Christine Buell and former student Kelvin Sanders III before their pre-op appointment at the University of California-San Francisco Medical Center in mid-December. (Courtesy Christine Buell)

The week between Christmas and New Year's — a time that's supposed to be filled with all manner of cheerful things like fancy dresses, ski trips and hot chocolate — is when Christine Buell is scheduled to be lying in a hospital bed in San Francisco while doctors carefully remove her kidney. The surgery is 100 percent voluntary.

Buell, a 45-year-old vice principal at the Sacred Heart Cathedral Preparatory School and a mother of two young girls, is donating the organ to a former student, Kelvin Sanders, who was diagnosed with end-stage renal disease last fall at the age of 19.  After they remove the kidney from Buell on Dec. 29, the surgeons will wrap it up, put it on ice and rush it over to another surgery room, where they will sew it inside Kelvin's body.

Buell had heard about Kelvin's situation by happenstance eight months ago while browsing her Facebook feed on an otherwise ordinary day.

As a teacher for more than 20 years, Buell was Facebook friends with a lot of her former students — some 500 to 600 of them — and enjoyed keeping up with them through social media. Sandwiched between the messages about new jobs, fabulous vacations, grinning babies and other life news was a more sobering update from one of Kelvin's friends. The note explained that Kelvin had suddenly become sick and his family was looking for a kidney donor.

At a school with more than 1,350 students, it's hard to remember everyone who walks the halls, but Buell prided herself on trying to do so. Kelvin had graduated in 2013 and was a good student, well-liked by students and faculty alike, and played wide receiver on the football team for all four years. He had excellent manners, she recalled, and was the type of kid who  always made it a point to stop and say a "Good morning/good afternoon, Ms. Buell."

She thought about her own health. While she didn't consider herself particularly fit, she did try to adhere to a California lifestyle by eating well and attending yoga classes. She did not have any diseases, at least none she knew about. Almost instinctively, Buell clicked on the button to sign up to see if she was a match. And after several months of testing, it turned out she was.

Both Buell, who is Catholic, and Kelvin, who was raised Baptist, talk a lot about faith when explaining how they are feeling about the upcoming transplant.

"Everything happens for a reason," Kelvin said. "I was shocked and happy when I heard it was my teacher who was the match."

As for Buell, she said she is "going into this with 100 percent faith that this is the right thing to do."

"It is a gift given freely," she said.


Kelvin Sanders, 20 years old, was scheduled to undergo kidney transplantation surgery on Dec. 18, but had to be rescheduled due to a death at the hospital where he was to undergo the procedure. (Liz Hafalia/San Francisco Chronicle)

There are 122,000 people on the kidney transplant wait list in the United States. Most will never get one; an average of 22 people die each day of kidney failure as the need for organs far outstrips their availability. About 11,500 will get transplants from deceased donors, and another 5,500 will get organs from so-called living donors like Buell.

While most donors are members of a patient's family, a growing number are acquaintances, co-workers, neighbors. In a widely shared story in 2001, Washington Post reporter Martha Hamilton gave her kidney to columnist Warren Brown, who sat near her at work for 20 years. Earlier this year, a personal trainer in Virginia gave her kidney to a  client.

When it comes to our internal organs, nature didn't build a lot of redundancy into our bodies. We only have one heart, liver and set of lungs. Kidneys are the exception. Humans are born with two even though most of us can live just fine with one — a realization that led to the first living donation of a kidney in 1954 when Ronald Herrick gave one to his identical twin Richard in 1954.

Living donor kidney transplants have always posed an ethical dilemma for doctors because they involve exposing otherwise healthy people to a surgical procedure that is based on pure altruism and not supposed to benefit the donors in any way. The issue became even more complex around 2000 when new, more powerful anti-rejection drugs were developed that made it safer for people without close biological ties to be a match.

While the surgery is generally very safe for the person giving the kidney, it isn't without risks. Donors have gotten infections, bled out on the operating table or later developed kidney disease of their own. A small percentage — 0.01 percent — die, and it isn't just a theoretical risk. Just two weeks ago, the University of California-San Francisco, one of the nation's leading hospitals, acknowledged that one of its donors had died after surgery and that it would suspend its living donor program as it investigates what happened.

Buell's and Kelvin's operations were originally scheduled to take place at UCSF on Dec. 18, the day after the suspension was announced, and the news sent everyone into a panic about whether the whole thing would — or should — be called off.

"I broke down," Kelvin's mother Nicole said when she heard the news. "I was worried about Christine and maybe she shouldn't go through with it. But she assured me as tears were running down my face that she understood there was a chance of something happening to her but that she was confident she would be in the percent that is fine. That lady is amazing."

And so their doctors worked out a compromise. Buell would have her operation at the California Pacific Medical Center across town and a team would transport the organ to UCSF where Kelvin would be prepped to received the organ as soon as it arrived.


