Since Sept. 25, Betsy James had wondered about the woman.
How did she look? What did she like?
Most of all, what would motivate her to give a complete stranger a precious kidney?
James, 53, lay on a gurney Oct. 18, prepped for surgery, and said a prayer for the faceless woman who was about to change her life.
Christine Voisin knew James’ face, but she knew only the most basic of facts about her: They were about the same age. They were both teachers, both women of faith.
But, two months earlier, Voisin had heard the voice of God over a minute-and-a-half-long TV news segment about James.
Besides, in her mind, Voisin, 53, had relinquished ownership of the kidney years ago. If it hadn’t been able to serve her greatest wish – saving her cherished baby brother – then, she believed, it still had a great purpose outside her body.
She was at peace. In her heart, the kidney was already James'.
‘Tired all the time’
Betsy James didn’t set out to be on television that August day, just a few weeks after the start of the school year. But when a WBIR reporter called Alcoa Elementary School, where James has taught for 23 years, the principal pitched a story: Devoted teacher plugging away despite her failing health, on the kidney waiting list for more than a year. Husband and big sister eliminated as donors because of health considerations; best friend and colleagues failed to match.
It was co-teacher Sandy Stuart and older sister Suzanne Singleton who persuaded James to be on camera. Still, James never expected the TV spot to actually lead to her getting a new kidney. She thought, at best, it might convince a few viewers to sign the back of their driver’s licenses to become organ donors after their death.
James had been a “sickly” child, she said, and began having problems with kidney function in her mid-30s. After a bout of shingles in late 2015, she said, her kidneys began to fail. Her doctors bought time with chemotherapy and steroids, but she was on the verge of needing dialysis.
Unable to bear children, James loved her students and poured her heart into teaching them. And she doted on her niece and nephew, repaying the mothering Singleton, 61, gave her growing up.
But a full day of teaching just exhausted her. Daily, she napped; on the weekends, she slept for long stretches.
“I thought, I’m a teacher; it’s normal to be tired all the time,” James said.
A sister’s love
On Aug. 23, the day James’ segment aired on WBIR, Christine Voisin had just returned to her Sevier County home from a trip to Atlanta. Taking a rare midday rest, she flopped on the sofa and flipped on the afternoon news, “which I never do,” Voisin said.
“It just touched my heart,” Voisin said. “I just knew that this kidney was supposed to be Betsy’s kidney. Truly, I felt called by God to do this.”
Voisin, a Louisiana native who moved to Sevier County with her husband, Kent, 13 years ago, meant to give up her kidney in 2011 to her baby brother, Danny, who was then in kidney failure.
That year, she went to University of Tennessee Medical Center, the only local hospital with a kidney transplant program, and went through testing to be a living donor for Danny.
On paper, they were perfectly matched. But Christine, though sturdy, is petite, and Danny, an offshore boat captain, was a big man. In the end, the transplant was called off because of a size mismatch.
“We were devastated,” she said. “He was brokenhearted.”
Shortly after, Danny experienced painful complications, and his health declined to the point that he was no longer eligible to be on the transplant list. In May 2014, he died. He was 47 years old.
In the years since, Christine hadn’t considered giving her kidney to anyone else.
“I’d kind of put it out of my mind,” she said. “You can’t live with the dead.”
That day, she turned off the television and prayed. Then she picked up the phone and called the transplant center.
A rare situation
When the call came from the transplant center, James and Stuart were driving back from a teacher training session.
“When the nurse called me, I started crying,” James said. “I was in disbelief. When it sunk in, I started calling my immediate family. … None of them expected me to get a donor so quickly.”
With everyone close to her eliminated as possible donors, James never expected to have a living donor – she thought any kidney she got would come from a deceased donor.
Why would a stranger willingly give her a kidney? Every time the phone rang, she wondered if her donor was backing out. Daily, James prayed for her donor and tried to imagine what she might be like.
“I knew she must be a very giving person, that she must have a heart for other people,” James said. “I had a feeling she was really patient, very kind and understanding. … I thought, I bet she’s a lot like me.”
James knew from the transplant center that having a living donor increases the chances of a successful transplant. From January to November this year, there were around 18,000 kidney transplants done in the United States. Only about 5,000 were from living donors.
Getting a kidney from a stranger, rather than a relative or loved one, is rarer still. Even when the donor is close to the recipient, said Linda Walker, living donor coordinator for UT Medical Center’s transplant program, a medical match alone isn’t enough. Potential donors go through a barrage of sessions where they’re questioned about their support system and their finances and given a psychological evaluation, just to make sure they understand what’s involved with donation and they’re not being pressured.
But if more people were willing to consider living donation, Walker said, it would go a long way toward solving the primary problem of the kidney wait list: the demand far outstrips the supply. Today, around 96,000 people in the United States are waiting for kidneys – and with rates of diabetes, a major cause of renal failure, continuing to climb, the list will continue to grow, she said.
“The demand keeps increasing, and the supply is really staying pretty consistent,” Walker said.
UT Medical Center began its kidney transplantation program in 1984, 30 years after the first kidney transplant. In a typical year, it will do around 60 transplants, Walker said; last week, it was up to 58 for 2017.
One of those, on Oct. 18, was James’.
Praying to heal, to meet
James didn’t know this, but two women actually called the transplant center after the WBIR story, offering to donate kidneys to her. Voisin was the better match; the other woman went on to donate a kidney to a man on the waiting list.
Voisin had, she felt, God’s blessing -- and, eventually, her husband’s.
“I knew I was going to be a match for her,” she said.
