I donated my kidney to help a stranger. But what about the person I couldn’t help?

Rith’s motorbike puttered like a tired lawnmower. Perched on the seat behind him, I could feel it protest as he steered us past rattling lorries and around rain-filled potholes that pockmarked the dirt road to Anlong Kong Thmei. The dust formed a grimy film on your skin that you could scratch off with a fingernail. The air smelled of soured garbage and wood smoke.

When we arrived in the village, about 14 kilometres southwest of Phnom Penh, it was little more than a pile of debris. Monsoon rains earlier in the week had crushed the impoverished community, making a poor place even poorer. More than 160 homes were damaged or destroyed. Rith and I worked at The Cambodia Daily, and had been assigned by our editor to write about the disaster.

What I remember about that day in 2003 is the family of six we spoke to. The father never stopped tearing away at his collapsed roof. He was collecting the nails so he could reuse them to rebuild. At 40 riel each – the equivalent of 1 US cent – he couldn’t afford to buy new ones.

The mother, meanwhile, watched over her four young children as they played among the broken wood and bamboo. Rith, who spoke Khmer, translated my questions, and as he listened to her story, he seemed to be in pain. His voice, usually a loud, rowdy squawk when he was telling bawdy jokes in the newsroom, was now a soft murmur.

The family relied on the father’s income as a construction worker in the capital. He took home around 2,000 riel a day – about 50 cents, or 50 nails’ worth. It was almost nothing, considering the family was $250 in debt: the couple had borrowed $100 to build their house at an exorbitant interest of $30 a month, and had no idea how they would repay what they owed.

Nor did they know how they would survive, especially now that their home was uninhabitable. They showed us the patch of bare dirt where they had been sleeping since the storms. Their only possessions I could see were a small tub of grey water, containing a few scraps of laundry, a broom and an empty ceramic bowl.

When we thanked them and moved on, Rith reached into his pocket and pulled out a handful of riel, his own money, and handed it to the mother. She put her palms together and bowed, repeatedly.

“Okun ch’rang,” she said. Thank you.

Rith returned her bows sheepishly. I watched in mute panic. My heart raced and my cheeks burned. I was horrified at the breach of journalistic conduct – it’s unethical to pay a source. What I had just witnessed was unquestionably wrong, and yet, on the silent, awkward ride back to the newsroom, shame crept over me, displacing my shock. Rith, who earned a fraction of what I made at the newspaper, had given what looked to be a week’s wages to a stranger. A stranger in as desperate need of help as anyone I’d ever met. I, on the other hand, gave nothing.

If you’ve ever hesitated before giving up your seat on a bus (remember when it was normal to travel by public transit?) or donated $20 to the food bank, when you knew you could afford to fork over $50, I get it. I do that, too.

I’ve been thinking a lot these days about giving, and the complexities it entails – the hesitation that arises the moment before we give, the relief we feel when we help someone in need and the regret when our efforts are not enough. I’ve been contemplating the ways we try to reconcile what we want to do and what we don’t with what we can and can’t do. And I’ve had something else on my mind, too. I’ve been wondering how my left kidney is doing.

Maybe it’s with its new owner, stuck at home communicating with loved ones over FaceTime. Maybe it’s braving the grocery store to pick up milk and tinned beans. Maybe it’s out taking the dog for a walk.

Wherever it is and whomever it’s in, I hope it – and they – are okay.

That fist-sized bean-shaped kidney that once resided in the small of my back was one of 302 live organs donated in Ontario in 2019. When people learn it’s no longer in my possession, the first thing they ask is whom I gave it to. The answer is I don’t know. The second thing they usually ask is what motivated me to give it away. I’ve been trying to figure that out ever since. And I’ve been trying to understand too why more Canadians don’t consider donating live organs. There’s no denying the need: Every year, more than 4,000 people sit on waiting lists for organs in Canada, and in 2018, the latest year for which figures are available, 223 people died while hoping to get one.

Over the past few months, I’ve been impressed by the kindness and generosity that people across the country have shown their colleagues, neighbours and strangers when faced with the new coronavirus. I’ve read about medical students volunteering to babysit for health care workers, about doctors and nurses isolating themselves from their families to treat infected patients, and about neighbours delivering groceries to elders.

I have also read about the anguish of health care professionals being forced to ration resources and wanting to give more care than they’re able.

What separates these individuals from the opportunists, who stockpile and resell medical facemasks and hand sanitizer? What happens when you reach the limits of what you can give? If you’re anything like me, you’re probably a bit of both altruist and egoist. I suspect we all have the capacity to be generous, but we don’t – and can’t – always act that way.

