In 2006, a 28-year-old man from Michigan signed up to give one of his kidneys to someone he had never met. He asked for nothing back. When his surgery finally happened, in July 2007, it set off a chain of ten transplants across five states. Each person who received a kidney had a loved one who then gave a kidney to the next stranger in line.
The chain that started with a stranger
The story is told in a 2009 report in the New England Journal of Medicine by transplant surgeon Michael Rees and colleagues. The young man had registered as an altruistic donor at a New York transplant center in the Alliance for Paired Donation. In April 2007, the registry's matching software found him a recipient.
On July 18, 2007, he traveled to Phoenix and donated a kidney to a 53-year-old woman with polycystic kidney disease. Her husband had wanted to give her one of his, but he wasn't a match. Eight days later, the husband traveled to Toledo, Ohio, and gave his kidney to a 32-year-old woman. Her mother, who also wasn't a match for her own daughter, became the next donor, and the chain kept going.
In all, the authors write, it was "a chain of 10 kidney transplantations, initiated in July 2007 by a single altruistic donor," carried out at six transplant centers in five states over eight months. The new part was patience. In five of the ten cases, a "bridge donor" kept the chain going as many as five months after their own loved one had already received a kidney. Nothing forced them to follow through. According to the University of Toledo's announcement, they all did. Rees described the idea as passing the first donor's altruism on to every donor after, with each of them choosing to "pay it forward."
How a chain works
Many people who need a kidney have a friend or relative willing to donate, but the two aren't compatible. Paired exchange gets around this by swapping donors between pairs. A chain goes a step further. It starts with what UNOS calls non-directed donation, where "the donor does not name the specific person to get the transplant." That one gift unlocks a pair, whose donor unlocks the next pair, and so on down the line.
The National Kidney Registry, one of the largest exchange programs in the U.S., says one chain can facilitate "anywhere from two to 30 transplants." Its home page counts 13,000 NKR-facilitated transplants so far. The registry also notes that chain starters have changed: chains used to begin with non-directed donors, but today many begin with "family voucher" donors. These donors give to a stranger now and, in return, can create vouchers for family members who might need a kidney later.
The need is still big. The registry says about 90,000 people need a kidney transplant and about 6,000 people donate a kidney each year. It adds that fewer than 5% of those living donors give to someone they don't know. UNOS reports that in 2025, more than 7,200 people became living organ donors, counting all organs.
Honest caveat: Living donation is major surgery, and the NKR says plainly that "donating a kidney comes with risks." It isn't right for everyone, and transplant centers screen donors carefully. Choosing not to donate is never a failure of generosity.
Today's act
The act: Most of us won't give a kidney to a stranger. Nearly all of us can do the small thing that keeps the larger system working: say yes to donation, out loud, to the people who would be asked.
- Register as an organ, eye and tissue donor at RegisterMe.org, the national registry run by Donate Life America. It takes a couple of minutes.
- Tell one family member tonight that you registered, so nobody has to guess what you wanted.
- If living donation has crossed your mind, read the NKR's page on donating to a stranger. Asking a transplant center questions doesn't commit you to anything.
- Know someone waiting for a kidney? Offer something specific, like a ride to dialysis or a dinner. Our meal train planner makes that easy to organize.
For more people who gave at real cost to themselves, see our collection of magnanimous acts in history.
Sources
- Rees et al., New England Journal of Medicine — A Nonsimultaneous, Extended, Altruistic-Donor Chain (2009)
- University of Toledo News — "Pay it forward" approach to kidney transplants highlighted in NEJM (March 2009)
- UNOS — Living donation
- National Kidney Registry — Start a chain
- National Kidney Registry — I want to help a stranger in need of a kidney
- National Kidney Registry — Home
- Donate Life America — RegisterMe.org