THE MATCH (UN)MAKERS: Why did Einstein halt life-saving transplant?

DOLLY CAREW is dying.

A stranger from Indiana wants to save her life. He was to do so today by giving her a kidney.

But after months of preparation and testing at Albert Einstein Medical Center, the hospital canceled the surgery last week, citing, among other reasons, the friendship that has developed among Carew, her 9-year-old daughter and the donor, Bob Randall.

"Yes, we bonded," Carew said. "Isn't that normal? He's giving me his kidney!"

Randall said that the hospital made it clear that it still wants him to donate his kidney - just not to the woman he wants to give it to.

"At this point, I've decided who is getting it and they just weren't happy with this decision," Randall said. "But they certainly wanted to be able to take it from me and put it where they wanted."

Carew, 46, of Mount Airy, and Randall, 44, of Etna Green, Ind., met online at Matching Donors.com, a Web site that pairs people in need of an organ transplant with living, altruistic donors.

It's like Match.com, but instead of offering love, it offers life.

Phil Gauthier, medical director of kidney transplants at Porter Adventist Hospital in Denver, said that MatchingDonors.com is "a great organization" that fills a very legitimate need.

"When we first worked with them, four or five years ago, it seemed so radical that people would meet over the Internet," he said. "Now, it's commonplace. It's like, 'Yeah, of course.' "

The Web site was founded in 2004 by Paul Dooley, of Canton, Mass., after his dying father was told that he was too sick to be on the deceased-donor list.

In its six years of operation, MatchingDonors.com has paired 121 donors with sick people in need, Dooley said. It is the largest living-donor database in the world.

There are 500 patients on the site and 8,000 prospective donors. Dooley said the average wait time for a connection is six months. The average wait time on the government's national deceased-donor list - the only other option for those who can't find family or friends to supply an organ - is between three and 10 years.

It costs $595 for potential recipients to register, but people wishing to donate their organs pay nothing to join, and no money is exchanged between patient and donor, he said. It's illegal to pay for organs.

For Randall, who runs a hardware store with his wife, Kelli, in his Indiana town of about 1,600, donating a kidney was the next step in his giving.

When he was 18, the fresh-faced airman in the Air Force was driving through Arizona and a cop pulled him over for speeding. Instead of writing a ticket, the officer gave him a choice:

"He said, 'You can go down and pay the fine or you can go donate blood,' " Randall said. "I had never done it before and thought 'Well, I'm going to donate blood.' "

Over the next 26 years, Randall estimates that he's donated more than 14 gallons of blood. He's also begun to donate platelets.

"I just wanted to take it to another level," he said.

Almost 700 miles to the east, Shirley Carew, Dolly's sister, and Dolly's 9-year-old daughter, Hannah, had been watching Dolly deteriorate after she contracted lupus seven years ago. They watched as her skin darkened, her hair fell out and she lost the ability to walk for months at a time.

Dolly, a graduate of Archbishop Carroll High School and Saint Joseph's University, found it harder and harder to run her beauty salon in West Philadelphia.

Then two years ago, Dolly's kidneys failed, and she has since had to endure dialysis - 4 1/2 hours, three times a week.

"There were times," Shirley Carew said. "I was scared. I need her to be alive. I want Hannah to see her mom live."

Shirley tried to donate her kidney but couldn't because of medical issues. So she told her sister she wanted to pay the registration fee to sign her up for the Web site.

Dolly wasn't interested. She was No. 278 on her waiting list for a deceased donor and didn't want to get her hopes up.

"I told Shirley, 'Please, don't waste your money,' " Dolly Carew said. "Shirley said, 'Please, just let me do this for you.' "

Once she signed up her sister, Shirley Carew sifted through more than 50 donors online before she found Randall.

Dolly and Randall began preparing in December for the transplant process, including undergoing intense physical and psychological screenings.

In February, Randall and his wife drove to Philadelphia for testing at Albert Einstein - and to meet Dolly, Shirley and Hannah Carew in person for the first time.

"My daughter loves lollipops," Dolly Carew said. "When she met Kelli and Bob, she gave them her lollipops and said, 'Thank you for saving my mother's life.' "

After that, the Randalls and the Carew sisters began to keep in close contact, exchanging e-mails and talking on the phone.

"We would laugh together, pray together and count down the days together," Dolly Carew said.

The day they were counting down to was today, April 30, the day when a part of Randall was to become a part of Carew.

Carew's relatives from Atlanta had purchased plane tickets to be by her side, and Hannah kept a journal counting down to today, when she would have her mother back.

But eight days before the surgery, Randall and Carew received calls from Einstein saying that it had been canceled.

"I was on dialysis when they called to tell me," Carew said. "I cried until I couldn't cry anymore. So did Hannah."

Carew was not given a reason for the cancellation.