It’s not easy to identify why people to help one another, whether it’s giving time, money, attention – or, for that matter, a live organ. In many ways, it’s a conversation between the mind and the heart.

Piecing together the reasons I chose to give someone I’ve never met a kidney has led me to examine my many privileges and failures – all the times I could have been generous, but wasn’t, all the times I gave, but could have given more.

It has also forced me to reckon with a deep well of regret over the one life I wish I had saved but did not.

There was a bench on the far side of security in Pochentong Airport, Phnom Penh. Clutching our tickets home to Canada, I sat down and buried my face into my fiancé Neil’s shoulder and wept.

It was the summer of 2005. Two years had passed in Phnom Penh. Back then, in my early twenties, it felt like half a lifetime. At The Cambodia Daily, the independent English-language newspaper where I worked, my colleagues and I had covered stories of government corruption (of which there were many), political disputes, child rapes, foreign sex tourists, overcrowded prisons and unpunished crimes of the former Khmer Rouge. Our work could have been plotted onto a Venn diagram of stories about people trying to survive, people doing heroic things to better their country, and people plundering it for their own gain. The categories were not mutually exclusive.

The experience had been everything I had hoped for as a young reporter. Putting together a daily newspaper (its slogan: “All the news without fear or favour”) had given me a sense of pride and purpose: We were shining a light in dark corners, fighting the good fight and all the rest.

But I was tired, on the verge of burning out, and I needed to scrub away some of the cynicism that encrusted me like rust. I feared I was becoming inured to the suffering of others. By the end of my stay, I was buying bootleg DVDs from the market on my days off (because legal ones were nowhere to be found) and holing up in my fourth-floor apartment, watching banal Hollywood comedies to make myself feel clean. I wanted to go to a beach without being on guard for foreigners who appeared too friendly with local children. I wanted to go out for a pleasant evening with Neil without discussing the monstrous things a certain government minister allegedly did to girls in his spare time. I wanted to walk down the street without being pestered by people begging, and worse, shooing them away empty-handed. Recently engaged, I wanted to start our married life together in a place that felt secure, orderly and safe, where there was at least a semblance of justice and equality.

What made me sob, there at the airport, was that I could. I could leave. I was leaving. Like countless foreigners before and after me, I was leaving Cambodia in no better shape than when I arrived. I was leaving my colleagues, fellow reporters such as Rith, Van Roeun, Naren and Lor Chandara, behind. For them, there was no escape. And I was overwhelmed with the grief of knowing my life would go on, as would theirs. But while I would be forever changed as a result of my time with them, they would carry on as though I had never been there at all.

It was getting close to Christmas 2017. I sat at my desk at work, troubled by an article I was writing about Canadian organ donations. The statistics for 2016 had just been released. That year, 4,500 Canadians were waiting for an organ transplant, while 260 on a wait-list perished. The number of people who became donors after they died was on the rise, which seemed like a silver lining for those needing an organ. But the number of living organ donors had declined 3 per cent from the previous year to a paltry 544.

This last number stood out for me.

Getting more Canadians to sign their organ donor card, which offers the possibility of a transplant at the time of death, is a worthy endeavour. But it isn’t enough.

The number of people who are actually able to donate in these situations is surprisingly low. Only those with brain death or cardiac death are eligible to donate – in other words, individuals in critical care with massive brain injury or massive bleeding who have no potential for recovery, says Peter Nickerson, a medical adviser with the Canadian Blood Services’ organ donation and transplantation team. These cases account for only 1 to 2 per cent of all deaths that occur in hospitals. (Individuals infected with COVID-19 are not eligible to become donors.)

“A lot of people think there’s got to be so many donors,” Dr. Nickerson says, but that’s a misconception. “Those people who actually qualify to be an organ donor are relatively rare.”

So-called “presumed consent” systems, expected to take effect later this year in Nova Scotia and proposed in Alberta, assume patients agree to donate their organs after death, unless they opt out. These kinds of systems could theoretically boost the supply of organs. Spain, which has a presumed consent system, is considered a world leader in deceased organ donations, with a deceased donor rate of 48 donors per one million population (Canada’s is 20.6). It has also trained hospital staff to initiate difficult conversations with families and improved the infrastructure needed to make deceased organ transplants more efficient.

