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For years, Williams had ridden an emotional rollercoaster of rising hopes that a match would be found, followed by sinking disappointment. The months leading up to the surgery would prove to be no different. Williams came down with an infection, so the surgery had to be postponed. Then a test revealed that Ramsdell had been exposed to hepatitis B, a potentially fatal liver disease. But a further test showed that while Ramsdell had been exposed, she did not have hepatitis and nor was she a carrier.

Finally, after a four-year wait, surgery was scheduled for Feb. 4, 2003, at Tufts-New England Medical Center in Boston, a hospital that offered laparoscopic surgery for Ramsdell, which is less invasive. Overseeing the two operations would be Dr. Richard Rohrer, chief of the transplant surgery division. Williams and Ramsdell spent the night before surgery with their husbands and mothers in a hotel across the street from the hospital. Williams' mother gave them each care packages with fresh toiletries, nightgowns and matching slippers.

In living-donor kidney transplant surgery, the two operations take place in adjoining operating rooms. Since a kidney from a living donor increases the five-year success rate to 90 percent, compared to 78 percent from deceased donors, the operations are timed to coincide to maximize the advantage. After Ramsdell's kidney was removed, it would be iced and flushed with a cold preservative, then whisked next door, where it would be implanted below one of Williams' nonfunctioning kidneys and attached to her bladder.

For Ramsdell, the biggest risk was the surgery itself. For Williams, an additional risk was infection due to the immunosuppressant medications she would need to take. The medications could also have side effects, such as high blood pressure and osteoporosis.

But taking immunosuppressant medicine would be important, to help prevent her body from rejecting the new kidney. Research conducted by Robert Woodward, Forrest D. McKerley Professor of Health Economics at UNH, underscores this point. Woodward has found that before 1990, lower-income patients had a 4 to 5 percent higher risk of kidney transplant failure because Medicare, which pays for about 70 percent of kidney transplants, was covering the cost of immunosuppressants only for the first year. But when from July 1993 to July 1995 Medicare gradually extended coverage of these medications to three years, Woodward's data showed the survival rates became equal.

For Williams, there was also the possibility that the donated kidney would fail. After implanting Ramsdell's donated kidney, Williams' medical team would watch to see if it began to function, which they would take as a good sign.

The morning of the surgery, just before they wheeled Ramsdell into her operating room, the women exchanged hugs and I-love-yous.

"Later, the nurses and doctors told me how Brenda had learned each of their names and was talking to them right up until the anesthesia took hold," says Williams. "That's so her—she always makes a point of meeting everybody and remembering everybody's name."

Surgery for both women initially went smoothly. Less than a minute after Ramsdell's kidney had been transplanted into Williams, it began working—the best possible outcome. But when the surgeon began to close Williams' incision, a complication arose. Because Ramsdell's kidney was bigger than Williams', one of her arteries pinched off and the kidney stopped working. The doctors immediately opened her incision, fixed the problem and reclosed the incision.

It would be another day and a half before the two women saw each other. Ramsdell was still nauseated from the anesthesia and was having a lot of abdominal pain. "I hobbled down to Casey's room," recalls Ramsdell, "and there she was eating a big meal. She said to me, 'Wow, I feel great!' and at that moment, I knew it was all worth it."

They spent much of the next few days together in the hospital, "shuffling like old women around the hallways and talking," says Ramsdell. Williams, although in some pain herself, was feeling better than she had in years. The tingling and numbness in her hands and feet were gone, as was the restless leg problem. By the end of the week, they were both home recuperating, a process that would take a couple of weeks before the pain went away, and two to three months before they were both back to work.

Now, a year later, both women are doing well. Williams continues to take her anti-rejection medicine, but side effects have been minimal and tests on her new kidney show that it is working better than average, exceeding everyone's hopes. If all continues to go well, her new kidney should last 10 to 20 years; if she's lucky, she'll never need another transplant. Her blood pressure has been normal, the gout is gone and she may be able to cut back on the immunosuppressant medicine soon.

"I have a lot more energy, I'm thinking clearer and I'm sleeping better, too. People tell me that my color is better," says Williams. "What Brenda did for me was incredible, but that's the person she is. She is so caring. Our friendship has always been strong, but now we have this physical link." Ramsdell likes to ask Williams if she's started craving her favorite foods. Not yet, Williams replies, laughing.

Bonded: Brenda Reagan Ramsdell '81, left, and Casey Caswell Williams '81 outside their UNH dorms. Photo by Perry Smith

Ramsdell knows that had the roles been reversed, Williams would have done the same for her. "I feel so lucky to have Casey in my life," she says. "She has a gentle spirit and we laugh so hard when we're together. Both of us are amazed that things worked out the way they did, after all those years of being friends."

Ramsdell has become an advocate for organ donation and hopes that her story will inspire others to get tested. On her car is a bumper sticker that reads, "Don't Take Your Organs To Heaven; Heaven Knows We Need Them Here."