Randall, who had been planning to drive the 11 hours to Philadelphia with his wife, was stunned. The only explanation he received on the phone was "ethical reasons."

Carew and Randall had told the hospital from the beginning that they'd met through MatchingDonors.com, and no one seemed to mind, they said. In fact, Einstein has conducted three prior transplants in which the donor and recipient had met through the Web site, Dooley, the site's founder, said.

Thinking back on it now, Randall believes that the trouble started during his first visit to the hospital, in February.

The first thing the surgeon said to him when he walked in the room, Randall recalled, was: " 'Are you ready for me to rock your world?' "

"I said, 'OK,' " Randall said. "I figured he meant the kidney surgery."

But instead of asking about Carew, the surgeon began talking about what are called "paired" and "domino" kidney donation.

Paired donations, explained Porter Adventist Hospital's Gauthier, work this way:

"Say I want to give my brother a kidney, but I'm not compatible. You want to give your husband a kidney, but you're not compatible," he said. "But I'm compatible with your husband, and you with my brother. You would donate to my brother and I would donate to your husband."

Gauthier said that domino pairing is similar but that it's not an even exchange.

"I would donate to your husband, you would donate to someone else and so on," he said. "It's like a chain, a more complicated paired exchange."

Robert Montgomery, director of comprehensive transplant at Johns Hopkins Hospital, in Baltimore, said that they have worked with several people who met on MatchingDonors.com and that in all but one or two donations, they have done paired or domino exchanges.

"The reason we do that is we want the altruistic donor's gift to be more fully realized by enabling multiple transplants instead of one," Montgomery said.

Randall said that after learning of those processes from the surgeon, he spoke with Dolly and they decided to stick with their original one-to-one plan. He said that, at the time, he didn't feel pressure from Einstein to do paired or domino donation, but now he feels that his decision to stick with Carew may be the reason the hospital rejected the operation.

Carew's Medicaid covers the cost of the operation for both of them, and financial issues were never offered as a reason for not doing the transplant.

"I got the feeling that they wanted a feather in their cap, doing a paired donation," Randall said. "You tend to get a whole bunch of press for it."

A spokeswoman from Einstein declined to comment to the Daily News on the case, citing "patient- privacy regulations."

On Wednesday, Radi Zaki, chairman of the division of transplant surgery at Einstein, faxed a letter to Randall explaining why the hospital had backed out.

The reasons listed include that the hospital couldn't ensure that the surgery wouldn't put Randall or Carew in "a compromising situation," although that situation is never described.

Montgomery, of Johns Hopkins, said that two of the concerns about MatchingDonors. com from those in the transplant field is that the site enables people to, in essence, "jump the line" for an organ transplant, even though there is no national, living-donor transplant waiting list.

He also said that the registration fee that's required from patients who sign up raises concerns about whether all individuals in need have equal access to the site.

Dooley said the registration fee is waived for patients who can't afford it. The fee has been waived for 30 percent of the patients listed on the site, he said.

The letter from Einstein also said that transplant-field literature now shows that "participants in paid-for Internet solicitation processes can be particularly vulnerable," although it doesn't say to what they may be vulnerable.

Gauthier, the Denver transplant director, said he's never seen any such literature.

"There's always a chance for a donor to be exploited, regardless of the way in which they meet their recipient," he said. "It can happen in a family and does not seem to be any more prevalent in sites like MatchingDonors.com."

Finally, the letter states that the hospital became concerned when Randall told them that he was developing a "very close relationship" to Carew and her young daughter.

"It seems like that should be the reason to do the surgery, not to not do it," Randall said. "For them to do this eight days away is very disturbing. If you had this feeling, you should have said so from day one. You should not have put her through this entire process."

The letter also notes that Randall was offered paired and domino donations, but declined.

Robert Hickey, 62, a clinical psychologist from Vail, Colo., was the first recipient of a kidney through MatchingDonors.com in 2004.

Hickey, who got his kidney from a donor on a one-to-one basis, was appalled when told of Carew's and Randall's ordeal.

"It's totally unethical for you to go through the process of finding a living donor and then having them try to hijack that donor without your knowledge," he said.

Dooley called the hospital's cancellation of the surgery just eight days out a "serious, serious act."

"It's not like he's donating blood or taking a splinter out of her toe," Dooley said. "He is saving her life, and to delay that could be a death sentence for her."

Hickey said he was going to help Carew and Randall file formal complaints about the incident with the federal Center for Medicare and Medicaid Services; the inspector general for the Department of Health and Human Services, and the state Board of Healing Arts.

In the meantime, Carew still has broken kidneys.

She has an appointment Monday at another city hospital, to see if the surgery can be done there.

"Kelli and I assured Dolly that this is just a temporary setback as far as we're concerned," Randall said. "She is getting one of these kidneys."