By Sean Gorman

During the month of April, VCU Health News will be publishing a series of stories to mark National Donate Life Month, a national effort to spread awareness about the importance of organ, eye and tissue donations. 

Jay Gould’s kidney disease had been slowly progressing for 30 years and he knew there was a possibility of needing to undergo a transplant one day.

That time finally arrived in 2022 as his declining kidney health put him in danger of having to start dialysis unless he received an organ transplant. His nephrologist, Todd W. Gehr, M.D., told Gould that the time for a new kidney was approaching.

“He said it looked like I was at a point where I needed to go to the transplant clinic for a work-up,” Gould recalled. Transplant specialists determined Gould was healthy enough to undergo the procedure, but he’d need a kidney from a compatible donor.

A family member of Gould’s was considered as a potential living donor but given Gould’s size — 6 feet 6 inches tall — he needed a bigger kidney from a larger person.

An offer to help

Adam Alford, who works with Gould at the Virginia Commonwealth University Center for Trauma and Critical Care Education, was well aware of his colleague’s health challenges. The two first met in 1999 while Alford was taking life-support classes that Gould taught at VCU Health.

Gould and Alford became coworkers years later at the center. Both are paramedics who teach nurses, doctors and other EMS providers about how to provide lifesaving care.

After learning Gould’s family member was not a match, Alford decided he would get tested to see if he could donate his own kidney. It was something Gould didn’t ask for, but it was also something Alford felt compelled to do.

Alford, a volunteer paramedic in his spare time, thought about the dialysis patients he’d transported to and from appointments in his ambulance — bedridden individuals having to undergo frequent and very long appointments throughout the week where machines pull waste from the body that the kidneys cannot.

“I just didn’t want to see Jay in that condition,” Alford said. “I don’t want anybody to go through that.”

The need for living donors

Living donors are often members of the recipient’s family. But relatives aren’t the only ones who can donate, says Maureen Bell, a living donor transplant coordinator at VCU Health Hume-Lee Transplant Center.

“We see every relationship in living donor transplants, whether it’s kidney or liver donations,” Bell said. “It can be co-workers. It can be childhood friends. It can be neighbors. It can be members of the same church. A donor does not have to be a family member. Jay shared his story, and Adam stepped forward.”

The typical wait time for getting a kidney transplant from a deceased donor is 2 to 6 years, Bell says. But a recipient who has been referred for transplant early enough and has a living donor can avoid that wait and the years of dialysis that often come with it.

Unlike kidneys from deceased donors, living donor kidneys don’t need to be transported to Hume-Lee, so they’re in better condition. Bell says the procedure on the donor and recipient is done simultaneously, with each patient in their own room with their own medical team, with the kidney only out of the body for about 30 minutes.

Living donor kidneys typically start functioning immediately following the procedure, while organs from deceased donors can take days or weeks to start working.

“In 99 percent of our living donor transplants, the recipients who had no urine output before, start making urine in the operating room before they leave,” Bell said. “Typically, by the next morning, they have normal kidney function.”

Before any of that happens, potential living donors undergo a rigorous battery of tests to ensure they are healthy enough to be a donor.

“From the get-go, I shared with Adam that he had to go through a very comprehensive evaluation, which included EKG, chest X-ray, and CT scan,” Bell said. Transplant teams look at numerous factors, such as compatible blood types, similar-sized organs, body mass index and more to see if the donated kidney is suitable for the recipient.

Coworkers compatible

Alford doubted he could be a match for Gould.

Thankfully, the testing showed his hunch was incorrect.

“We matched enough to where they decided I could donate,” Alford said. “I called him immediately and said, ‘Hey Jay. I’m a match.’”

The transplant was performed Aug. 29, 2022 with Adrian Cotterell, M.D., doing the procedure on Gould and Amit Sharma, M.D., performing Alford’s living-donor procedure. It was one of 40 living-donor kidney transplants conducted at Hume-Lee in 2022, Bell says. In 2021, the center did 53 such transplants, and 46 in 2020.

“I’m really blessed that Adam decided to do this,” Gould said. “I’m one of the very fortunate few I know who preemptively got a donation before ever going on dialysis. I’m just ecstatic about that.”

The morning following the procedure, Alford walked over to Gould’s room on the inpatient unit. By that time, Alford’s donated kidney had already produced six liters of urine.

“People talk about their heroes,” Gould said. “Well, Adam is my hero, obviously, along with lots of other people who have taken care of me. The team at Hume-Lee is an amazing group of people.”

Alford recalls some nervousness before undergoing the procedure and being in some pain afterwards. A man with no family history of kidney issues, Alford talks about the donation with a mixture of nonchalance and humor.

“It’s just an extra kidney,” Alford said. “I’m not missing it.”

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