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A kidney for Christmas

Posted December 19, 2022

The bottles of piss were the biggest surprise. When 26-year-old Tim Bradley started the process to donate his kidney to a stranger in 2020, he had prepared himself for the litany of blood tests, the hospital scans and the psychological assessments. But collecting his own urine for a full 24 hours was a task he gingerly describes as “the most interesting” part of the donation journey. “You don’t want to just carry it onto the bus,” he laughs. “So I had to put it in a New World bag to try and cover up the fact I’ve got a big bottle of my piss with me.” 

Bradley is one of a handful of New Zealanders opting to give one of their kidneys to a stranger in a non-directed donation, also known as an altruistic donation, every year. In 2021 there were 448 New Zealanders on the waiting list to receive a kidney, but only 187 total kidney donations (from both deceased and living donors). Of the 85 live kidneys donated in 2021, just five of them were non-directed. “A lot of people miss out,” explains Traci Stanbury, general manager of Kidney Health NZ. “You could be sitting on that waiting list for years and years.” 

Without a transplant, the only option left for those managing end stage renal disease is dialysis. “You have to be tied to that machine multiple times a week. You usually can’t travel around the country. It’s very very restrictive,” says Stanbury. According to a study by the New Zealand Institute of Economic Research in 2021, dialysis patients in New Zealand have a six-year life expectancy, compared with a 20-year life expectancy from a live organ donation. “We really do need more living donors,” says Stanbury. “It makes all the difference in the world.” 

It was in his early 20s, while studying economics and law at the University of Auckland, that Bradley first began toying with the idea of being a non-directed donor. During an online economics forum he was introduced to the concept of effective altruism, which he explains as “evaluating how you’d like to give and making sure you’re getting the biggest impact that you possibly can”. With that idea in the back of his mind, a 2017 Vox article about kidney donation led to him assessing the “cost-benefit analysis” of donating one himself. 

“The crazy thing about kidneys is that we don’t really need two,” he explains. “I started to think to myself ‘OK, what do I actually need out of my extra kidney resource versus what could it do for someone else who really needs it?’” 

When Bradley first called the hospital at the age of 23, they told him he was too young (in New Zealand, the minimum age for kidney donation is 25). By the end of 2020, after a year working in housing policy during the pandemic, he started the donation process in anticipation of his 25th birthday. “It was a really depressing place to be working in some ways, looking at the impact on a lot of people across society and how housing is affecting them,” he says. “I just kept thinking: here’s one thing that I can do, let’s start the ball rolling.”

He contacted the hospital in January 2021, received some forms to fill out, and had the first of many rounds of blood taken. Over the next 18 months, he would find himself having to occasionally monitor his urine, or check blood pressure, or undergo an X-ray, or sit through psychological assessment, or have a Zoom with a surgeon. “The tests and the amount of prep work that they did was slightly more than I expected,” he admits. “It’s a confusing process, but I would definitely say you’re really, really well supported.” 

That helped to smooth some of the concerns held by those close to him, says Bradley. “My partner was initially kind of reluctant, but eventually became quite supportive of it.” Although those around him had worries, Bradley says he remained “clear-eyed” about the decision throughout the preparation process. “Obviously this is a surgery and there’s always going to be an element of risk and recovery time and stuff, but that just pales in comparison to what it does for someone else.”

We meet the day before his surgery at a cafe near Auckland Hospital. He and his partner have been flown up from Wellington free of charge and put up in accommodation in Avondale – they could even bring their cat Gabs with them. A busy day of pre-op check-ups have all gone well and, in even better news, Bradley has just found out that his one kidney will provide the missing link in a chain of nine people who have been waiting for matches. “I’m really happy about that,” he grins, a ‘kidney donor companion booklet’ at his side. 

Stanbury from Kidney Health NZ later explains why non-directed kidneys are so essential in the wider donation eco-system. “You might have found a living donor transplant in your wife, your brother, your sister, anyone like that. And they could be a great possible donor, but not your match, so that pair kind of gets put on hold while they look for someone else that can match,” she says. “So often, there’s a missing link and that’s one of the best things about the non-directed kidney: the fact that they can be part of any chain.”

Bradley doesn’t know who is getting his kidney, or who else is in the nine-person kidney supergroup, but he has ticked the box that indicates he can be contacted in the future. All he knows is that “I’ll get some tubes put in my arm, and then I’ll count backwards from 10 and I’ll wake up in a hospital bed somewhere.” While he readjusts to his surroundings, his kidney will already be in transit, headed across the Tasman to be donated to someone in dire need of it. “It is a bit funny to think tonight is my kidney’s last sleep with me,” he says. 

Two days later and with one kidney less than before, Bradley is tired but in good spirits in his ward at Auckland Hospital. Does he feel like he is missing something? “No, I don’t feel an absence in a spiritual or literal sense,” he laughs, wincing slightly. “It’s just gone and that seems good.” The last thing he remembers from the surgery is being under bright lights and talking about documentaries with a woman who was clearly on “distraction duty”, before waking up a few hours later with a carbon dioxide filled gap where his left kidney used to be. 

His piss is under surveillance yet again – “it never stops” he jokes – but otherwise he is looking forward to getting out of hospital and recovering in his hotel for the next week. His wages are covered entirely for up to 12 weeks, and he’s got plenty of reading to catch up on (Jeanette Fitzsimmons’ memoir for one). I ask if there’s anything he would want to say to the recipient of his kidney. “I guess I hope you have a good life,” he says. “I hope this can keep you well for a while, and you can enjoy yourself and do what you will with the time you have.”

Both Bradley and Stahbury’s hope is that more New Zealanders will look into non-directed donations as a potential option in their future – although both acknowledge that it won’t be for everyone. “The experience isn’t super painful or terrible, and I don’t feel like it has disrupted my life that much at all,” says Bradley. For those who are in need of a kidney, Stanbury describes it as a “phenomenal” gift. “They call it the gift of life. Think of all of those people in that chain who will be so incredibly grateful at the gift that this person has given,” she says. 

“That’s an amazing Christmas present, that’s for sure.”