Christine Buell and her family. (Courtesy Christine Buell)

****

Kelvin Sanders III had always been a happy, easy-going and responsible kid — the kind who picked up his little brothers and sister from school so his mom could go to night school to get her college degree, who voluntarily did the grocery shopping, and who made sure his dad and his girlfriend continued to be part of the family even after the divorce.

His mother, who is now 40 and works in finance at the airport, was just 19 when she had him and struggled a lot in those early years, and was determined that Kelvin have a better life. That meant having a strong education. After looking at a number of private schools for ninth grade, they finally decided on Sacred Heart Cathedral, where his mom was impressed with the academics and Kelvin was excited about the sports. Buell was the principal in charge of extracurricular activities at the time, and in addition to running into her at school, Kelvin would often see her and her family cheering for the team during games.

Kelvin graduated in 2013 and enrolled at San Francisco City College, where he was thrilled he could continue to play football. But that summer, Kelvin began having terrible headaches and his vision became blurred. His weight dropped from 180 to 165 pounds. His first thought was that maybe it was due to a head injury. But a doctor who checked him said that wasn't an issue and sent him home. The problems continued to get worse, however, and his next stop was an eye specialist. The eye doctor was startled to find blood in the back of his eyes, and when he took Kelvin's blood pressure and saw that the systolic number (the top number) was higher than 200, he sent Kelvin to the emergency room.

While his football team played a game that Halloween afternoon in 2014, doctors told Kelvin the devastating news that his kidneys were failing and that he would need a transplant. Football was out of the question — not just for the time being but for the rest of his life, because, they explained, one misplaced impact could damage his kidneys even further.

"I had plans on playing throughout college, and being told I won’t be able to play anymore was pretty heartbreaking for me," Kelvin recalled. "We are a big football family."

Moreover, he would have to start dialysis — which would keep him hooked up to a machine 10 hours each night — immediately. That meant no late-night dinners, outings with friends, travel or a lot of other things young people tend to do at this age.

There was little hope that his life would change soon if he went through the traditional transplant route. The doctors told Kelvin that the waiting time in the San Francisco Bay area could be  eight years or longer.

Nine out of 10 people on dialysis die within 10 years.

When they heard about the idea of a living donor, Kelvin's mother, father — a sergeant with the city police — and a number of his father's co-workers immediately signed up to see whether they were a match.

Some made it to almost the final stages of testing, but in the end all of them were ruled out.

Desperate, the family turned to Facebook to get the word out.


Kelvin Sanders, 20 years old, with his mom Nicole at home in Daly City, California, on Friday, December 18, 2015. (Liz Hafalia/San Francisco Chronicle)

***

Qualifying to become a living donor is not a simple process. It begins with a simple questionnaire designed to screen out people with certain conditions that could make it dangerous for them to donate a kidney such as diabetes, high blood pressure or obesity. If you pass that first stage, you typically get a comprehensive blood test to check your health as well as to run something called a "cross-match" to see if you are compatible with the recipient. If you are, the real evaluation begins and involves interviews and more testing with a battery of specialists including social workers, transplant surgeons and nephrologists.

"We do everything we can to assure the donor’s risk is not zero but as close to zero as we believe it can be," explained Matthew Cooper, director of the kidney transplant program for Medstar Georgetown. You'd also likely get an MRI, chest X-rays and EKGs of your heart  as part of a process that could take as long as three months.

The actual surgery takes two to four hours, and these days, it's minimally invasive — meaning it involves only a small incision through which the organ is removed, but it's done under general anesthesia, which carries its own risks.

Nationwide, only one in five people who start the living donor evaluation process end up qualifying to be a donor.

In the months when Buell was going through the testing, she said she learned a lot about herself both mentally and physically. "Apparently I’m healthy as a horse, which is good to know," she quipped. At every step, she said, UCSF told her she could change her mind and stop the process, but she said she never wavered in her decision.

In fact, she said, "I feel blessed to be able to physically and emotionally do this."

Throughout the process, she said, her daughters, who are 10 and 12, and her husband, Jose Vargas, an English teacher at a different private school, have strongly supported her.

Her husband is "not enthusiastic about his wife being cut open," Buell said, "but he totally supports me and understands this morally and intellectually."

When she revealed her plans to her employers and friends, the reaction was mixed. Most people applauded her decision, but some admitted they were concerned. While no one explicitly used the word "crazy"  to describe what she was doing, she knew that's what they meant. They pointed out that she has a husband, two young daughters and an important career where she makes a difference in the lives of many hundreds of students each year.

Buell has responded that the surgery won't affect her responsibilities in other parts of her life. In fact, she purposely asked that the surgery be scheduled during the holidays so she could take off as little time as possible from work.

Her plan is to go in for the surgery Dec. 29 while her husband remains in the waiting room reading one of his thick books and her children hang out at her mother's house. She's counting on being discharged in time to celebrate New Year's with her family at home and returning to her job as a principal soon afterwards.

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