Adding resources and support to presumed consent systems could allow Canada to one day catch up with Spain. In the meantime – and it is a big meantime – living donors could help address our urgent demand for organs. Living donors allow patients with organ diseases to avoid having to go onto a wait-list altogether, never mind languishing there. This potentially spares lives and suffering, and it saves health care costs, too. For instance, hemodialysis, used for treating kidney failure, costs about $100,000 a year per patient, according to data from the Canadian Institute for Health Information (CIHI). By comparison, a kidney transplant has a one-time cost of about $100,000 (including costs for both the donor and recipient), and roughly $20,000 a year after that for follow-up treatment for the recipient, CIHI said.

Moreover, organs that come from living donors are preferable to those from deceased donors. They have a better chance of working after they’re transplanted, and they tend to last longer.

Regrettably, many Canadians still think of living donations only as a last resort. Susan McKenzie, a co-founder and chair of the Ontario-based Transplant Ambassador Program, says there’s a general belief among patients and some health workers that giving up an organ is too much to ask of others, and that they shouldn’t put someone through a donation surgery if they can avoid it.

Through her patient-led research program, for which I now volunteer, Ms. McKenzie often meets patients with kidney disease who feel reluctant to talk to family and friends about their need for an organ. As a kidney recipient herself, she says one of the biggest barriers they face is the fear of rejection.

Imagine, for instance, that you need a kidney and no one steps forward – that your sibling, parent, child or best friend responds by saying, “Oh my God, I could never be a donor.” That can be incredibly painful and completely change the dynamic of your relationship, she says: “That was very much my fear.”

At a time when hospitals are scrambling to catch up with surgeries delayed by the pandemic, the need to address the country’s organ shortage is now greater than ever.

Wait-lists are likely to get longer, says Mark Cattral, director of the living donor liver transplant program at Toronto’s University Health Network. “And with that, there’s also an increased risk of mortality on our waiting list.”

At home that night, after writing my article, the thought nagged at me: If others knew what it’s like to have to wait for an organ and if they knew what it’s like to be a living donor, then perhaps more people would volunteer to lift that number. What’s more, if I expected other people to give up an organ, it would be hypocritical of me not to do the same.

The day after my article was published, I received an e-mail that clinched my decision. The note came from a reader, who explained his wife had just received a new set of lungs. “Thank you for your article,” his message began. “Each article, video, tweet, post on this subject can save lives.”

The message was meant to be encouraging, but instead, reading the words “thank you” made me feel embarrassed. Was writing or tweeting the best I could do when the health and lives of others were at stake? If I were one of those 4,500 Canadians on a transplant list, would I feel thankful if someone merely tweeted about it?

I didn’t think so. I already had an inkling of what it might be like to be desperate for a new organ. Separated by an ocean and 12 time zones, Rith in Cambodia was slowly, painfully dying of kidney failure.

I hadn’t been back to Cambodia in close to a decade. In that time, I had gotten married, lived in the Czech Republic, moved back to Vancouver, moved on to Toronto, bought a house and had a child.

Every so often, Rith and I would connect on Facebook. He remained one of a few people from the old newspaper in Cambodia with whom I still corresponded. By then, he was putting his three children through school and in the midst of a divorce.

He was constantly broke. I’d wire him a few hundred dollars whenever I could, or whenever I’d remember. Perhaps we stayed in touch, in part, because he was tenacious, but also, because I knew about his suffering – and when you know about someone else’s pain, the knowledge of it becomes part of your own.

Born in 1964, Saing Soenthrith was 11 years old when the Khmer Rouge claimed Phnom Penh and drove him into the countryside to work in the fields, separated from his parents and three siblings. For the next three years, eight months and roughly 20 days, his life consisted of constant hunger and hard labour, collecting animal dung, twigs and leaves to mix for fertilizer.

When the genocidal regime fell and its adherents retreated north, he made the long journey back to his family home in the capital, and scrawled a message on the door, “I am alive,” in the hope someone would come looking for him. No one did.

Alone and without any possessions, he was taken in by a monk (“my monk,” he called him), who offered him shelter and an education. With Cambodia now under the control of a pro-Vietnamese communist government, Rith went on to study briefly in the Soviet Union, where he learned to speak Russian poorly, and, by his account, had many Russian girlfriends.

Rith seemed to have thrived there. He boasted about the way he helped a top Cambodian diplomat smuggle blue jeans into the Soviet Union to make money, at a time when imports to that country were severely restricted. The job added to his popularity and allowed him to show off his street smarts.

By the time the United Nations intervened in Cambodia after the Paris Peace Agreements, Rith went to work as an English translator, which led him to meet international peacekeepers and journalists and, eventually, to become a journalist himself – and an excellent one at that.

