back to riding horses. My creatinine was 1.5. I wrote to Jessica Wilson that summer and told her I hadn't felt that good in a long, long time.
I meant it.
* * *
Craig recovered well. He is healthy. He has one kidney and a full life and, several years after our surgery, a heart attack that he survived. He is still my neighbor. He is still my friend. We live our ordinary lives in the same community, and sometimes I think about what that ordinariness contains — the quiet fact that he is walking around with one kidney because he loved us enough to give the other one away, and that he had known he would before I ever called to ask.
There is no adequate response to that. I have not found one in sixteen years.
What I have found is the obligation to live well. To take care of what he gave me. To stay informed, stay engaged with my own health, advocate for myself the way I advocated with Dr. Hammond when I said I would not be starting dialysis. To be worthy, in whatever way a person can be worthy, of what was sacrificed.
Craig's kidney has been inside me for sixteen years. It is functioning at the high end of normal for someone with two kidneys. I have one.
The transplant team at UMMC knew they were doing something unusual that April. The procedure they pioneered has since been documented in peer-reviewed medical literature, cited by surgical teams around the world. The 2009 paper that Kramer, Bartlett, Cooper and their colleagues published in the Journal of Urology described twenty patients. A follow-up study in 2016 extended that record. Somewhere in those numbers is me. Somewhere in the data is April 23, 2010, and Craig's kidney, and the fact that I never spent a day on dialysis.
A life, reduced to a data point. And yet the data point is part of the evidence that convinced other surgeons, at other hospitals, to attempt this procedure for other patients who were told the same things I was told and who deserved the same chance I had.
I am in my early sixties. I take immunosuppressants every day. I monitor my tacrolimus levels carefully because they matter enormously and because the margin for error is narrow. I am managing some additional health challenges — testosterone, thyroid, weight — the ordinary complicated health of a man my age who happens to be carrying someone else's kidney and doing very well by it.
I am not finished advocating for myself. I don't expect to be.
What I have learned, in the years since April 23, 2010, is that the medical system is not designed for the individual patient. It is designed for the average patient, the typical presentation, the standard protocol. Protocols exist for good reasons — they represent the accumulated wisdom of thousands of cases, the statistical best outcome for the largest number of people. I am not arguing against protocols.
I am arguing for the right to think clearly about whether the protocol applies to you.
When the protocol said start dialysis, I asked whether dialysis was actually necessary in my specific situation. It wasn't. When the protocol said perform these surgeries sequentially, I asked whether they could be done simultaneously. They could. When the screening process found problems in eight potential donors, I did not see failure — I saw eight people who now had information that could protect their lives.
The question is always: does this make sense for me? Not for the average patient. For me.
Asking that question clearly, and being willing to act on the answer even when it runs against the grain, is not easy. It requires information. It requires the willingness to be an inconvenient patient. It requires, sometimes, the willingness to sit across from a doctor you respect and say, respectfully, that you disagree.
It also requires a partner who believes in you enough to make the journey with you. Who sits in waiting rooms and temple pews and Baltimore hotel rooms and does not ask you to be less than what you are. Who steps out for lunch with her sister and comes running back when her husband calls, and never once makes you feel the cost of what that call required.
Jen has never asked me to be less than what I am.
* * *
I think about Craig's wife's father sometimes. A man I never met, who received a kidney decades before I did, who died from something that couldn't touch either of us. I think about what his death meant to Craig's wife. What it meant to Craig, becoming part of that family and knowing that story.
And then I think about Craig sitting quietly through all those months of testing, watching other donors come and go, knowing — somehow knowing — that it would be him.
"I've been waiting," he said. "I've known I'll be it."
I believed him the night he said it. I have believed him every day since.
There is a version of this story that is a medical story — about PKD and bilateral nephrectomy and the University of Maryland Medical Center and a surgical team that had the skill and the courage to do something most hospitals wouldn't attempt.
That version is true.
There is also a version that is a story about faith — about what it means to go to a quiet place with a question about one thing and come home with an answer about another, and to have the courage to act on what you felt.
That version is also true.
And there is a version that is a love story — about a woman who was by my side at every moment that mattered, who waited through every surgery and drove through every crisis and made it possible, by her presence, for me to be the kind of patient I needed to be. And about a daughter who held her fear quietly inside herself and waited for her dad to come home. And about a neighbor who already knew.
That version is also true.
All of these versions are the same story. The medical and the spiritual and the human don't separate out neatly. They run together, braided, each one holding the others in place.
I am the one percent. One percent kidney function on the morning of April 23, 2010. Zero days on dialysis. Sixteen years of exceptional function in Craig's kidney, still doing its quiet, faithful work inside me.
My kidneys were fighters. Craig is a hero. Jen is my partner in everything that matters. Ellie held it in and waited, and her dad came home.
I am still here.
That's the whole story, really.
I am still here.
To Dr. Howard Reichman: you came to fix my spine and an anesthesiologist's question changed my life. I hope you know what that moment set in motion.
To Dr. Stephen Bartlett, Dr. Matthew Cooper, Dr. Andrew Kramer, and the entire surgical and coordination team at the University of Maryland Medical Center: you gave me back my life. Jessica Wilson, your patience and warmth through every fax machine failure and blizzard and donor change made an impossible process feel human. Thank you.
To Craig: there are no words. There never have been. But you knew that already.
To Jen: everything. Always.
To Ellie: I know you held it in. I know how scared you were. You were fourteen years old and braver than you knew.
To the eight people who submitted to testing and were turned away: you know who you are, and you may know by now what the screening found. I hope you have taken good care of what it told you.
To my kidneys: I'm sorry it took me so long to call you what you were. You were fighters. You were mine. Thank you for holding on.
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