The surgical staff in Operating Room No. 11 gathers around the white cardboard box like children around a gift on Christmas morning.

After a nurse peels away the duct tape, Stuart Geffner reaches inside with both hands and pulls out a clear plastic jar, unscrews its top, then carefully lifts the contents into view: an orange plastic baggie cradling the plump, fist-size kidney of 25-year-old Khary Walker.





Chain of Life - Kidney transplant chain helps six patients







It is 11 a.m., Thursday, March 12, and a half-dozen masked men and women at Saint Barnabas Medical Center in Livingston watch while the surgeon plops the organ into a pan the size of a bread loaf and lets it sit for a moment chilling on a bed of ice -- the cold, still center of an operating room percolating with activity.

"Can I have a light back here?" says Geffner, the director of renal and pancreas transplants for the Saint Barnabas Health Care System. He wants to spruce up the kidney before transplanting it. Cut away a little fat here, tie off a few branches on the renal vein there. It takes just 10 minutes.

"Okay, let's bring the patient in."

Those who donate a kidney are a singular breed, and the surgeons who transplant their perfectly healthy organs into desperately ill patients regard them with nothing short of awe.

"This is not matter-of-fact at all," says the 45-year-old Geffner. "I hold the living-donor operation sacred. They volunteer for a surgery of significant magnitude, with no medical benefit whatsoever to them. It's unique in the world of surgery."

And yet "matter-of-fact" is exactly how many of these donors describe their acts of charity.

"I knew my wife needed help and I wanted to do whatever I could," says John Rocco.

"It wasn't hard. I watched my mother suffer and I wanted to help her," says Walker.

"It's pretty simple," says Thomas Leger. "I wanted to make a difference."

Six people saw an opportunity. This is what all of the donors say. Four were motivated by love; another by gratitude; one by the logic of charity. In March, at three hospitals in two states, their lives mingled in a historic 12-person kidney exchange.

Woven into the chain, the donors and recipients were strangers to each other, but connected by disease and by devotion, by choice and by chance, over what would be a life-altering 36 hours.

Paul Murray, who turned 45 today, can tell you exactly how long he waited for that moment.

"Five years, two weeks, nine hours," he says.

Sitting in his sparse, neatly decorated mobile home in South Jersey, Murray shakes his head slowly as he describes the long journey to the transplant.

"It tests your spirit," he says. "At times I didn't know how it was going to work out. I had my doubts."

Those doubts grew with each passing month he languished on the deceased-donor waiting list.

"I kept saying, 'Well, it's only been two years.' 'Well, it's only been three years.' I kept a good attitude through the whole thing. I said, 'You gotta do what you gotta do.' I had no choice."

A history of hypertension in his family made Murray vulnerable to renal failure, and in 2003 he nearly died when his kidney function plummeted to just 15 percent and his heartbeat became erratic.

In early February of this year -- his fifth year on the deceased-donor waiting list -- Murray got an unexpected phone call from someone in the renal transplant department at Newark Beth Israel Medical Center.

The woman on the other end told him about a living kidney exchange program for donors and recipients who don't match. They needed someone to close the chain, and his name came up on the list.

"Do you want to be part of it?" she asked.

"Absolutely," he replied.

Saint Barnabas Operating Room No. 11 seems unusually chilly. "It reduces the bacteria," explains the scrub nurse as she leans over a stainless steel bowl, chopping clumps of ice into tiny pieces.

The bowl sits atop a cooling machine that hums and sighs as it rises and falls, as if breathing for everyone in the room. Periodically, fresh ice is added to the pan holding the kidney. Deep inside Paul Murray's abdomen, a small bag of ice also chills the space the surgeon has made for the new kidney.

Murray's old kidneys, Geffner explains, will remain right where they are, because there is no medical benefit to taking them out. The new kidney will be placed lower in the midsection, near the pelvis, and closer to the surface of the abdomen.

Geffner, who conducted New Jersey's first laparoscopic living donor surgery, is trim and athletic. Born in Brooklyn but raised in Marlboro, he says he has performed about 1,500 kidney transplants and 1,500 living donor operations during his 14-year career. Recently he became the first surgeon in the world to transplant a kidney robotically.



Together, Newark Beth Israel and Saint Barnabas do about 270 kidney transplants each year, making them one of the top 10 kidney-transplant programs in the nation.