The transplant went smoothly. Surgeon Dr. Oscar Grandas told the women the vessels were easy to attach, and the kidney, once transplanted, started working immediately.
“It was really amazing to see how quickly that kidney started working,” James said.
It was a relief to her – she couldn’t imagine the disappointment had her body rejected the priceless gift.
Transplant centers are fiercely protective of donors’ privacy. Had Voisin wanted to stay anonymous, James might never have known anything about her other than her gender.
Both women were open to meeting, but it wasn’t until after the surgery that they did.
Voisin wrote James a letter, introducing herself as a former teacher-turned-medical technologist, now semiretired and managing rentals with her husband.
“I hope and pray that both our recoveries are going well, and that our kidney has found a happy new home in you,” she began. “I had many long talks with her and told her to behave herself in her new home.”
In the letter, Voisin touched on losing her father, then Danny to renal failure. She spoke of her husband, how he supported her but struggled to make peace with her decision, then found Scripture in the books of Daniel and James that gave him that peace.
“I knew from the first moment I saw your story that this is what I was called by God to do,” she concluded. “Please pray for me as I am praying for you that we can continue to live our lives full of joy, hope, faith, love, health and happiness.”
She signed it: “Hope to meet you soon. Christine.”
Deceased donation as an option
Voisin had promised her husband that if she weren’t a match for James, she’d “move on” and not consider donating her kidney to anyone else. Being a living donor isn’t the right decision for everyone, she said. Like James, Voisin wasn’t able to have biological children, so she didn’t have the possibility her own child would someday need a kidney from her.
But “everybody can sign the back of that driver’s license card,” Voisin said. “The need for organs is just tremendous.”
It was that need that drove Voisin, who would have preferred to stay private about the transplant, to share her story. While more than half of Americans are registered to be organ donors on their driver’s licenses, fewer than 40 percent of Tennesseans are.
Knoxville developer Travis Fuller can testify to the difference it can make. Fuller grew up seeing his mother, her twin sister and their brother all suffer from kidney failure, with dialysis, blood transfusions and transplants part of regular life. His father donated a kidney to Fuller’s older brother Mike, who inherited kidney problems. Their cousin Billy Jarvis, who has had kidney transplants also, works as an educator for the nonprofit Tennessee Donor Services.
At 16, Fuller showed early signs of kidney problems; by 22, he was on dialysis, scheduling the four-and-a-half-hour sessions at day’s end so he could get in a full day of work first.
“I was the last one,” the youngest in his family to have kidney failure, Fuller said. “If you weren’t afflicted by kidney disease, you’d already given one of your kidneys to another family member.”
18 years and counting
In 1999, Fuller had plans to travel with his parents during the Thanksgiving holiday to the University of Alabama at Birmingham, where brother Mike was recovering in the medical center from complications from a kidney transplant. Jarvis and other family members also had kidney transplants at UAB, so the doctors there knew the family well.
Fuller had scheduled his dialysis for the morning, so he could leave directly afterward. For the first time, the process had made him ill. He arrived at UAB having not eaten that day, and the doctors there then urged him not to: Four kidneys had arrived from deceased donors, because their best matches were patients in the region. But because of the holiday, there was a chance some of the smaller rural hospitals weren’t staffed to do a transplant – and with no recipient, a kidney would go to waste.
At 3 a.m. Thanksgiving Day, a nurse came to prep Fuller to be transplanted with one of those kidneys. It wasn’t an ideal match; deceased donor kidneys that are good matches last, on average, a dozen years, but those that aren’t good matches typically don’t last nearly that long. Still, the recent dialysis experience had been unpleasant enough that Fuller was willing to risk having the kidney for even a short time.
“Three to five years of not being on that machine sounded great to me,” Fuller said.
Eighteen years later, he still has that kidney, though he expects it will give out in the next few years. At that point, he’ll be on the waiting list again, hoping for a donated kidney that will do as well, that will take him 20 more years, into his children’s adulthood.
“I want people to understand the importance of organ donation,” Fuller, now 44, said. “I was a young man at that time. I got to have two kids. I got to watch them grow up, and just have a fulfilling life.”
‘New sisters’ on a shared journey
When Voisin and James finally met, their bond went beyond blood and tissue.
“I feel like we should have been friends years ago,” James said. “We like the same things. We talk like we have been friends for years.”
She’s pleased Voisin’s recovery has gone well, and she’s ecstatic to share how her own life has improved.
“I don’t take naps now. I don’t go to bed early,” James said. “I feel like I’ve got so much energy. My mind feels fresher, more clear. … I want to do more things. I want to get out.”
At the same time, she’s determined to be a good steward of Voisin’s kidney, watching her diet and getting regular exercise. She eagerly anticipates returning to her classroom in March, after the threat of flu season subsides. She relishes being able to again eat some of her favorite foods – like sister Suzanne’s lasagna.
“I feel like I have new sisters all of a sudden,” Voisin said of James and Singleton. “I couldn’t have asked for a better person to be the recipient.”
James said she and Voisin talk on the phone weekly and have plans to spend more time together. They joke, James said, about getting an RV and traveling the country, urging organ donation.
On the day they met, James presented Voisin with a charm bracelet, the first charm depicting two hearts entwined. She plans, she said, to add another charm each Oct. 18 – their transplant anniversary.
Voisin painted a rock for James. On the front, it has the date and the word “faith”; on the back, “James 2:14-26.”
“For as the body without the spirit is dead,” that passage ends, “so faith without works is dead also.”
“It was a big journey of faith for both of us,” Voisin said. “I feel God’s got a plan for Betsy. … Now she can go on to do all the great things that she would have done if she had been healthy.”