Playwright Michael Hollinger on the comic aspects of a kidney tranplant

Michael Hollinger's latest play chronicles the tense family dynamics that arise when a man asks his estranged daughter for a kidney that she'd just as soon not part with.

Naturally, it's a comedy.

Under the Skin, which will begin previews Thursday and run through March 15 at the Arden Theatre, is the result of Hollinger's deep dive into the world of organ donation - a months-long process of interviewing local donors and recipients and examining the fraught interactions that arise when a person is asked to hand over a chunk of her own precious tissue.

It's a serious topic, but it started with a smirk - at a 2008 New York Times "Ethicist" column, about a pair of siblings vying to supply their aging father with a kidney.

"I found the notion of two children who both wanted to be the donor for their parent to be an inherently comic idea," Hollinger said. "It got me thinking about the varieties of relationships in my own family, in my wife's family, in the families of friends of ours, and about all the different ways that those issues become more dramatic and consequential when there's an actual life at stake."

The play - Hollinger's eighth world premiere with the Arden - is his first family drama. But, said director Terrence Nolen, it's more like a life-and-death battle from the moment the ailing Lou shows up on his daughter Raina's doorstep.

Space and time become malleable as their story unfolds through negotiations and memories that can't be confined to the past. Spare hospital furnishings - a tiled floor, a series of dividing curtains - subtly shift the scene from Raina's doorstep to Lou's hospital room, to a doctor's office, a bedroom and a cafe. And actors, including Raina's foil, a young man named Jarrell, assume multiple roles as they untangle a lifetime's dysfunction.

"I was exploring the question: What does it take to move us from, 'This is mine over here,' to a place of generosity?" Hollinger said.

Marie Manley, a transplant assistant at Lankenau Hospital who served as a consultant to the playwright, deals with these questions daily as she assists people donating to parents, spouses, siblings, cousins, friends and strangers. (In general, she noted, the situation with kidney donation is not life-and-death, but about preserving quality of life.)

Manley, of Drexel Hill, said many are eager to donate - but not all.

"We've had people that felt that they have to try, and we always tell them we'll give them a medical out" if they're reluctant, she said. "That way, it doesn't affect the relationship with the family."

Even altruistic donors - that is, people who donate to strangers - contend with family issues. Manley was one: She came across a plea for a kidney in her parish bulletin six years ago, and felt moved to answer it. But first, she had to explain the choice to her four children.

"The boys said, 'That's weird, Mom, even for you,' " Manley said. "But they were all on board by the time it happened."

Manley has also experienced the transformative impact that donation has on the relationship between donor and recipient.

"It's not family. It's not friend. It's a whole different situation. It's really special," she said. "I've never seen anyone who it didn't enrich that relationship."

During Hollinger's research, he discovered that several people he knew had been donors or recipients. They helped him understand what it's like to experience kidney failure and dialysis, and what concerns and hesitations run through the minds of prospective donors.

"The stories I was collecting as part of my research were mostly stories of unbounded generosity," he said. "That impulse is also present in the play in the character of Jarrell."

But he also spoke with a man who declined to give his father a kidney.

And he referred back to his own family, and his sister's succinct way of expressing affection: "She'll refer to someone in her life as 'kidney-worthy.' "

"I think we know what that means," Hollinger said. "How close are you? How worthy are you of giving this very intimate piece of yourself?"

On the first day of rehearsal, Nolen brought those questions to the cast, asking them: To whom would you give a kidney? Whom do you deem kidney-worthy?

"It's not until you're asked the question that you have to decide where you draw a line," Hollinger said.

A few years ago, when a relative was diagnosed with advanced kidney failure, he learned his own limits: He immediately volunteered to be tested to see whether he was a donor candidate. The man declined, and died a few months later of other causes.

But Hollinger's research had shaped his response.

"You can't hear all these stories of altruistic donations without thinking about the fact that most of us have more than we need to live," he said.

It took more investigation into the character of Raina - a deeply conflicted individual who's constantly doubling back on her own thoughts, qualifying and negating them - to discover where she draws the line.

As the deepest of family secrets are unearthed and the situation toggles between a scarcity of organs and an overabundance of them, dark humor prevails - although, Nolen cautions, the play is a comedy in the same way Breaking Bad is a comedy

"It's really funny," Nolen said, "but I also think audiences will be very moved by these characters and this story."

If it were a liver transplant, Hollinger said, it might have been a different story.

After all, he said, "Kidney is a funny word. It starts with a 'k' and all comic writers knows that words that start with 'k' are funny. So for me, kidney was kind of perfect."

Under the Skin

Through March 15 at Arden Theatre, 40 N. Second St.

Tickets: $15-$50.

Information: 215-922-1122 or www.ardentheatre.org

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