science of us

The Things You Learn About Your Friends When You Need a New Liver

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Last spring, I had dinner with an old friend. I’d known Kevin since elementary school, when I had the worst crush on him. (It’s not my fault: He was the first person I ever slow-danced with.) We’d stayed friends through college and beyond, catching up a few times a year. This time, though, was a little different than our usual dinner talk.

“I’d give you my liver if you need one,” he said.

“It’s fine,” I told him. “My brother is probably going to be the donor.”

At that point, my own liver was a hazard. I was first diagnosed with a rare liver cancer at 23, and it had recurred nearly two years later, in 2015. That had prompted a grueling regimen of chemo, surgery, and what I thought was remission. But seven months later, I found out that I was playing host to yet another tumor. The only option was a liver transplant.

A good liver is hard to find, especially in the U.S. It’s even harder if, like me, you have a cancer-addled but otherwise very healthy liver. The MELD score (which stands for Model for End-Stage Liver Disease) assigns you a number based on your liver function: Six, the lowest, is a Serena Williams–level liver, while 40 is the sort of beaten, battered liver you wouldn’t touch with a fork. Forty is also what you’d call the top of the transplant list; you’ll get a liver within days if you’re up there. So, presumably, someone with a failing liver is prioritized over one with a functioning liver.

It makes sense. The problem is that in spite of the cancer (and four years of college), my liver function was excellent, so good that my MELD score was a useless 7. I was looking at a year or more of waiting.

So my doctor suggested a living donor. Here’s a cool fact: You can actually split someone’s liver and plant half in another person, and within months, each piece will grow back to its original size and do its job for both of you. (Science!) It was my best bet for a transplant — and, hopefully, remission — within the foreseeable future.

I could see how losing half your liver sounds scary to healthy people who’ve never had to stare at the inside of an MRI machine for 40 minutes. Maybe more people would be into the idea if they understood that all it involves is a few scans, some needles, a laparoscopic procedure, and no drinking for a few months. Plus, donors are placed at the top of the transplant list should they ever need an organ themselves. And that’s great, because they’ll never have to know that only 1 out of every 10 friends will offer up a piece of themselves to save their life.

I didn’t take Kevin’s offer seriously at first. I’d already zeroed in my brother. My sister has her own health issues, and my parents were over the donor age limit. But when we found out my brother was risky for a surgery, I was fresh out of luck.

That’s when I learned that a good liver donor is also hard to find. Not many people know that living donation is even possible. (If living organ donation received the same amount of airtime that Proactiv gets, we might not have a liver shortage, but alas.) Every time I explained the concept to someone, I felt like I was casually insinuating that they consider it. Maybe I was. I was desperate enough.

I found that there are two types of friends: those who’ll share their organs carte blanche, and those who’ll find all sorts of excuses not to do so. “I wish I knew anyone that generous, but I don’t,” one friend told me. “I’m scared they’ll find something wrong with me when they do testing,” said another. Most people tried to avoid the topic like the plague. I could see the terror in their faces when I told them how easy it was to be a living donor. (To be fair, I’ve had enough chemo to take down an elephant, so everything seems easy to me now.)

The worst, though, were those who did offer, but never followed through. My boyfriend at the time was one, along with two of my closest friends. “Yes, obviously we’ll get tested,” they said. And then they dragged their feet and told me about how crazy work is, but they’re going to do it! They promise!

They didn’t, and I felt ghosted. But this isn’t like saying you’re going to show up to a birthday party when, really, you know full well that you plan to hang out in your sweatpants all night. I had cancer for a third time. If I waited, I risked metastasis. And dying.

When I found out my brother was a no-go, I called Kevin. He got tested within the week and was a match. My former boyfriend’s oldest brother, who seems gruff, but is clearly a softy, also got the green light within a matter of days after learning I needed a donor. And my oldest cousin, Nick — who comforted me after a high-school breakup, who’d crashed a wedding with me, who’d texted me nonstop during chemo — came up to me at a family wedding. “Hey, D,” he said. “I heard you need a liver. Let me know if you need me to get tested.” He got tested. He was a match.

Kevin, Paul, and Nick were my only potential donors. They’re the only ones who promised to get tested and actually did. I knew what made them different — one cousin, one childhood friend, one boyfriend’s brother — but I’ve always wondered what made them the same.

Apparently, their desire to help me may be universal on some level. Researchers continue to debate whether humans lean more toward naturally selfish or naturally cooperative — but they haven’t settled the issue, because amid all the selfish, crummy things we do, people keep showing flashes of true selflessness. “Real, sincere altruism — actions motivated by genuine concern for others — is inherent in people,” says Stephen G. Post, a professor of family, population, and preventive medicine and founder of the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University. “We see clear, empathic motives and actions when we study toddlers.” Obviously, that altruism can get muddled with age and time and circumstance. But it’s still there.

“At a secondary level and as a by-product, it is likely that the altruist will feel happier, more purposeful, resilient, and have more meaningful relationships,” Post adds, but this isn’t the main motivator for selflessness: “These inner benefits are not primary motives, but fairly reliable side effects.”

Nick ultimately became my donor. I don’t know if he reaped any of those warm, fuzzy feelings, but I hope he did. He was in the hospital for three days, and a year later, his newly regenerated liver is so healthy that the doctor couldn’t tell whether he was pre- or post-op. He’s feeling so good, in fact, that he called me over at another family wedding this past May.

“Yo, D!” he shouted. “Come over and do some shots with us!” I’m not allowed to do shots — because I’m taking good care of my new liver — but damn, it feels nice that he’s always so willing to share.

The Things You Learn About People When You Need a New Liver