At 12:13 p.m. Geffner lifts the donor kidney from the tray and gently plants it in Murray's belly. While the surgeon works, Bob Dylan serenades the room with "Knockin' on Heaven's Door," courtesy of the doctor's iPod.

Geffner removes the clamp on the renal vein, and Murray's kidney goes from gray to slightly blue. Then he opens the arterial clamp, letting oxygenated blood flow back into the transplanted organ, and within seconds the kidney pinks up like a Polaroid instant photo coming to life.

"It's firming," he says, squeezing the kidney ever so slightly between his fingers. "Before it was squishy ... Vein is nice and soft, artery is good."

Now Bruce Springsteen is wailing away. Geffner says that along with a few of his high school buddies, he has attended concerts during every tour of the Boss since the 1970s.

By 1:16 the ureter has finally been connected to the bladder, and Geffner pours saline solution into Murray's abdomen.

"Now we can close."

Murray became the last link in a chain sparked by one man, Thomas Leger, a 27-year-old writer, teacher and businessman who decided to donate a kidney because it seemed the logical thing to do.

Leger, who lives in Brooklyn, says he knew very little about dialysis or transplant waiting lists, and knew no one with kidney disease, before he decided to become a non-directed, or altruistic, donor. What he did know was that his life had prepared him in an unusual way for his act of charity.

Several years ago Leger began the transition from a woman to a man. It was his experiences during that process, he says, that gave him his singular perspective.

"I've had surgeries that were not about being sick, but instead were actually life-affirming," says Leger, the senior executive vice president of a small document-translation company. "My body works well for me now, but in the past it didn't. I felt lucky that in reality I was able to get the body I wanted. It's always worked properly, but it made me think about people who have bodies that don't."

Last year as he was thumbing through a volume of Best American Essays in preparation for teaching a writing class at Hunter College, Leger stumbled upon an article with the provocative title, "What Should a Billionaire Give -- and What Should You?"

The essay, about the ethics of giving, was written by the controversial Princeton philosopher Peter Singer and discussed the social obligations of the richest Americans toward the world's impoverished. It mentioned a real estate mogul who gave away not only most of his $45 million, but also a kidney.

Singer wrote: "When we read that someone has given away a lot of their money, or time, to help others, it challenges us to think about our own behavior. Should we be following their example, in our own modest way?"

To Leger, who describes himself as essentially a pragmatist, the reasoning seemed unassailable.

"Singer's argument was that it's unethical not to give what you can," he says. "If someone said that if you give a kidney or some other organ you could cure someone of AIDS or cure cancer for one person, you'd say, 'Sign me up.'"

Signing up, however, was not easy.

"I left a message at one hospital, then another, and no one ever called back," says Leger.

After he located the National Kidney Registry through the Internet, he was put in touch with the transplant coordinator at New York-Presbyterian Hospital/Weill Cornell Medical Center, who did return his call.

Leger's first chance to donate came and went. Right blood type. Wrong tissue type.

Then Leger was asked if he would consider being part of a chain in Atlanta, but that, too, fell apart.

Finally, late in the afternoon of Friday, Feb. 27, David Serur, medical director of the Rogosin Institute Transplantation Program at New York-Presbyterian, called.

"Is this Tom Leger?"

"Yes."

"We have a match for you. ... Are you free March 12th?"

Leger knows nothing about the woman he is donating to, not even her name. For her part, Diana Rocco knows nothing about Leger.

Rocco is 4-foot-8 and has a warm smile and a generous nature. She longs to go back to her job as a cafeteria worker at St. John's Prep in Queens, but she is on dialysis three times a week, the result of polycystic kidney disease, a genetic disorder that riddles the kidneys with cysts and often makes them swell to the size of footballs.

Last September, the 50-year-old woman became so tired she could not get dressed in the morning. By the end of 2008 she was on dialysis. She and her husband, John, a sanitation worker, entered the National Kidney Registry, where Leger was listed as a non-directed donor.

So that his wife can receive a new kidney, John Rocco, who is not a match for her, is giving one of his kidneys to Israel Flores. Just 23 years old, Flores came into the world with end-stage renal failure, born with posterior urethral valves, in which extra tissue prevents the smooth flow of urine from the bladder. By the time Flores was 4, his kidneys were damaged beyond repair. His mother and his aunt, still only teenagers at the time, were too young to donate, so his grandmother gave him one of hers.

