HOUSTON – Michael Wingard arrives at Houston Methodist Hospital with a cheerful "Howdy!" He's a rangy young man with a scrub-brush of a beard, and a healthy left kidney that's where it's always been – safely tucked up just below his rib cage.
In a couple of hours a surgeon will remove the kidney and sew it into someone else's body.
This also happens to be the day before his 20th birthday.
"I'm barely even thinking about that," Michael tells NPR. "No cake, unfortunately. It'll be like Jell-O or something like that."
The Wingard family is from Kerrville, Texas, about four hours west of Houston. Michael's parents, Adrien and Ed, are with him, and they tear up as Michael is checked in.
"I'm very, very nervous and scared and all those emotions, but I'm so proud of him," Adrien Wingard says. "He knew that his friend needed a kidney and he had to do whatever it took to make it happen."
A chain of life
Michael Wingard's kidney isn't going to his friend, though, because he wasn't a match for her. But he was a match for someone else.
And that's how Wingard became the first link in a 10-person chain that took place at Houston Methodist earlier this month.
In addition to Wingard, the swap involved:
This 10-person procedure takes place over four days, and it's uncommon. The last one at Houston Methodist was in 2020. Usually the hospital has chains that involve up to six people.
With all its complexities – from matching antibodies to patient health – a kidney swap of this size is hard to pull off. This one was postponed three times.
But it's worth the effort.
There are about 90,000 people on the Organ Procurement and Transplantation Network list, waiting for a kidney. Many will remain on the list for years. Some die waiting.
Transplanting kidneys from living donors greatly increases the number of kidneys available. Additionally, a kidney from a living donor functions for 12 to 20 years, on average, while a kidney from a deceased donor works for about 8 to 12 years.
Alternative to 'dialysis or death'
Dr. Richard Link, Michael Wingard's surgeon, arrives a few hours after Wingard checks in to explain the surgery will be laparoscopic; he'll remove the left kidney through a 2-inch long incision in the abdomen. Dr. Link describes this as a relatively routine operation.
"You'll be surprised that we can get a kidney out of the size of the hole that we make," he says. "It's a little bit of a magic trick."
When a nurse comes to take Michael Wingard to the operating room, his parents hold each other's hands.
"Rock it, buddy," his father says into his ear.
While Wingard is getting wheeled down the hall, Heather O'Neil Smarrella is getting prepped to receive his kidney, and Lisa Jolivet is just settling into her room.
The 43-year-old from Houston has an easy, infectious laugh. Even though it's the night before her surgery, she's cracking up at jokes about Jell-O shots, the Astros and "crap" kidneys. Jolivet is here because her mother, Barbara Moton, who loves casinos and her grandchildren, learned that she was in renal failure in 2019.
"She had kind of said, 'This is my fate. These are my cards,'" Jolivet says.
Before Moton arrived at Houston Methodist, her doctors told her she only had two options: dialysis or death. Her daughter refused to accept that, and researched a third option: a living donor transplant. She made her mom a pinky swear.
"If you're denied, we'll never say anything about it," Jolivet told her. "You don't have to do dialysis, and you can just ride out into the sunset."
But Moton passed every test and got approved for a kidney transplant in August 2021.
"I'm so ready to exhale," Jolivet says. "It's been a long, long wait."
The surgery
NPR was at the hospital for most of the 10 surgeries. Each was amazing and intricate, but it's routine for surgeons. They know all the stops, turns and shortcuts. The territory inside a body becomes familiar.
Dr. Link, Michael Wingard's surgeon, slices through skin and tissue around muscle and toward the left kidney. He steers the surgical tool, called a laparoscope, equipped with a tiny light and camera to guide the snips made with a harmonic scalpel that cut and cauterize in the same slice.
The journey to the left kidney is captured in 3-D images that enhance the colors, and the view is other- and inner-worldly. The spleen looks like a smooth pink bean. The stomach walls are whorls of light pink and ivory.
