This story was originally published in 2022.

Listening to the hum of machines and the lilt of a British nurse discussing documentaries, Tim Bradley fell asleep. It was a sleep many years in the making and one which changed more than one life.

This year, the 26-year-old​ public servant​ gave a kidney as a non-directed donor. In other words, he did not know the recipient. In doing so, he was part of a chain of donations involving about 11 people and multiple trans-Tasman exchanges.

In 2018, in his third year studying law and economics, Bradley was introduced to effective altruism – a movement which aims to find the best ways to help others and put them into practice. In his words, it’s “doing the most good you can, with what you have available”.

What he had was two healthy kidneys.

READ MORE:
* Man whose life was saved by brother’s kidney urges others to consider same ‘gift’
* Life at 4 per cent: Carey ‘Wocky’ Penn’s kidney transplant journey
* Stalling numbers of kidney donations would cost millions of dollars in dialysis, research finds
* Kidney recipient honours gift of life she was given 30 years ago

In 2019, a 23-year-old Bradley phoned a hospital to express interest in donating a kidney. You have to be 18 to donate in Aotearoa, but he was told to get back in touch when he was 25.

In December 2020, he started thinking seriously about it again, broaching the topic with family over Christmas – which, he jokes, started a bit of an argument.

The desire didn’t go away. In January 2021, he put his hand up, again, before turning 25 in July. Finally, the ball started rolling.

Prospective donors undergo exhaustive physical and psychological assessments. Over months, Bradley gave countless vials of blood, wore a blood pressure monitor twice for 24-hours at a time, and had to collect urine over 24 hours to be screened.

Doctors check the potential donor is healthy enough to give a kidney, to live without one and assess a person’s motivation and ability to consent.

For Bradley, the reasons to donate overpowered any potential counterargument not to.

If a person’s kidneys fail, options include dialysis – a process which cleans the blood by filtering out waste products kidneys would usually get rid of – or a transplant.

About 500 Kiwis are waiting for a kidney, National Renal Transplant Service clinical director Dr Nick Cross says.

About 100 kidney transplants occur from deceased and non-directed donations annually. There’s also live, directed donations, where the recipient knows the donor.

Only 1-2% of deaths in New Zealand occur where organ donation might be possible.

“We literally don’t have enough kidneys to give to everyone,” Cross says, and with an average wait of 2-3 years for deceased donor kidneys, “some don’t make it through”.

More than 3000 Kiwis are on dialysis, and several hundred more start each year.

Dialysis is a “really poor substitute” for kidney function. Many still suffer pervasive symptoms and spend 12+ hours hooked to machines every week.

A person starting on dialysis has an average life expectancy of 3-5 years, though this varies with age, and underlying health conditions, Cross says. Some can remain well on dialysis for much longer.

Transplanted kidneys last 15-18 years on average, and some Kiwis were transplanted 30-40 years ago, he says.

The change a transplant can make, though not a panacea, is “remarkable” and a “magical thing” for recipients and their whānau, Cross says.

This, coupled with the fact healthy people can live well with one kidney, that Bradley is young and early in his career (though there’s no strict upper age limit for donation), only cemented his decision to donate.

The kidney exchange

It’s not just one person who will be helped, either. Bradley’s donation puts him in a kidney exchange.

A paired kidney exchange allows would-be recipients with willing, yet incompatible donors to match with other donor-recipient pairs in the same situation.

After pairs are matched with each other, they effectively ‘swap’ kidneys, with each donor giving to a recipient in another pair, in an ongoing chain of pairs.

Australia and New Zealand operate a joint kidney exchange, matching pairs across both countries. Non-directed donors, like Bradley, account for more than 25% of transplants generated in the programme.

About a month out, he’s excited the procedure is finally booked in: “It’s my good news thing I keep telling people.”

He knows very little about who his kidney is going to. That’s by design – anonymity between pairs is strictly maintained by the programme. It’s also why Stuff cannot specify when Bradley’s surgery occurred.

But the ‘who’ isn’t so important, he said, just that they get it.

“I would love if it lasted 20 years – I probably wouldn’t be happy if it slipped onto the floor – but you know, even a couple of years of someone being able to travel, hold down a job” makes it worthwhile.

The surgery

The day before Bradley went into surgery, he, partner Becca​ and Persian cat Gabs​ fly to Auckland from Wellington.

He has a final round of checks that afternoon and a Covid-19 test.

He’s never had surgery before, but isn’t feeling too nervous. He’s resolute in what he’s doing.

The next morning, he’s wheeled into theatre about 8.30am.

He doesn’t remember waking after the roughly 2-hour procedure, but recalls calling family and friends to say he was OK.

While in hospital for two nights​, he’s told his kidney was doing “really well” in the recipient: “That made me really happy.”

Bradley was propped up on a double bed in an airy hotel room, six days after surgery. His abdomen bloated and swollen, but his eyes and face bright.

Save for one day when he didn’t feel so flash, Bradley is surprised at how little the procedure took out of him, and how well he’s feeling.

He hasn’t been in too much pain, and was up and moving around the following day – bracing his belly, as a nurse instructed, which feels a bit like he’s “keeping his guts in”.

Some pre-surgery excitement has dissipated. After waiting so long, “I’ve done my piece”.

Bradley says it’s possible the gravity of what he’s done hasn’t yet sunk in, but that might change one day, if he ever ends up connecting with the recipient.

Reflecting on why he’s done this, Bradley says, all around us, people are struggling in ways we don’t know and cannot understand: “For me, this is a tangible thing I can do that can really ameliorate someone else’s suffering”.

Bradley encouraged people to think about whether they’d be a donor when they die, and have a conversation with whānau so they know your wishes.

He also advised anyone thinking about live donation to make a call to a renal unit and see whether it’s right for you.

“It really can make an enormous impact on someone’s life.”