Cathy Garvey dropped a stack of red folders on the table as a huge image of two kidneys flashed on the conference room screen.

She flipped open the first file: A 27-year-old woman with no children who wants to give a kidney to her father -- for his third transplant. "She's a great candidate," said a doctor across the table.

A second pair of kidneys appeared on the screen. They belonged to a 55-year-old man who would rather donate to his sister than go to her funeral. "We can sacrifice this one," said another doctor, pointing to the left kidney.

The third candidate was a firm no. A farmer, a rare perfect match to a 15-year-old boy on dialysis, couldn't give up a kidney because his medical screening revealed high blood pressure. Garvey set his folder aside. "That's too bad," she told her colleagues. "That kid has been looking and looking and looking."

Every Monday at noon these doctors, nurses and social workers meet at University of Minnesota Medical Center-Fairview to decide who can save a life and who can't. They are reluctantly playing the role thrust upon them by their own success -- that of gatekeeper…

"Every center has their own little rule book," said Dr. Andrew Posselt, a transplant surgeon at the University of California, San Francisco medical center. "And there are always exceptions."

The Mayo Clinic in Rochester, for example, is more likely to approve a donor with high blood pressure.

In the early days of transplant medicine, things were simpler. Only genetically related relatives were accepted as donors. But family dynamics are complex; doctors and hospital social workers sometimes had to find ways to say "no'' on behalf of reluctant relatives who couldn't find the courage to say no themselves.

"There's much more coercion in families than outside of families," said Dr. Stephen Textor, a kidney specialist at the Mayo Clinic.

Star Tribune by Josephine Marcotty, 10/1/09

Tags: kidney, Transplant, Transplant