Paying it Forward

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Sometimes saving a life means giving up a piece of your own.

Matt Harmody has often been reminded of his father while working in the emergency department over the last 20 years. When dialysis patients come in to his North Carolina ED, he sees his father, who died of renal failure while needing a kidney transplant – all the while refusing a donation from family members.

Last year, at the age of 56, Harmody followed through on an unspoken desire he’d carried for nearly 27 years, donating one of his healthy kidneys to a stranger. His donation was anonymous and unmatched – no strings attached. While thousands of kidney donations occur each year among loved ones, fewer than 200 are given in this manner. These anonymous donations provide a critical link in the organ donation chain and enable other organ donations to occur around the country.

Matt Harmody, the oldest of three children, was a sophomore in college when he got the dreaded phone call from his mother. His father was being admitted to the Cleveland Clinic for what was presumed to be acute renal failure. “He went from being a Type A guy with a very strong personality and a career as an attorney and Cleveland City Councilman, to basically being tied to hemodialysis three times a week, essentially for the rest of his life.” The subject of receiving a kidney donation from a family member came up, but Harmody’s father refused to consider it.

“My father was very decisive and wasn’t one to consider other people’s opinions very much. So it was pretty much impossible to talk to him about one of his family members being a kidney donor.”

For years his father received peritoneal dialysis under the care of the Cleveland Clinic. Four times a day he’d use a small catheter in his abdomen to extract toxins from his body. His small comfort was that he was able to preform the regimen at home.

Once it became impossible to receive the peritoneal dialysis at home, Harmody’s father finally considered a transplant. But once again, he refused to consider a transplant from a family member. He received a cadaver transplant, but it didn’t take and his body eventually rejected it. At age 59 he began a steady decline. Finally, during one of many hospitalizations, he called in his family. After a grueling nine year battle, he was done fighting. “I’ve led a good life,” Harmody recalls him saying. “I’m not taking hemodialysis anymore.”  Harmody knew that this was a decision to die.

As the oldest son, he’d felt a certain obligation to donating a kidney to his father, but the conversation never went anywhere. “My father felt that when push came to shove, he had lived 50 good years of life and he didn’t want to risk his children’s lives at such a young age.

I think you can argue both sides of it, as far as whether it was the right decision. It was the right decision for him, and I think that’s what’s most important.”

PAYING IT FORWARD

Years passed and Matt Harmody transitioned from engineering into medicine – in part because of his experience caring for his father. He started medical school at age 30 and went into emergency medicine in North Carolina. Along the way he had two boys of his own. Looking at his own sons now – aged 21 and 16 – Harmody has a better understanding of the difficulty of his father’s decision.

“That would be a big ask of them. It does put things into better perspective and what my father was going through.” The sense of a lost opportunity stayed with him, unspoken, until his youngest child entered college. Then something clicked. His children were living on their own, and he and his wife were financially secure. “If something were to happen to me, they would be well. From a maturity standpoint, I think they’re old enough to understand.”

Harmody felt himself entering a sweet spot – old enough to feel secure about his family’s wellbeing but young enough to be a healthy kidney donor. And so, at age 56, Matt Harmody began to do research on how to become a kidney donor himself. He started at UNC, where he’d done his residency, and slowly began the monthslong process of getting approved to donate.

“I think it finally became not ‘Why?’ but ‘Why not?’ I don’t have any more excuses.”

OVERCOMING DOUBTS

Harmody had little doubt that he’d be deemed healthy enough to donate. He’s an adventure racer who has competed in 72-hour ultra marathons. But it still took several months for him to walk through the requisite physical, psychological, and financial hurdles.

The Harmody family kept the process close to the vest for the months leading up to the surgery. Matt didn’t want people getting interested or excited before he was approved. Plus, there was an emotional element that took time to resolve. Specifically, Harmody’s wife struggled to understand his desire to take on this unnecessary risk.

“I had a lot of reservations in the beginning about Matt donating a kidney,” said Susan Harmody. “Not having known his dad and seeing what he went through and also not understanding the challenges of living on dialysis or in need of a kidney, I couldn’t understand Matt’s motivation.” At first Susan couldn’t bring herself to join her husband at his appointments at UNC. She just couldn’t talk about it. But after “a lot of prayer” and conversations with their pastor, Susan found peace with his decision.

Given Harmody’s medical background, the donation process didn’t present any major surprises, save one big positive. He marveled after the fact that he could go in for major surgery at 8 a.m., undergo a 5-hour organ donation, and come out feeling awake and alert, and not in much pain.

“It took a little bit of sinking in. I guess it was a big unknown, laying there in the pre-op holding area. What’s it going to feel like? It was of course much harder for my wife to be there in the hospital while I was in surgery. I’m out, so I have no idea. She was there through it all.” The day of the surgery, his sons finished up school and joined their mother at the hospital. They were all together when he woke up.

