The perfect match: Nothing says love like a kidney

The perfect match: Nothing says love like a kidney
Wife of 42 years donates organ to ailing husband.
By Mary Ann Roser

AMERICAN-STATESMAN STAFF

Published: 10:40 p.m. Monday, July 5, 2010

Austin political power couple Gay and Alan Erwin lay side by side on gurneys in San Antonio's University Hospital surrounded by their three grown sons, along with Alan's brother and sister. The couple stretched out their arms from under the sheets to hold hands and wait to be operated on.

If the Erwins were nervous, they didn't show it. They laughed heartily when someone pointed out that Alan's shower cap-like hat had become askew and was now tilted jauntily, beret-style. Then Gay was wheeled into surgery first, and the tears that followed attested to the bond between the couple, who met in a chemistry class at the University of Texas and have been married for more than 42 years.

"They couldn't lean over and kiss each other (goodbye), but they both looked into each other's eyes and told each other, 'I love you,' " son Josh, 36, recalled.

On April 29, Dr. Glenn Halff, director of the Transplant Center at the University of Texas Health Science Center at San Antonio and University Hospital, made a 3-inch incision below Gay's navel and two half-inch cuts on her lower left abdomen, one for a tiny camera, the other for surgical instruments. Halff then removed Gay's left kidney from the largest incision, rinsed the organ and put it in a tray as the surgical director of the kidney transplant program, Dr. Gregory Abrahamian, waited across the hall to put it into Alan's right side.

Within a few hours, Alan, who had been on dialysis to keep him alive with two nonworking kidneys, joined a group of Americans whose lives are forever changed by a spouse's rare gift.

Last year, 799 U.S. husbands and wives donated kidneys to their spouses, according to United Network for Organ Sharing, which coordinates transplants nationally. Kidneys from spouses were the fourth-biggest donor category — after siblings, children and parents — among living donors and represented 4.7 percent of all kidney donations in 2009. At University Hospital, Halff says more spouses are donating kidneys, and he expects that to continue growing.

"I knew all along I was going to do this," Gay said, tearing up during a recent interview at the couple's home in Rollingwood. She knew she and Alan shared the same blood type, A-positive, key to donating an organ. But she didn't know their compatibility on tissue type and other blood factors.

She also didn't immediately tell Alan she wanted to give him one of her kidneys because she knew what he would say.

"No, you're not," he replied.

"Yes, I am," insisted Gay, who is known as tough and determined.

Kidney failure

Alan Erwin, 65, said he had not felt good in decades and blamed it on Agent Orange exposure in Vietnam. He was in the U.S. Navy and was an adviser to the Vietnamese navy. He made frequent trips on swift boats that were inadvertently caught in the spray of the dioxin-containing herbicide from U.S. planes targeting the enemy's jungle hideouts. Alan said he believes he developed skin cancer and neuropathy — the loss of feeling — in his feet from the exposure and, ultimately, kidney failure.

His doctor, Timothy Hines, did not return phone calls seeking comment.

The government was slow to recognize damage to Vietnam veterans from Agent Orange and today lists a host of ailments related to it — neuropathy is on the list, but kidney failure isn't.

Alan's kidneys failed — the first one several decades ago, he thinks; the other, more recently — and he felt bad most of the time. But he was afraid of something happening to his energetic wife if she gave him a kidney. Although studies say most donors do well and live normal life spans, complications, from bleeding to infection, can occur. In rare cases, donors have died. Alan told Gay he would wait for a deceased person's kidney, even though the Transplant Center said that might mean five or six years — an unreasonable wait for someone in his 60s, Halff said.

Alan had begun dialysis in November after his second kidney failed. Three days a week he rose at 3 a.m. for a 5 a.m. treatment that lasted about five hours. Then he would head to work at his public relations and lobbying firm, Erwin & Associates, and come home wrung out. He wondered how he would manage with his clients when the Legislature came back in session in 2011.

