A few weeks ago, a confused and frightened man walked out of Georgetown University Hospital, leaving behind a 2-year-old son and taking with him one of the child's few chances of survival.
The child, whose first name is Albert, is suffering from a congenital kidney disease and is too young to survive more than another year without a kidney transplant. When his father proved unable to undergo the surgery the day before the operation, and his mother was found to be medically incapable of donating one of her kidneys, Albert's options suddenly narrowed drastically.
He now is dependent on doctors finding someone willing to donate a suitable kidney from the body of a relative who has died recently.
The situation has become so desperate that Albert's foster parents and his doctors have decided to go public with their plight in the hopes that it might increase the chances that he will find a kidney suitable for transplant before it is too late.
Because the most suitable kidneys for transplant often come the victim of a fatal accident where there is neither a debilitating disease nor an injury to the needed organ, it often seems, said Irean Nelson, the child's foster mother, "as if we were waiting for someone to die."
Lately, "for some reason, we just have not had enough cadaver kidneys come up." said the child's doctor, Zoe Papadopoulou-Columbis, director of the pediatric hemodialysis unit at Georgetown University Hospital. "Often people are just not aware that cadaver kidneys are in great need. It is particularly hard for the relatives of accident victims. We are just hoping that, even though it is a hard thing to think about at such a time, that the donation will give them the satisfaction that they are saving another person's life."
Albert is not the only child waiting for a kidney. There are at least five others, most of them in their teens, at Georgetown University Hospital alone. According to the hospital's surgical transplant coordinator, Geordie Thompson, each year about 90 people in the Washington area must wait for a kidney transplant. About 60 of them get one.
Both Thomson and Papadopoulou call Albert's case "extraordinary," however, because of his age. While adults are often able to survive years undergoing the dialysis process in which they are hooked up to a machine for hours at a time several times a week, a child of Albert's age measures his life in a matter of months.
Three times a week, for hours at a time, the child is plugged into the dialysis machine, which cleans his blood of waste normally removed by kidneys, said Dr. Papadopoulou. However, at his age, "it is difficult to find an artery or a vein that is big enough" to grant access to so small a body, he said.
The child's own kidneys, only one of which was barely functional, were removed late last year after his father agreed to donate one of his own and his kidney was found to be a very good match.
But there are no villians to this piece. Although the child's kidneys were removed because of his father's apparent willingness to undergo the operation, they would have had to be removed nonetheless if Albert were to be physically ready for a cadaver kidney, the only other option when living relatives prove unsuitable.
But Albert's father's last minute change of mind simply heightened the bitter tone of tragedy that has pursued the child since he was first rushed to the hospital with acute renal failure.
Albert's mother, who speaks with the sharp accents of a country twang, thought her 2-year-old son merely had a cold instead of the kidney disease that had him near death last March. In May he was made a ward of Fairfax County and turned over to the care of a foster parent couple because of his special medical needs.
Earl Nelson, a private chauffeur, and his wife Irean, are paid $250 a month by the county for Albert's care, but it is not the money that keeps Irean by the child's side every night in order to hold him as he sleeps. Albert's social worker calls them "a remarkable couple" for the love they give the children placed in their care.
Now, says Earl Nelson, "we're really up against it. We just don't know what else to do." Even if a suitable cadaver kidney is found through vast computer network that tries to match donors with recipients, the chances that such a transplant will be are between 20 and 40 percent, successful, doctors say.
With a well-matched kidney from a living relative, however, the chances jump to 70 percent. "That's why we were so happy about his father's kidney match-up," said Earl Nelson.
Kidneys from living donors unrelated to the patient are rarely used because the chances that such a transplant will succeed are no greater than those involving cadaver kidneys, doctors involved in the case said.
But Albert's father is a country man, say the doctors and social workers involved in the case, a man who had never been in a hospital before, a man who did not believe much in "doctoring." Although he had expressed his willingness to donate his kidney, and had undergone the often painful tests that established his suitability as a donor, his fears mounted.
The day before the operation, the situation came to a head. He was frightened not only of the operating table, said one of the doctors involved, but afraid as well that he would never have his child back. The social worker had brought his other child, another son, to see him in the hospital. The child, after a year away from his father, did not seem to know him.
He demanded a promise that his children would be returned to him within a year and did not understand, the social worker said, that there were procedures for such things, hearings and court orders.
"I couldn't seem to get through to him that our goal was to return his sons to him," she said.