He was scrappy and puckish and built like a badger. He didn’t walk around the newsroom so much as he slumped through it, brazenly taking afternoon siestas with his head resting on a broken, legless chair on the office floor. Between naps and harassing eager younger reporters, he never failed to alert us when he had a scoop on a mob killing, a mass prison break or a shooting instigated by a high-ranking official’s son.

The strength of his moral compass was admirable, though sometimes it pointed in questionable directions. A married man and fiercely proud father, he had a reputation for philandering and occasionally hard-drinking, or as he liked to put it, getting “heavy drunk.” His more unsavoury characteristics included his unyielding bigotry against Cambodia’s neighbouring countries and historic enemies, Thailand and Vietnam. He lamented that his own country was a “beggar nation,” and was woeful of its dependency on foreign aid and its constant need for handouts. Yet he loved Cambodia and devoted his life to improving it. In his spare time, he ran an English-language school, which he built himself, in the countryside. And for what but love and honour would he continue to work for more than 20 years at the newspaper, earning a few hundred dollars a month, while his peers made double or triple that amount at non-profit organizations?

In the spring of 2016, via Facebook, I noticed he was complaining frequently about feeling weak and ill, and I worried that he wasn’t getting proper treatment for the diabetes he’d lived with for more than a decade. I asked him to send me the test results from his most recent visit to Phnom Penh’s Calmette Hospital, so that I could ask my father, a retired family physician, to review them.

In a swift e-mail reply, my dad’s prognosis was alarming and grim. “He needs dialysis and maybe a kidney transplant,” he wrote. “Bad news indeed.”

Around the world, living donor rates tend to be highest in places where deceased donations are very limited, says Dr. Cattral at Toronto’s University Health Network.

South Korea, for instance, has among the world’s highest rates of living organ donors, with nearly 52 donors per one million population, according to the International Registry of Organ Donation and Transplantation. But its deceased donor rate is 8.7 pmp. Similarly, Turkey has a living donor rate of 53 pmp and a deceased donor rate of 7.5 pmp.

How can governments and policy makers encourage people to become live organ donors? In the United States and Canada, some have proposed offering financial incentives for living donors. A 2012 study, published in the Clinical Journal of the American Society of Nephrology, suggested many Canadians who would not otherwise consider donating a kidney while alive could be persuaded to do so for payment. More than 50 per cent said they would consider donating a kidney to a relative for $10,000 and more than 60 per cent would consider it for $100,000. (Money, however, seemed somewhat of a turn-off for people willing to donate an organ without payment. Of these survey respondents, 7 per cent said they would not consider donating for $10,000.)

As the authors of the study noted, however, the idea of paying for organs is contentious. While the researchers found many people were receptive to financial incentives, health professionals were much less supportive. Those who opposed the approach tended to believe giving an organ “should come from the goodness of one’s heart.” Commonly cited concerns about bringing money into the process include the potential for exploiting individuals in financial need and treating human body parts as though they were commodities.

Other countries, such as Israel, offer a different kind of incentive: Organ donors or relatives of donors get priority for transplants. In other words, people who either have been living donors themselves or whose first-degree relatives were deceased donors, and those who sign their organ donor cards, would move to the front of the line should they ever need an organ.

Faced with a global shortage of organs, scientists also continue to pursue xenotransplantation, or animal-to-human transplantation – a potential solution wrought with all kinds of technical and ethical complications. Safe and successful transplants of pig livers and baboon hearts are still a long way from reality.

But there are simple ways to encourage live organ donation, too. In Ms. McKenzie’s Transplant Ambassador Program, recipients and donors share their personal experiences with others who are considering receiving a transplant or donating a kidney. Their message to would-be recipients is to simply talk to others about what they’re going through; you never know who may offer to be a donor.

The program’s aim is to make the road to transplantation less intimidating, and ultimately to inspire more kidney transplants through living donations. Ms. McKenzie has found sometimes the most unexpected people step forward when presented with the opportunity to donate. Among her own social network, six people volunteered to get tested to see if they were a match when they learned she was in need. Ten years ago, she received her sister-in-law’s kidney.

“You guess at who will do it and who won’t. And let me tell you, you’re not right,” she says. “The people who you didn’t think would come forward do.”

For Rith, getting a kidney transplant in Cambodia was not going to be possible. For one thing, no hospital in the country at the time was equipped to perform transplant surgeries. (If you needed any sort of serious medical care and could afford it, you’d be advised to seek treatment in Thailand.) For another, where would he get an organ?

