When Joyce Roush first met the Bienieks at the outpatients centre of Johns Hopkins university in Baltimore, nobody knew quite what to say. A week earlier they had never even heard of one another, and yet here was Roush all set to give 13-year-old Christopher Bieniek a very unusual present: her left kidney.
"I gave her a big hug," says Christopher, better known as "Bear". "I said, 'Thank you.'"
For Bear, whose kidneys failed last Christmas, the meeting was the end of eight miserable months of eight-hour-a-day dialysis. He'd been told he could wait up to seven years for a kidney, and faced spending the rest of his teens unable to play sport, swim in the sea or stay at a friend's house, but then came the extraordinary offer from Roush.
A week later, on September 7, she became one of the first people ever to donate a kidney - or in fact any internal organ - to a complete stranger about whom she knew absolutely nothing. Both she and Bear are now doing well, although the kidney could still be rejected.
While thousands of live donors give kidneys each year, the recipients are relatives, friends or, more rarely, someone they've heard of in the media. But Roush simply offered up her kidney to whoever needed it. "Joyce didn't have any idea who her kidney would go to," says Christopher's mother Terry. "It just so happens that it was Bear. "
Roush, a nurse, made her offer after attending a presentation about a new, less intrusive method for removing kidneys. "I felt like God had tapped me on the shoulder," she says.
The new keyhole method, developed in 1995 by surgeon Lloyd Ratner, of John Hopkins university, involves a small viewing device being passed into the abdomen through a small incision. Other small incisions are made into the abdomen, and tiny surgical instruments passed through them in order to remove the kidney. The recovery period is about two to three weeks, including two or three days in hospital - half the recovery time for traditional surgery, where a long incision is made around the flank.
At first Roush's offer was treated with caution. She was counselled by a social worker and psychologist."That was the first time I had given it any thought that people would come forward altruistically," says Ratner. "We made her jump through all sorts of hoops to make sure it wasn't an impulsive offer."
But in the end the doctors agreed - after all, kidneys from live donors are far preferable to those from cadaver donors since they last longer. A transplanted kidney from a cadaver has a 50% chance of working for eight years or more, while a kidney from a live donor has the same chance of working for over 15 years. Only about one third of the 12,000 kidney donations made in the US last year came from live donors, a figure that is even lower in Britain, where they represent about 15% of kidney donations.
Since publicity about Roush's operation, the John Hopkins university has taken at least 25 calls from people interested in making a similar donation. Nobody expects the flurry of offers to explode into a massive new pool of kidney donors that will cut the US waiting list of 43,000 (in Britain 4,600 people were waiting for a kidney in July). But medics hope that "altruistic donations" will become more commonplace, and that hospitals around the world will develop protocols for dealing with such offers.
New possibilities create new dilemmas, however. To what degree should any individual risk their own health for that of a stranger? The operation itself carries a three in 10,000 risk of death, and living life with only one kidney also presents risks. What if, in later life, one of Roush's children needed a transplant?
"There's nothing inherently unethical about someone offering an organ to an anonymous recipient," says Mark Fox, physician and professor of medical ethics at the university of Rochester medical centre, "so long as we are sure they know what they are getting themselves into."
