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On Sept. 5, Pastor Jeff Smith of the Living Word Lutheran Church in Petaluma will donate one of his kidneys to a complete stranger, starting a chain of seven kidney transplants across the country. The chain includes four recipients who most likely would might have never received a new kidney if not for Smith's willingness to give one of his own.

The husband and father of three grown children first learned about "kidney chains" in a letter he received from a member of his church in early March. He admits he was intrigued by the prospect right away, but said that it took some serious thought to commit to the idea.

"When I first heard about it, it wasn't like I immediately wanted to do it," Smith said. "I began investigating it and thought it sounded like something I might want to do, emphasis on the word &‘might'."

Part of Smith's initial hesitation stemmed from the fact that he doesn't know anything about the person who will receive his kidney. But when Smith realized his single donation could spark the opportunity for multiple people in desperate need of kidneys to be matched with perfect strangers, he knew he had to do it.

Smith's donation is part of a growing phenomenon in America called the kidney donation chain. People in dire need of a kidney transplant often have willing donors in their families and circle of friends, but cannot find a donor that matches their biological needs. That's where a third-party good Samaritan like Smith comes in.

Smith will donate his kidney to a needy recipient who has a friend or family member willing to donate one to someone else in need, thus beginning the kidney donation chain.

All it takes is one willing "good Samaritan donor" as the National Kidney Registry calls it, to start off the chain. Easier said than done since this random donor has nothing physical to gain from donating. There is no relative the donor is trying to help; there is no single person they have in mind. They are simply willing to give a kidney, thus providing the catalyst for a kidney donation chain.

As crazy as it seems to many others, Smith says that he has been conversing with several "good Samaritan" chain starters via email and chat rooms and that they echo his sentiments of feeling a need to donate simply because they are able.

"Not everyone has the health to do this," Smith said. "I've talked to a number of other &‘Good Samaritan' donors who say that they — like me — just felt compelled to do this."

During the last four months Smith has endured multiple doctor appointments, blood draws, urine analyses, kidney x-rays, heart examinations and psychiatrist visits just to be cleared to donate one of his kidneys.

"It's been a very long process," he said. "Even my wife had to meet with a psychiatrist to make sure she was up for it and knew what the donation really involved."

Smith said his wife, Karen Smith — a registered nurse, ironically — was skeptical at first, but nevertheless has always been supportive.

Karen Smith said she was surprised by her husband's proposal in the beginning, but is now simply ready to get the procedure finished.

"It's all we've been talking about for several months now," she joked, smiling as she gently reached for her husband's hand. "Since this journey began, our daughter has gotten married, we've had other things happen, but all we talk about is the kidney donation. I'm just ready to do it and move on."

But moving on isn't as easy as it sounds. Smith will face a long recovery and will have to closely watch his kidney function for the rest of his life.

"The biggest thing for me is ibuprofen use, or Advil," he said. "I was told I can never take that medication again. It's Tylenol from here on out."

Not that Smith uses the medication frequently, but it's a change he will have to adjust to. With an estimated four-to-six week recovery period, during which laypersons from his congregation on Ely Road will read prepared sermons in his stead at church, his wife will care for him at home. Smith admits the recovery won't be a walk in the park.

"I'm not supposed to lift anything for a month and a half and I'm not allowed to drive for two-three weeks," he said. "I think the biggest challenge will be the mental fatigue that you go through when recovering from something like this."

But what if Smith donates one kidney and then his other kidney fails? This is a question Smith said he has considered throughout the entire process.

"I realize this is a possibility, but I have been told medically that the chances of that happening area very low, and I think the rewards outweigh the risks," Smith said.

The rewards in this particular chain are very great. Smith's singular donation has sparked a chain involving seven donors and seven recipients, four of whom are considered "highly sensitized."

According to the Montefiore Einstein Center for Kidney Transplantation in New York, highly sensitized patients account for 30 percent of all those waiting for kidney transplants and are extremely difficult to match due to a buildup of antibodies in their systems. In fact, only 6.5 percent of highly sensitized patients each year are matched and they wait on average three to four times longer than unsensitized patients for a compatible donor.

"Most chains are lucky to get one highly sensitized person in them," said Smith.

It's reasons like these that will cause Pastor Jeff Smith to arrive at the University of California, San Francisco Parnassus campus in early September and undergo a laparoscopic kidney removal that will spark fourteen other surgeries across the country to give seven kidney recipients a new lease on life.

"I can't think of a better way to spend my morning," said Smith.

(Contact Janelle Wetzstein at janelle.wetzstein@arguscourier.com)