I considered offering him one of my own, but all I could see were hurdles. How could I get tested to see if we were a match and to determine whether my kidney would work for him? Where in the world could we arrange the surgery? The logistics and costs of a transcontinental transplant seemed insurmountable. In the end, I thought it best not to mention this idea at all.

There was something else I kept from him, too.

While I emphasized to him the seriousness of his health condition, I didn’t relay to him the starker reality my dad shared with me in a subsequent phone call: Your friend is dying. Without dialysis, my dad suggested he might be expected to live only a few weeks or months. With dialysis, he anticipated Rith could prolong his life, but he was quite certain death would come sooner than later.

After I gave him my father’s initial, more general, assessment, Rith made a long and bumpy road trip to a hospital in Bangkok, where doctors confirmed his kidneys were indeed failing and he needed dialysis. He couldn’t afford to stay there though, and so he eventually returned with a prescription for the care he needed but no means of paying for it.

I connected with other expat reporters from the newspaper, who helped organize efforts to send money to him and lend their support. The response Rith received was generous and swift, but it wouldn’t last. All of us among his friends and former colleagues were journalists, not aid workers, and we were inexperienced at fundraising for the long haul. It didn’t help that there was no way of transferring money directly into his Cambodian bank account through various crowdfunding sites. So we sent money haphazardly, in fits and starts, through the U.S. bank accounts of other expat acquaintances living in Cambodia, through grey-market money exchangers, and through Western Union, in spite of that company’s hefty fees.

My own contributions were spotty and of inconsistent amounts, depending on my fluctuating willingness to part with cash and on the exchange rate for the Canadian dollar. My financial state was tied to my mortgage and utility bills, and whether I was saving enough to pay for a kitchen renovation. At times, the exchange rate meant my donation would be worth 40 per cent less by the time it reached his hands.

Whole months went by when I sent nothing at all. Rith’s predicament would slip my mind. I’d tell myself I should wire some cash to him, but then instead I’d go back to cleaning my house, biking to work, taking out the trash, living my life.

Fundraising for him was a micro-economic version of all the well-meaning, but ultimately doomed, foreign aid projects that littered his country; it was dependent on reliable and sustained donations. But eventually, donors reach their limit or lose interest.

In all our discussions by phone and online chats, Rith and I never mentioned the eventuality of his death, even though I told him, repeatedly, how much he meant to me and that I was grateful for our time working together. I was slowly saying goodbye.

Yet at some point, from somewhere, he got the idea that he wanted to buy a new kidney. He had heard it was possible to pay prisoners in China or India to obtain one. This was a solution neither I, nor my colleagues, would support, but the fact that he expressed this wish was a testament to his desire to live.

I wanted new kitchen floors; Rith wanted to stay alive.

My decision to donate an organ was easy. Much harder was choosing which to give.

Donating a kidney is quite safe (one of my surgeons informed me I was about as likely to get hurt in a traffic accident on the way to the hospital as I was from the operation itself), and the recovery time for the donor is relatively short, at an average of roughly four to six weeks. Donating a liver – or more accurately, a partial liver – involves a more complex surgery and requires a longer recovery of about six to eight weeks on average, but the trade-off is arguably greater.

While a kidney will improve the recipient’s quality of living, and replace or prevent the need for dialysis, which can be an agonizing procedure for many, a successful partial liver transplant can actually save someone’s life.

Donating part of a lung is possible. The first Canadian live-donor lung transplant was performed in Winnipeg in 1999. But such surgeries are much more rare. And frankly (my apologies to anyone who needs a lung), I was hesitant to part with mine. As much as I wanted to help someone else, the idea of having a permanent reduction in lung function was more than I wanted to sacrifice.

Kidney or liver? Kidney or liver? I pondered the question for weeks, running through the potential scenarios in my head. If I gave up part of my liver, it would grow back, and later on, I could potentially give a kidney, too. But if something went awry, such as a bile duct complication, that could affect my health for the rest of my life. If I gave a kidney, and wasn’t too put off by the surgery and recovery, perhaps I could entertain the idea of donating part of my liver down the line.

From some of the studies I scanned, the survival rate for recipients of live kidneys appeared to be better than those of live partial livers. What if I gave a partial liver, and it only managed to prolong someone’s life for a year or two? What if one of my kidneys could allow someone to live 12 years longer? Would those 12 years be worth more than a single year for a liver recipient?

