The algorithm of kindness

Ash Wednesday, the beginning of Lent, calls on the faithful in our predominantly Christian nation to perform acts of kindness and sacrifice for the less fortunate.  They are the poor who are forced to live with little hope in our highly unequal society.  They are the sick singled out by fate to suffer a slow debilitating death.  Or they may be the momentarily needy, forced by circumstances to turn to friends, kin and strangers for help. The call to selfless kindness is one of humanity’s hardest tests.

Many of us fail this test because, whether we are aware of it or not, we seldom give without expecting something in return—recognition, a reward, or repayment in loyalty and future favors.  Christ remains the enduring figure of unconditional love, and I have always believed this is what Christianity is about. “When you give something to the poor,” he tells his disciples, “do not have it trumpeted before you, as do those who want to be seen in the synagogues and in the streets in order to be praised by the people. I assure you, they have already been paid in full.” (Matthew 6:2)  This may as well have been addressed to our politicians who think that a good deed has value only when it is stamped with their names and faces.

But the world is filled with Good Samaritans. They emerge out of nowhere, as if to remind the rest of us of the obligations of our humanity.  One such person was 44-year-old Rick Ruzzamenti of California, whose selfless offer last year to donate one of his kidneys to anyone who needed it set off a chain of 60 operations involving 30 living donors and 30 grateful recipients of healthy kidneys.  The donors and recipients remained anonymous until New York Times reporter Kevin Sack stumbled upon this inspiring story and tracked down the individuals who formed this amazing chain of need and altruism.  (Sack’s article may be accessed at:  https://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html?nl=todaysheadlines&emc=tha2)

Ruzzamenti is not a crazy fellow, although that was what the staff of Riverside Community Hospital initially suspected he might be when he presented himself as a kidney donor with no particular recipient in mind, and, more importantly, with no expectation of compensation or recognition.  He was subjected to psychological screening and medical tests to determine not only his mental fitness but also his suitability as a donor.  The hospital’s transplant coordinator probed him about his motivations and warned him about the relative risks.  Ruzzamenti dryly told her: “People think it’s so odd that I’m donating a kidney.  I think it’s so odd that they think it’s so odd.”

Ruzzamenti explained what prompted him to do it.  He said he was not a saint.  He had not even donated blood in the past. But something hit him when one day he learned that the receptionist at his yoga club had donated a kidney to a sick friend she happened to meet at a shopping mall.

Mrs. Ruzzamenti vehemently objected to the whole idea, and threatened to leave him.  But, undeterred, he explained to her why it was important to him and what great benefit it would bring to somebody out there. Perhaps she never fully understood his reasons. But she stayed by his bedside to nurse him after his kidney was taken out.  That too is love.

Ruzzamenti’s kidney traveled across the United States to be transplanted into the body of a 66-year-old man in a New Jersey hospital who had been suffering from end-stage renal disease.  A niece of this patient had volunteered to give him one of her kidneys but her blood type was not compatible with his.  So, in exchange for the kidney her uncle was receiving, she agreed to donate hers to a woman in Wisconsin whose former boyfriend, David Madosh, had offered to donate one of his kidneys.  Madosh’s kidney, in turn, went to Janna Daniels in Pittsburgh, whose husband, Shaun, gave his kidney to Mustafa Parks, a young father in San Diego.  Parks’ donor’s kidney in turn went to somebody else in the chain.

This roundabout way of matching donors with recipients is made necessary by the fact that the kidney of a willing donor, perhaps a relative or a friend, may often not be the best match for the intended recipient. In the United States, where federal law strictly prohibits the sale of organs, this situation has given rise to the phenomenon of paired exchanges, which the law allows. Pairs offer an extremely restricted supply of kidneys. But stitching together available pairs into a longer chain enlarges the pool.  The algorithmic and logistical requirements of such a scheme are formidable but not insurmountable.

This is where the Samaritan wisdom of Garet Hil came in. His young daughter had fallen victim to a congenital kidney ailment, and she needed a transplant.  Neither his nor his wife’s kidney proved suitable for the child. As they watched their daughter die, a distant relative came forward to offer one of his kidneys, and it was a perfect match.  But the thought of finding a more methodical approach to the problem never left Hil. On his own, he worked on an algorithm that took into account a multiplicity of factors in order to arrive at the best matches for various chains of anonymous donors and patients. He contacted transplant hospitals all over the United States and urged them to join his National Kidney Registry.  A web of interlinked donors and recipients, held in place by a mix of kindness and self-interest, has resulted from this effort. More lives have been saved by the graciousness of others.

All it took to start this intricate web was a first act of kindness, unconditional and pure.

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