P.C. Eide, 45, had been on the waiting list for a kidney for so long, she had given up on having a life beyond her dialysis tether. Her husband wanted to give her one of his kidneys, but he wasn't a match for her and neither were her sisters. Eide had been on the transplant waiting list for 10 years.

"I was always tired but I got used to it," she said. "After all those years, it just seemed normal."

Although Eide's wait was particularly long, a situation caused by the lack of donors matching her B blood type as well as the antibodies she had developed during her pregnancy, kidney patients on average in Hawai'i wait one to three years longer for a transplant than those on the Mainland.

Living donors are the solution — every person has a pair of kidneys — but the number of living donors in Hawai'i remains low, in the single digits statewide until just a few years ago. While the number has increased recently, the transplant community has undertaken an effort to increase awareness of the need in hopes of attracting more donors.

Contributing to the problem of not having enough donors, said Dr. Whitney Limm, surgeon and director of St. Francis Medical Center's kidney transplant program, are the high rates of diabetes and hypertension in the state. Those conditions have pushed Hawai'i into the top five states for the number of patients on dialysis, per capita.

"There are only a few places that are ahead of us — Washington, D.C., and a few states in the south," Limm said.

Limm said a wait as long as Eide's can be fatal.

"It's called transplant waiting list mortality," Limm said. "About 5 percent of the people on the list pass away each year."

Most organs transplanted, including kidneys, come from cadavers, he said. But with Hawai'i's lack of superhighways and tendency within the community to avoid violence, the state suffers a shortage of people who die young and quickly enough to leave behind healthy organs for transplant.

As a consequence, nearly 450 people in Hawai'i are awaiting kidneys, using machines and chemicals to clear their blood of toxins.

St. Francis transplant coordinator Cathy Bailey oversees their files, looking for new ways to whittle down the list. While studying the Respicio-Jumawan and Eide files, she thought she saw a possible solution. Something about Chad Jumawan's blood work had caught her eye.

P.C. Eide had a B blood type, and Eide's husband, Kenneth, had a blood type that looked compatible with Respicio's. Would the families be willing to make a trade: one of Jumawan's healthy kidneys to P.C. Eide, one of Kenneth Eide's to Respicio? Was it doable if they agreed?

"Cathy proposed it during one of our meetings," Limm said. "I was apprehensive at first."

The trade would require coordinating the resources and labor power for four related surgeries in one day; not an impossible task, but not an easy one, either.

Yet what really bothered the surgeon was the emotional question: just how committed were the donors?

"For instance," he said, "if we did Mrs. Eide's surgery first and something went wrong with the transplant, would Mr. Eide still want to give his to Mrs. Respicio?"

Incredible givers

Dr. Whitney Limm, director of St. Francis Medical Center's kidney transplant program, talks extensively with donors before allowing surgeries. Bruce Asato • The Honolulu Advertiser

"Most of the people who call and offer to donate are eliminated with a telephone interview," Bailey said. Health considerations put an end to the plan.

Those who pass the preliminary interview are subjected to more probing questions about their personal and family health histories, given tests to uncover unknown conditions and sent to talk to a psychologist or psychiatrist.

Limm said he has had a waiter who donated a kidney to a customer and a woman who gave one to her daughter's karate instructor, but he was even more taken aback by Brett Henderson, a 35-year disabled military veteran who wanted to be a donor even though he didn't know anyone who needed a kidney.

Henderson, a veteran of the first Gulf War, said he had been an Arabic language translator in the military, and worked as an interrogator.

"I was injured on a drug interdiction operation," he said. "Broke my back, both my legs."

After being medically discharged, he said, he spent a lot of time reading and thinking. He joined a veterans for peace group and became involved in the anti-war movement. He went to college. None of it felt like enough.

"I wanted to give back to the community after taking for so long," he said. "I guess, after doing the type of work I did in the military, I needed some repentance."

It didn't surprise him that his mother and sister tried to talk him out of donating a kidney. He was surprised to get a similar reaction at St. Francis.

Just before the surgery to transplant Henderson's kidney into the body of a mother with two small children, Limm visited Henderson in his hospital room.

"He closed the door and said: 'You can still change your mind and nobody will say a word,' " Henderson said. "He'd already told me that he wouldn't do this."

Both Henderson and recipient are in good health after the December operation.

"With the altruistic donors," Limm said, using the term St. Francis applies to those who donate to other than close friends or relatives, "I almost try to talk them out of it. I feel it is my responsibility."

"I tell them it is a big operation with risks involved," he said. "I tell them they won't be able to help a close family member who might need it later on. I tell them some insurance companies — a small percentage of them — consider kidney donations elective surgery and won't cover them to take the month off.

"And I wouldn't be an altruistic donor," Limm said. "I would do it for someone I knew, but not for someone I didn't. I'm a husband and a father, and wouldn't take the risk."

Limm doesn't always succeed in his efforts to warn off altruistic donors. St. Francis has used six of them.

"The donors are incredible to me," Limm said. "They are optimistic, positive, giving people. This is one of the best things about being a doctor; working with people like this."

Free, at last

Bailey talked to the Respicio-Jumawan and Eide families. They were ready to do the trade, which Bailey and Limm had started to call "the two-way." Another round of blood tests showed both recipients matched their donors.

St. Francis began to prepare for the long, grueling day of surgeries, which were staggered throughout the day on Friday, May 13. Four operating rooms, four surgeons and three anesthesiologists were used.

Chad Jumawan, Respicio's son, went first.

"Then when we were sure he was doing OK, we went on to Mrs. Eide," Limm said. "And then Mr. Eide, and then Mrs Respicio."

On the day of the surgeries, Limm was still talking to the donors; would they still go through with the trade, even if something unexpected happened?

Jumawan and Kenneth Eide said they would.

When P.C. Eide's transplant was completed and Kenneth Eide was en route to the operating room to donate his kidney to Respicio — knowing his wife was finally safe — he remained committed to the plan. But Eide's teenage son couldn't resist a little last minute teasing.

"They told me later," P.C. Eide recently told Limm, "after my surgery. He said: 'Alright, she's OK! Run, Dad, run!' "

Five weeks after the surgery, all four people in the "two-way" were doing well.

"I feel so free," Respicio said. "We're planning to go to Disneyland, and I might go to Las Vegas next year."

"I'm going to Singapore in February," P.C. Eide said. "And I'm going to get to go to Europe, and to all these different countries."

Hawai'i's first kidney transplant trade had been a success. Would others follow?

"Well," Bailey said. "I haven't been able to find a two-way, but I did find a situation where the recipient from the first family doesn't match with the second family, but she looks like she might match with the donor from a third family and the recipient from that family might match with ... "

"A three-way?" Limm said. "Are you kidding? The two-way took us from 8:30 a.m. to 5:30 p.m. A three way?"

"I haven't gotten all the blood work back yet," Bailey said.