Eleven years later, however, hypertension -- a side effect of the many medications Flores took daily -- destroyed that kidney, too.

This time Flores' mother, Sandra Ruiz, was old enough to be a donor. But when repeated urinary tract infections damaged that kidney as well, it was finally Janet Beltran's turn.

Beltran, Flores' aunt, had waited half her life to be a donor.

"I consider him my first son," she says. "As soon as I saw him I fell in love with him."

When the kidney from Flores' mother began to fail last year, Flores' aunt responded immediately.

"There's nothing that's going to stop me now," she said.

But just two weeks before she was to donate her kidney, Beltran, who works at a newspaper plant in the Bronx, received a call from the hospital. The final cross-match came up positive: Flores had too many antibodies, which meant his body would end up rejecting his aunt's kidney.

"I was brokenhearted," says Beltran.

Within days, she learned about the living donor exchange program.

"It wasn't just one person being helped," she says. "I get to bless someone else. It was beautiful. It's like you won the Lotto."

Today the 37-year-old woman has grown children of her own. Energetic and outgoing, her large dark eyes shimmer when she speaks about her nephew, a slender, soft-spoken young man with an exquisite sensitivity to the vagaries of life, and a deep understanding of its brevity.

Growing up unable to take part in many activities, and with virtually no friends, Flores kept asking his mother for a baby brother or sister. Feeling guilty, Ruiz often responded by getting him pets. Over the years they included Rafael the turtle, Sylvester the cat and Prince the parrot.

The menagerie, now numbering four, is scattered throughout a small apartment above Chelita's Laundromat in Brooklyn. Flores lives here with his mother and his 13-year-old brother, John. Beltran's home is just two blocks away.

Though he has never been well enough to finish high school, and has never been far from home, Flores has a girlfriend, Rosie, he met at a wrestling match at a nearby Gold's Gym, and he wears her name on a gold chain around his neck.

There is a weariness to Flores -- in fact, to all the kidney recipients -- which is not surprising, considering the pain, the hospitalizations, and all the restrictions on their lives. Yet there is a sweetness, too, born more than likely from a deep appreciation of their rare moments of respite.

Flores has spent his life looking for silver linings, and he counts John Rocco's generosity among them.

"I feel like I've had guardian angels. Every blessing I've had is because of them," says Flores. "This donor is an angel for doing this great miracle for me."

On Thursday morning, Bayonne resident Norman Perdomo nervously rubs the feet of his longtime partner, Valesca Gomez, as she lies in a hospital bed, waiting for Janet Beltran's kidney to be delivered from New York City. The next day it will be his turn to give back.

By 5 p.m., eight surgeries have been completed at three hospitals. Four patients, including Gomez, have new kidneys. Just two more transplants to go. All of the remaining operations will be at Newark Beth Israel.

On Friday, surgeons Stuart Geffner and Harry Sun perform a kind of duet, removing and transplanting four organs. Geffner begins to operate on Perdomo at 8 a.m.

His kidney will be transplanted into Iyanna McDuffie, a 24-year-old part-time college student who was born with inflammatory kidney disease. McDuffie, who lives in Rahway, found herself pregnant in 2005. She was advised to terminate the fetus or risk losing her remaining renal function. The young woman, soft-spoken and steely, declined.

Within months of her baby's birth, she was on dialysis. She would stay on it the rest of her life, unless she could somehow get a transplant.

McDuffie, like Paul Murray, was placed on the waiting list for a deceased donor. Then, on Thursday, March 13, 2008, she received an e-mail from Elizabeth Ard, whose 18-year-old son had undergone a kidney transplant 16 months earlier.

One of Beth Ard's 11 siblings had provided the organ for her son, and Ard, a 55-year-old slender, effervescent business executive and lawyer from Basking Ridge, felt an urgent need to give back.

As she sat in her kitchen that Thursday morning, she suddenly found a way. Ard was reading The Star-Ledger, every now and then stealing glances out the back window at her son, Dan, home for the weekend from college and happily shooting hoops with friends. She thought how much better he was now, how just two years earlier he could barely walk because of the pain of kidney disease.

As she turned the pages of the paper, her eyes caught a headline:

For her baby's life she risked her health

Now a young mother needs a kidney to replace ones ravaged by disease

The story was about McDuffie, and for Ard, it was a revelatory moment.