CHAIN REACTIONS

According to the UNC transplant team, only two or three people a year sign up as “unmatched” donors providing an organ without being tied to a recipient. UNC does around 70 transplants a year, but the vast majority are matched or from a cadaver. When an unmatched donation occurs, the National Kidney Registry uses a powerful algorithm that matches people all over the country. The algorithm uses unmatched donors to fill in the gap in a chain of matched donations. For instance, take a woman who is in need of a kidney; her husband who wants to donate but is not a match. Most spouses are not matches. But the husband is a match for another person in need of a kidney.

These matches create short chains of organ donation; the unmatched donations like Harmody’s provide a link in the chain. When Harmody gave UNC his window of being able to donate, they started putting together a chain of recipients and donors. On the 26th of September, the day of Harmody’s donation, he started a chain of six transplants that stretched into the next day, across multiple hospitals.

“It’s a pretty remarkable system they have in place,” said Harmody. As much as they’d read and discussed the matter, the reality of what Matt Harmody had done didn’t truly sink in for he and his wife until after the surgery, during the two-week follow up. As they sat in the transplant clinic waiting room, they got to meet people waiting for kidney donations, all at different stages of illness. Everyone in the clinic was either getting on the transplant list, had recently had a transplant, or were a donor.

“I’ll never forget my wife meeting a young couple probably in their mid 30s, a husband and wife. He was working on getting on the transplant list. And they had young kids. She was working on her PhD. He began to develop a slow deterioration of his kidney function, and they were tracking it. I don’t think my wife could even imagine a couple of that age going through raising young children and trying to work, each with their own careers, while needing to get a kidney transplant in the near future. It put a face on what it meant to be a recipient of a kidney.”

At one point, the wife suddenly turned to him and asked, “What are you, a pastor?” Matt and his wife laughed. “Who would even consider doing something like that besides someone who’s committed themselves to God or a higher being?”

Harmody responded, “I have to be honest with you, that’s the first time anyone’s ever mistaken me for a pastor.”

“When I finally got to meet people dealing with kidney disease, it really opened my eyes and my heart to their need,” says Susan. “It gave me such a wonderful appreciation for what Matt was doing and the sacrifice he was making for someone else. People often say to me aren’t you proud of what Matt did, and I tell them it’s not pride so much as he has inspired me! He has shown me what it truly means to give of yourself!”

“Before this, I’d never really been told I was an inspiration to anybody,” said Matt.

THE RECOVERY

Currently, Harmody isn’t that concerned about his health. He’s aware of the risk of injuring his remaining kidney, so he won’t be engaging in any extreme sports in 2018, but otherwise, it’s life as usual. Or at least back to normal for an ultra runner.

There’s a 100 kilometer trail race that takes place a mile from Harmody’s home. He’s run it five consecutive years. He may still run part of it this year, but he’ll have to monitor his fluids closely. “I may be out there doing dipsticks in my urine periodically to check for blood and ketones, which are signs of acute renal injury, because I can’t afford to take that kind of chance anymore. I’ve talked to other donors that have gone on to run marathons and other endurance events. So I wasn’t too concerned about that. If I never do a multi-day race again, it’s not the end of the world. It’s not like I’m some Olympic athlete. I’ll always enjoy riding and running, and I’ll probably be a little bit more cautious on my mountain bike than I used to be. But nonetheless, it’s all good.”

Among Harmody’s emergency medicine colleagues, the response to his donation has been all positive, tinged with the typical dark humor. “There’s always the kidding around amongst your colleagues about punching you in the flank and which side you do it on…”

The UNC transplant teams ask donors and recipients to write notes to one another. If both parties are at UNC, the hospital will arrange a meeting if both parties are interested. “On my side, the recovery is a lot easier than the recipient,” said Harmody. “They’re on anti-rejection medications and have to avoid all kinds of things, especially in the first 6 to 12 months. And it takes them a little bit more time, I think, to come to the realization of getting in contact with the donor. So, I wrote my note. I haven’t heard back from the recipient. But they tell me that’s not terribly unusual. So, it remains to be seen whether we’ll get a chance to meet each other.”

THE ORGAN DONATION ADVOCATE

As positive as the response to his donation has been, Harmody struggles with how open to be about it all. He’s conscious of wearing it on his sleeve. He was given a Living Donor pin when he completed the donation, but he struggled with whether to wear it. Would it feel like bragging?

“I probably would wear it at work only. But how would people take that? I’ve kind of struggled with that a little bit.” Harmody has also struggled with the role of organ donation advocate that he was thrust into as a result of his actions. He’s signed up to be a mentor with the UNC transplant program.

For anyone interested in becoming a kidney donor, Matt Harmody is ready and willing to share his story and his experience, for the sake of saving another life.

ABOUT THE AUTHOR

MANAGING EDITOR
Logan has edited and designed Emergency Physicians Monthly since 2005. In 2010, Logan launched Emergency Physicians International, a new magazine and social network for global emergency care development. He is also the editor-in-chief of Telemedicine Magazine.

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