It took more than four hours of surgery for Danielle Merchant to donate her kidney to a complete stranger so her husband could advance to the top of the transplant list at Buffalo General Hospital.

Now Brad Merchant keeps his cell phone close—in a pocket while he sleeps, on the bathroom windowsill when he showers. His waiting game is on.

"Waiting is a funny thing," said Merchant, 45. "When we were in the hospital, it would get me thinking, get me excited. Then all of a sudden four weeks out, and you kind of get the feeling this call isnt coming. When you know it could be any day, its harder to go through your normal day."

The fist-sized organ is key to Brads future, yet no relative was determined a good match.

So this summer, Merchants wife of 19 years, Danielle, donated one of her kidneys to a total stranger. She did so with the knowledge her action would increase Brads chances of receiving a new kidney of his own.

There are approximately 500 patients in Western New York on the kidney transplant waiting list, according to Erin J. Harvey of Upstate New York Transplant Services. Buffalo General and Erie County Medical Center are the only two hospitals in the area that perform kidney transplants. At Buffalo General, there are 368 patients waiting for a kidney and roughly 77 others whose cases are pending evaluation.

Most have been on the waiting list for an average of two years, said Harvey, and while many factors, including blood type, antigen match and medical condition, can easily stretch the wait, there are actions that can shorten it.

An "altruistic donation" — surrendering your kidney to a stranger — is one such action.

"I never ever asked myself if I wanted to do this," said Danielle Merchant, 39. "I just did it. Brads illness is so debilitating, it has brought us together, but its also torn us apart. The things that we used to be able to do, we cant do anymore. You have no physical relationship. Its a different life now. Weve actually become better friends."

When kidneys fail

Brad Merchants descent into kidney failure began in 2000, when he was diagnosed with kidney disease. It was attributed in part to the diabetes he has suffered since his teens, but it did not stop him from achieving a black belt in tae kwon do.

But by the summer of 2007, Merchant, who works as a building maintenance technician at First Amherst Development, found it increasingly difficult to climb a flight of stairs. After performing 20 jumping jacks at the gym, he became fatigued and ready to go home. The culprit was creatinine, a toxin produced by the muscles that is usually filtered out through kidneys. That, and a decreasing number of red blood cells, compounded Merchants fatigue.

"Im tired all the time," said Merchant. "I sleep like Im dead. I dont think people realize what kidney failure does to the whole body."

Merchants words come in measured doses, much like the dozen or more medications he takes daily. Fatigue shows in his speech and in his gait. By February 2008, when his breath smelled of uremia and his vomiting was beyond control, he was officially diagnosed with kidney failure. It was time to start looking for a kidney,

The demand for kidneys is great. In December 2008, 80,972 people in this country awaited transplant. That same year, the Scientific Registry of Transplant Recipients recorded 10,551 cadaver donations and 5,966 living donations.

"There is no picking and choosing," said Hayley Guzowski, registered nurse and transplant coordinator at Buffalo General. "There is no number on the list. When a donor becomes available, the list is run, first by blood type and then the antigen match. We all have six antigens. And last, how much time you have on the list.

"If its a perfect match for someone way down on the list, they move up," Guzowski said. "A perfect match is like hitting the lottery. The list changes with every donor. Danielle gave to the list, so Brad moves up on his list."

Shortly after Brads name was added to the kidney transplant list, the Merchants were approached by Guzowski, who suggested a kidney swap.

In search of kidney

Paired exchanges, or swaps, match kidneys for incompatible pairs. For example, Danielle, who is blood Type B, is not compatible with Brad, who is blood Type A. She was, however, a match for a spouse whose partner was a match to Brad. This four-person "swap" would involve simultaneous surgeries, and the Merchants gave full approval.

But in spring 2008, right about the time they celebrated their 19th wedding anniversary, and when Brad began dialysis, he was diagnosed with bladder cancer.

"To be removed from the list it has to be deemed that transplant is no longer in your best interest," said Guzowski. "Your heart may not be strong enough or cancer may not be curable. Different cancers have different wait times. It is recommended that you wait two years from your cure date before transplant."

Merchant became an "inactive" patient on the transplant list, meaning he was not healthy enough for transplant, yet he would not lose his place. In addition, protocol dictated that the cancer diagnosis would inactivate him for two years. Further discussion would reduce this time period to six months provided he was cancer- free throughout.

"We were devastated, angry and sad," Danielle recalled, sitting by her husbands side in the living room of their two-bedroom apartment in Cheektowaga. "What kind of life is this for Brad? We cant go on like this."

Last test is the worst

Most patients in Western New York waiting for a kidney are between the ages of 50 and 64, according to Harvey of Upstate New York Transplant Services.

For Danielle Merchant, donating a kidney was a four-week process that required a battery of blood work and hours and hours of testing that ended with a renal angiogram, which in Danielles words, could have "brought the party to an end."

"The last test is probably the worst," she recalled. "If your kidney is not shaped properly, if you have too many vessels going into it, or if its crooked, it may be fine inside of you, but theyre not taking it out."

After it was determined that Danielles left kidney was suitable for transplant, she met with a psychologist to ensure she had not been "coerced, forced or paid," she said. "Then I went in at 5 oclock in the morning and gave them my kidney."

"With living donors, we can actually plan your transplant date," said Guzowski. "We can make sure you are in the best health to get the kidney at that time. Obviously, if youre a living donor, the kidney is not out of the body very long. With cadavers, the kidneys travels, and it could take hours to get here. With living donors, the kidney travels from one [operating room] to the next."

Danielle was assigned a room at Buffalo General on the orthopedic floor, where her family gathered during the four-hour surgery. By state law, all of her medical expenses were covered by the recipients health insurance.

"The worst part is the back pain," Danielle said. "Its still sore, but a lot of the pain for me is emotional right now."

She also is battling depression, another symptom of the waiting game.

"Spouses who are having trouble ought to try owing your life to your spouse," Brad Merchant said. "Its an amazing thing. We have talked to our friends, and there are some who would give their kidney directly to their spouse, but very few who would donate to the list."

A fundraiser for Brad and Danielle Merchant will be held from 5 to 10 p. m. Nov. 7 at the Fraternal Order of the Eagles, 4569 Broadway, Depew. Tickets are $20. For more information, visit

www.bradskidneytransplant.com

. If you would like to make a donation, call Chris Witkowski at 684-0512.