Juan Ramirez tried to give his sister a kidney. His sister tried to say "no."
"It's nothing," he'd tell Daisy. "God gave me two kidneys so I could give you one."
Of course, it was not nothing. But she couldn't work anymore. She couldn't play. For nine hours at a time, she had to tether herself to a home dialysis machine in Brooklyn that would cleanse her blood.
Finally, she relented, only to find she was incompatible with her brother's blood type and tissues. She'd have to wait for a match, doctors told her, a wait that in New York could take eight or nine years.
Meanwhile, a similar story with different characters was playing out 850 miles to the south. Betsy Allen, 48, an ex-police officer from Newnan, Ga., was starting to reject the kidney her sister had donated in 1990. When no other family member proved a suitable donor, her old high school friend, Marie Johnson, stepped up.
"How can I watch my best friend die?" is how Johnson, a 48-year-old USDA worker, puts it.
Turns out that Johnson's kidney wasn't suitable for Allen.
But it was a perfect match for Daisy Ramirez.
A gift exchange
They found each other through the paired donation network, a sort of swap meet for healthy organs.
Doctors at Piedmont Hospital in Atlanta and at Einstein Medical Center in Philadelphia - where the Ramirez family had turned - told the couples that no one in Georgia or Pennsylvania had performed double kidney transplants before. But that swap offered the best hope - if their loved ones were willing.
And they were. So Juan Ramirez flew to Atlanta, where on Friday doctors transplanted his kidney into Betsy Allen. Marie Johnson flew to Philadelphia, where her kidney went to Daisy Ramirez.
On Tuesday, via a Web camera set up in a conference room at Einstein, they gathered for the first time as an intimately connected foursome. Daisy Ramirez, 46, held Marie Johnson's hand.
Dr. Radi Zaki, Einstein's transplant chairman, looked on. He was involved in both surgeries here, and walked the small basin that held the fist-sized, healthy kidney from one operating room to the other. Together, the procedures took almost 41/2 hours to complete.
"How do you feel, Betsy?" Johnson asked. "You look good."
"That's because she's had a makeup artist work on her," Juan Ramirez, 43, kidded.
Friends for life
The two Georgia women met as high schoolers in Turkey, where their fathers served in the military during the 1970s. Twenty years later, they ran into each other again at their sons' wrestling match outside Atlanta. They've been buds ever since and run an antique business together.
Marie Johnson started to tear up. She'd say after their 20-minute visit, "A lot of people have said to me what you're doing is heroic and wonderful. No, it's not. It's what you should do."
Daisy Ramirez, meanwhile, talked giddily: "I want to exercise. I want to run. I am so ready for this new life."
She used to ski, play tennis and golf. As her kidneys got worse, she'd start to pack the car for a trip with her boyfriend, then have to send him off on his own.
Zaki said the program tries to make it difficult for donors. There are risks during the surgery and afterward, and the donor's chance of kidney failure increases, of course. "It's a lot to ask of people," he said. But the benefits . . .
A new kidney from a live donor typically extends the recipient's life by more than a dozen years. Daisy Ramirez, who worked as an accountant, now talks of getting her master's in sociology "so I can help people." The illness has nudged her daughter toward nursing.
And there's another benefit.
She squeezed Johnson's hand and said, "She's my new friend, forever."