Since 1987, HUP surgeons have performed more than 150 spousal kidney transplants. Ali Naji, who heads the hospital's kidney transplant program and has performed many of them, says that "the love and affection between the spouses adds tremendous positive gratification." Spousal kidney transplants have been done at the rate of roughly 700 a year since the national Organ Procurement and Transplantation Network began keeping statistics in 2002.
"A lot of spouses see it as not just doing something for the other person, but as doing something for the relationship," says Carolyn Cristofalo, who works with donors at HUP. "And of course it might eventually lighten the burden on the caregiver. People want to move on with their lives together."
While blood relatives may often be the most compatible match, says Naji - who did not operate on the Gutners - advances in immunosuppression drugs have dramatically increased success rates for transplants between unrelated persons.
A 1995 study at the UCLA School of Medicine found three-year organ survival rates of 85 percent for spousal kidney transplants, slightly better than transplants between other unrelated persons, and even parent-to-child transplants. The organ survival rate for organ-bank kidneys was lower: 70 percent.
In any possible match in which the individuals' blood types are compatible, physicians test compatibility of the possible match based on six of the cell proteins called transplantation antigens.
Except in the case of identical twins, perfect matches are rare, perhaps one in 100,000. But since the wait for organ-bank kidneys is close to five years, physicians usually settle for a less-than-perfect antigen match. And here is where intangibles come into play.
"It's harder to say no to a spouse who's trying to donate," says Donna Collins, coordinator of the HUP transplant program. "We're a little more liberal accepting a spouse as the donor. If they get turned down, it can be devastating to them. The spouses just work harder to be the donor."
And no one may have worked harder than the Tomeos of Holland, Bucks County. Sabatino "Sam" Tomeo, a club manager, and his wife, Lisa, have each lost 75 pounds through bariatric surgery after doctors said their weight made them ineligible for the transplant program, Lisa, 56, as donor and Sam, 58, as recipient.
Sam, who recently started home dialysis, had a portion of his stomach removed. Lisa had the size of her stomach reduced by a gastric band. They expect to have the kidney operation in November.
When Lisa first asked about donating, says Sam, whose kidneys were failing due to worsening diabetes, "I was against it. It was my wife, and I didn't want her to sacrifice."
But he was even more opposed to asking a blood relative.
"He doesn't ask for much," said Lisa, smiling across the kitchen table. "And he can't talk me out of anything. It's easier for a husband and wife to do it. The day I found out I was a match was the happiest day of my life."
"I think it will strengthen our marriage, if that's possible," she added. "We were already attached at the hip. Now he'll have my kidney."
Sometimes there is almost a spiritual dimension to the donation.
Three years ago, as Beth Llull, 48, of Havertown found herself weakening from polycystic kidney disease, she was placed on the transplant list. Since the disease was inherited, no blood relative could donate, so her husband, Gabe, 50, immediately volunteered. "When you love somebody and you can do something for them, you just do it," said Gabe, who works for a wholesaler of plumbing and heating equipment.
During a screening test, however, he was found to have an irregular heartbeat, and the doctors did not think it was safe for him to donate. A relative of his had other health issues that made him ineligible. And by last winter, Beth, who works as a financial analyst for GlaxoSmithKline, prepared to do self-dialysis, the procedure followed by Sam Tomeo.
Then, for reasons no one can explain, Gabe's irregular heartbeat disappeared. "I had been praying for a miracle," Beth said. "I thought, 'This is my miracle.' " Last June, Gabe donated his kidney to Beth.