"I thought someone was telling me: This is the person you are supposed to give to."

Ard was tested to see if she could donate a kidney, but once again she was not a match. This time, however, the doctors had an alternative for her: Would she be willing to pair with McDuffie and go into a pool of donors and recipients at the National Kidney Registry? McDuffie could receive a new kidney if Ard agreed to give one of hers to someone else.

"I thought, I started this for her, I'll go in as a pair with her."

Ard's is the second-to-last operation of the day, and the final donation of the six-way exchange. Her recipient will be Lavoria Cure, Khary Walker's mother.

Cure, a nursing home aide from Toms River was diagnosed with diabetes after routine blood work in 1998. Her health deteriorated over the next decade until she was placed on peritoneal dialysis, which, unlike hemodialysis, can be self-administered.

She worked at the nursing home from 7 a.m. until 3 p.m., and every night at about 8 she hooked herself up to the machine through a port in her chest. As Cure slept on her back, the device cleansed her blood of impurities, its buzz jarring her awake four or five times a night.

Earlier this year, as he watched his mother's health decline, Walker told her he wanted to donate his kidney. They were not a match, so their names were entered into the National Kidney Registry.

By 2:38 p.m. on Friday, March 13, in the second-to-last surgery of the two-day marathon, Geffner finishes making his initial laparoscopic incisions into donor Beth Ard's abdomen.

Now the norm, laparoscopic kidney donation means Ard's recovery will be much more rapid than in years past, when the operation left a crescent-shaped surgical scar the size of a shark bite. Like all the other donors, she should be in the hospital overnight, two days at the most.

"I really did this donating thing for me," she says. "I felt that I owed it to -- I don't know -- my brother, my son, the world, to pay back the gift my son received."

Geffner believes the stakes in the donor operations are the highest of any he does, and he speaks about these patients in an almost reverential way.



"It has to work every time. It has to be as close to 100 percent as possible."

Extending the laparoscopic scalpel through the small incision in the upper left quadrant of Ard's abdomen, Geffner cuts the tissue around the colon and the spleen, then moves them out of the way, finally exposing the kidney.

He dissects the renal vein, renal artery, and the ureter, then widens one of the half-inch-long incisions in Ard's belly. Geffner is finally ready to take the organ out. He plunges his right hand up to his wrist through the small opening. After fishing around for a few seconds, his hand pops back into view, fingers firmly clasped around Ard's left kidney.

So far, the operation has taken just 51 minutes. Now the organ is handed to Sun, who flushes and trims it before walking it over to an adjacent OR. Lavoria Cure is ready for her transplant, and by 7 p.m., when the 12th and last surgery is over, the chain will be closed.

In a day and a half, six patients have received new kidneys and renewed lives. Four of those kidneys came from donors willing to sacrifice a part of themselves for a loved one. Two of them came from donors willing to sacrifice a part of themselves for love alone.

During the 36 hours that have restored the lives of six people, 360 others in end-stage renal disease will have died.

As Geffner peels off his surgical gloves, he can't help but wonder out loud:

"Of all of us walking the earth, how many would volunteer to do this?"

Tomorrow: An emotional meeting of strangers.

For more information about becoming a living donor, or if you are in need of a kidney, but your loved one is not a match, visit the

National Kidney Registry website

or call (800) 936-1627.

For more information about living-donor kidney transplant programs:

-- Newark Beth Israel Medical Center Renal Transplant unit: (877) 878-7555 (Tatiana Alvarez)

-- Saint Barnabas Medical Center Renal Transplant Unit: (888) 409-4707 (Marie Morgieviech)

-- The joint Beth Israel-Saint Barnabas renal transplant program website

-- Hackensack University Medical Center: Department of Organ Transplantation: (201) 996-2613 (Joan Abrams)

-- New York-Presbyterian Hospital/Weill Cornell Medical Center transplant unit website: (212)-517-3099 (Marian Charlton)

-- For information about kidney transplantation at Robert Wood Johnson University Hospital, please call (732) 235-8695, or (877)-NuKidney (toll-free), or visit the hospital's website.

-- For more information about all 242 kidney transplant programs across the United States, visit the website for the United Network for Organ Sharing



Staff writers Mike Frassinelli and Vicki Hyman contributed to this report.