Gay, vice president of the government relations consulting firm Strategic Partnerships Inc. in Austin, was worried, too, because she knew how demanding his job was.

She had worked as chief administrator of the Texas attorney general's office and had overseen the operations and management of then-U.S. Sen. Lloyd Bentsen's Texas office.

Alan, a former Texas Public Utility Commission member who had also worked on statewide political campaigns, wasn't planning to slow down. Alan's friend Nick Voinis, who worked with him on Lt. Gov. David Dewhurst's 2002 campaign, noticed over their lunches with Alan that his skin was grayish. He could see the fatigue in Alan's eyes and the toll kidney disease was taking.

"He never really complained about it, but I could see how hard it was on him," said Voinis, senior associate athletics director at UT.

Gay was anxious to help her husband feel better.

"Gay is remarkable. She didn't even blink when this came up," said Mary Scott Nabers, a longtime friend and president and CEO of the company where Gay now works.

But Nabers and some of Gay's colleagues tried to brace her for the possibility that she and Alan would not be a match.

"She just brushed us off," Nabers said. "Al is the love of her life."

At the end of January, the couple went to the Transplant Center to start a battery of tests for compatibility.

"Eighteen vials of blood apiece," Alan recalls. Within 24 hours, they got the word: They were a match. Not only did they match well enough to be considered for the transplant, but they also matched better than most donors who are not blood relatives. Doctors tested their tissue compatibility on six antigens, or substances that could cause the recipient to be more likely to reject the kidney; they matched on four, said Carmen Nolan, a Transplant Center nurse who was Gay's advocate during the donation process.

The doctors will do the surgery on people who don't match on any of the six factors, but generally speaking, the more factors the donor and recipient match on, the better the organ is accepted, Nolan said.

Other factors were in the Erwins' favor, Nolan said. Gay was in excellent shape. "She eats right, and she exercises ... and it shows," Nolan said. "All of her testing came back beautiful. I really admire her."

Even so, she advised Gay that she could back out at any time, even the day of surgery.

Gay was steadfast.

Feeling better

On the day of surgeries, the Erwins' sons leaned on the couple's rector at Good Shepherd Episcopal Church, who appeared in the waiting room at 5 a.m. with breakfast for the family. "These were people dealing with real life with a great amount of grace they had learned from Gay and Al," the Rev. Morgan Allen said.

The surgeries went smoothly, Halff said.

The first thing each one did upon awakening was ask about the other, said Josh Erwin, their middle son and the first assistant district attorney in Caldwell County. Told that Alan looked great and his new organ was functioning perfectly, Gay "got a big smile on her face and said, 'That's my kidney,' " Josh Erwin said. "She's real proud of it."

Alan almost instantly felt better. He had color in his cheeks for the first time in a long time. Gay was wheeled in to see her husband in the intensive care unit, attached to a morphine pump. She cried, and so did everyone else in the room, Josh said.

Gay got out of the hospital on the third day but was surprised by the amount of pain she felt, much of it from carbon dioxide gas used to expand her abdomen. It caused "referred pain" to her shoulder and other body parts. Alan was out on the fifth day, but he had to be readmitted three days later with fluid in his lungs, Gay said. It was a medication problem, and Alan spent five more days in the hospital while adjustments were made.

Gay and Alan were out of work nearly a month, and Gay said it took a long time to regain her energy — but she would do it again in a heartbeat. She has become a fierce advocate of organ donation and hopes their story inspires others.

"What Gay did for Al just proves what I've always known, that her kindness and generosity know no bounds," Dewhurst, their friend, said in an e-mail. "That's why I was not at all surprised that when she and Al faced this situation, she was the one to give her husband the gift of life."

"They are the perfect match," Voinis said, "in more ways than one."

maroser@statesman.com; 445-3619

To register to donate organs upon your death, go to www.donatelifetexas.org. Tell family members your intentions. Even if you have signed a donor card, they will make the final decision.

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