As promised, Dr. Link slides Wingard's left kidney out of his body through a slit about as wide as the edge of a credit card. He calls the organ "unremarkable" – and means it as a compliment.
Dr. A. Osama Gaber, head of the Houston Methodist's transplant program, sits ready at a silver bowl packed with crushed ice. He receives the fist-sized organ, rinses it, and places it in the bowl. The crushed ice begins to melt and turns the color of a watermelon slushy.
When the kidney has cooled enough, Dr. Gaber packs it with ice into plastic bags and puts it in a plastic bucket. He takes off down the hallway, delivering the organ to another operating room, where Heather O'Neil Smarrella is waiting.
Dr. Gaber sews it into place in the front of her lower belly, and when the ureter of the kidney is connected to the bladder, a few drops of urine spurt out.
Dr. Gaber laughs. He is delighted because Wingard's former left kidney is now O'Neil's kidney. And it's working.
"Apparently, I peed all over the table as soon as he hooked it up," Smarrella says the next day.
She's a little embarrassed by that, but mostly happy. She woke up that morning feeling better than she had in a very long time.
Before, "it was a struggle to even get in and out of bed and get through the day," she says.
She suffered from back pain, fatigue and memory issues. But now, she only feels the pain from her incision.
"I feel 100 percent better," she beams.
A 'whipsaw' diagnosis
"Everybody who makes it to our clinic has been through so much," Dr. Gaber says. "They've learned that organ failure, whether it's a liver, a kidney, a heart, the lung is about to kill them. It destroys the quality of their life almost completely. The expenses, the whipsaw between doctors and diagnoses, and the loss of hope."
Dr. Gaber, who graduated from medical school in 1976, initially was not a supporter of live organ donation. Success rates when he started his career were low, and he thought there should be enough deceased donors.
But there aren't, and over the years he has changed his mind.
Dr. Gaber and his wife, Lillian, also built Nora's Home to help transplant patients. It's a center on the grounds of Texas Medical Center where families can stay. It's named after his daughter, who was an organ donor.
"She was seven and a half years old, and we lost her in a car accident," Dr. Gaber says. "I now know how to respect and appreciate these people that give organs for others."
A portrait of Nora hangs in his office. It shows a little girl with dark hair, holding a sunflower.
Now, Houston Methodist performs about 700 transplants a year: kidneys, livers, hearts, and lungs. And success rates today are much higher.
"Having done this for the number of years I've done it," Dr. Gaber says, "I can tell you that it changes the lives of people to an extent that is very hard to even describe."
The reveal
Two days after Michael Wingard's kidney surgery, a group of strangers gathers in a conference room at the hospital.
Michael Wingard, Kaelyn Connelly, Heather O'Neil Smarrella, Staci O'Neil, Lisa Jolivet, Javier Ramirez Ochoa, Tomas Martinez, and Chris McLellan sit around a conference table. Family members and doctors hover around the periphery.
And then they aren't strangers anymore.
Smarrella's family gives Wingard a stuffed toy that matches one that she carries around.
Chris McLellan leans over to Tomas Martinez: "Thank you for giving me my life back."
And, he adds, "You have an awesome kidney."
Only Barbara Moton and David McLellan aren't in the room to meet each other. They've just gotten out of surgery.
Dr. Gaber tells Lisa Jolivet that her mother's surgery went smoothly. Lisa clasps his hands, and thanks him through tears. She looks at Kaelyn Connelly – who received Jolivet's kidney the day before.
"It's surreal. I mean we're all different ages, different walks of life," Jolivet says. "Just to be able to prolong her life is just amazing ... the fact that we're all just going through this together, it's unreal."
As the group breaks up, some stay at the hospital and others head home.
Michael Wingard and his family start the four-hour long drive back to Kerrville.
His parents say he can ride shotgun this time.
Gabriel Dunatov produced and D. Parvaz edited the broadcast version of this story. Visual editors Marco Storel and Catie Dull contributed to this story. contributed to this story
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