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About the time Williams moved back to New Hampshire, her health, which had been declining slowly and steadily over the years, took a bad turn. She began to feel numbness in her hands and feet, nausea and headaches. Trying to live a normal lifestyle, she had to force herself to eat. But every day was harder than the last.

For most victims of chronic kidney failure, the disease cannot be cured, and inexorably, the kidneys begin to fail. By the time Stage 5 (kidney failure) is reached, there are two ways to stay alive: dialysis, or a kidney transplant. In the United States, about 20 million adults—one in nine—have some degree of chronic kidney disease, according to the National Kidney Foundation, and more than 56,000 people are waiting for a kidney transplant. Williams started peritoneal dialysis, a process that flushes impurities out of the blood. "I never wanted to be a patient; I didn't want that to define me; I wanted to have as normal a life as possible," she says, so she chose continuous ambulatory peritoneal dialysis, which can be performed by the patient without a machine.

As the first step, her doctor surgically inserted a plastic catheter into her abdomen. Then, four or five times a day, Williams would attach a two-quart bag of saline solution called dialysate to the catheter and drain the fluid into her abdominal cavity. After several hours, the solution, which had absorbed impurities that her kidneys could not, would be drained out again and thrown away.

"Although it wasn't really painful, it was inconvenient because I had to travel all through New England and New York for my job," says Williams. "I had to cart around a 30-pound box of stuff wherever I traveled, but I learned to do the dialysis myself in the car."

Two years into her dialysis, Williams came down with a potentially deadly infection called peritonitis. To recover, she switched to hemodialysis, a process that uses a machine the size of a medicine cabinet to cleanse the blood. Williams' doctor inserted a catheter into a vein below her collarbone that led directly to her heart. Three or four times each week, Williams would return to the hospital and lie on a gurney for four to five hours while her blood circulated through the hemodialyzer. The procedure was excruciating. Her kidneys continued to deteriorate, their function dropping to about 3 percent of normal. The disease began to affect every part of her body. "I was exhausted and in pain a lot," she recalls. "My fingers and feet often felt numb and tingly. I had restless leg syndrome, and I never slept well."

Although kidney dialysis has been in existence for more than 50 years—a young Dutch physician named Willem Kolff invented the first dialyzer in 1943—researchers do not know how long people can live while undergoing dialysis. Some patients tolerate the procedure well and live for decades. Others develop complications, including fever, vomiting, cramps, infections and seizures. More than 3,000 people on the waiting list die each year before receiving a transplant.

Williams' family, well aware of the risks of chronic kidney failure from her brother and sister's struggles with the disease, knew her best chance of survival was to receive a new kidney from a living donor. All her family members with healthy kidneys were tested as potential matches. Although some came close, no one was close enough.

The first successful living-donor kidney transplant was performed in 1954 between 23-year-old identical twins. Since then, thousands of kidney transplants between living donors and patients have been performed, making it the most common type of living-donor organ transplant. In 2002, there were 14,770 kidney transplants performed, 6,613 of them from living donors. Of those donors, about 29 percent were unrelated either by marriage or blood to the recipient.

To qualify as a donor, an individual must be healthy, physically fit and free from serious disease. Those who pass that first hurdle are tested for blood-type compatibility. Additional testing includes tissue typing for white blood cells, crossmatching for organ rejection, an antibody screen and an arteriogram, where a dye injected into the kidneys is viewed with X-rays. Perhaps most important, donors and recipients are both encouraged to undergo a psychiatric or psychological evaluation. For the donor, the procedure involves some risk, including damage to the remaining kidney as well as the kind of risks associated with any surgery—blood clotting, collapsed lung, allergy to anesthesia and death (three out of every 10,000 kidney transplants). The donor does not normally suffer diminished kidney function since the remaining kidney grows to take on the job of two.

When Ramsdell heard that Williams' family members had all been rejected as possible donors, she made a decision. She could see that Williams' condition was deteriorating, even though Williams never complained. "I had to force information out of her," says Ramsdell. Calling her friend on the phone, she told her, "'"I'm going to be tested, and I just know I'm going to be a match.'"

When the results of her tests arrived, Ramsdell was given the option of changing her mind. Someone from the hopsital would make the call, and Williams would never know that she could have been the donor. Ramsdell didn't hesitate. "I called her and said, 'Guess what? I'm going to give you a kidney!'"

Williams' reaction was one of guarded optimism. "I think, in a way, she felt bad—how could she possibly accept this from me?" Ramsdell recalls. "She gave me every opportunity not to do it."

"I did feel guilty, and worried," says Williams. "My thoughts were about her. I was hoping that there wouldn't be any complications; it's hard to know someone is going to go through that for you."

But for Ramsdell, there was never any doubt. "I was never scared. Because I had had surgery in the past, in a way I knew what to expect," says Ramsdell. "And the risks of serious complications are low. I thought, 'Oh my God, this could be the one big thing I do in my life to help someone; this could be the whole reason I'm here."

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