Kidney or liver? Kidney or liver? I knew I could put my life on hold for four weeks, but could I afford to be in recovery for eight? If I had a kidney removed, I’d only have to be in hospital for two or three days. For a partial liver, I’d likely be in hospital for five to 10.

Why, for that matter, was I keen to give away any organ at all? I was compelled by the simple fact that I knew I could. And if I knew I was able to help someone, but did not? Well, that’s not the person I wanted to be.

If you ask anyone who is now sewing face masks or donating food or running errands for others why they do it, I suspect their answers will be much the same. If we don’t carry each other through this crisis, we risk being swallowed up by despair.

I don’t mean to suggest that donating an organ is a selfless act, as some believe. Maybe that’s true. But for me, deciding which to give was very much a selfish one. In the end, the idea of having a low-risk operation, a shorter hospital stay and shorter recovery time for myself won out over the opportunity to save someone else’s life.

Generosity, I have learned, is anything but simple.

In the nearly 15 months between submitting the initial papers to volunteer my kidney and its actual removal, I discussed my intention as little as possible, with as few people as possible. I held off telling my own parents until I obtained a potential surgery date.

I had discovered early on, while undergoing an ultrasound to ensure my kidneys were viable, that I couldn’t handle other people’s responses well. I didn’t want anyone to feel as though I was judging them for not doing the same. (I’ve been around enough do-gooders to know their virtuous deeds can be grating and can make others feel terrible.) At the same time, it made me squirm to receive praise for something I didn’t think warranted it. I certainly didn’t consider myself exceptional by any means. If I did, I wouldn’t be able to hold onto the belief that most people choose to be generous when they’re given the opportunity, and that living organ donation can be commonplace.

In fact, giving away organs anonymously is not at all rare. In Toronto, Dr. Cattral says he sees five to 10 undirected donors a year for partial liver transplants alone. He has also seen multiple kidney donors who have gone on to become liver donors and vice versa.

As recently as 10 or 15 years ago, he says, doctors would likely have questioned why anyone would give part of their liver to a stranger. They often believed there was something wrong with individuals who wanted to do so.

“But we’ve certainly learned that’s not the case,” he says. Undirected donors derive the same benefit as donors who know their recipients, he says: the knowledge that they’ve helped somebody.

In the dim light of the cozy examination room, my ultrasound technician, an older, no-nonsense woman who reminded me of Angela Merkel, yelped when I answered that I didn’t know the intended recipient.

“I thought maybe it was a family member,” she said. “But you don’t know!”

I stammered that anyone in my position would –

But she interjected: “No! It is not normal.”

She sent me away with a printed ultrasound image of my kidneys to keep as a souvenir, and her conclusion that I was a “good person.”

I tucked the printout away in my desk at work, where it got lost among piles of papers and books. Was I really a good person? I reckoned perhaps I could be sometimes, but other times, I wasn’t so sure. If I were to plot myself on that Venn diagram of people just trying to survive, people doing things for the greater good, and people plotting for their own gain, I’d fall somewhere in the middle – no worse perhaps, but certainly no better, than anyone else.

Rith died on Jan. 5, 2019, at the age of 55. My response was a simple whispered, “Oh.”

My husband Neil made the discovery on Facebook and relayed the news to me. I did not cry. I was sad, without question. But I was expecting this outcome. Two years and nearly eight months had passed since I informed Rith about my dad’s assessment of his kidney failure. I felt as much sadness as I did relief.

Journalist that he was, Rith had steadfastly documented his demise, even though he had long stopped working. He posted photographs on Facebook of each of his dialysis sessions. His arms grew progressively thinner. His face, once round, became gaunt and weathered. His mop of black hair turned brittle and white. He was nearly unrecognizable, a withered ghost of his former self. In his final days, Rith, the orphan, was jobless, penniless. He sold his house to pay his medical bills. Except for visits from his children, he was alone.

It was a miserable end, but also an end to the misery, both his and mine – my own selfish, wretched misery of witnessing from afar his distress.

Unlike when the planes hit the Twin Towers or when Princess Diana died, I can’t even remember what I was doing when Neil told me Rith was gone. But I do remember I paused to let the weight of the news settle. Then, I went on with my day.

The transplantation surgery, scheduled on a spring morning before the sun rose, was entirely painless for me. I sometimes joke that all I had to do was show up and lie there, but that’s actually true. I counted backward from 10, as my anesthetist instructed, and awoke in a separate room roughly five hours later, the job completed. In the meantime, my surgical team had removed my kidney and transplanted it into the recipient, whom they had brought into the operating room next to me while we were both unconscious.

Later that same night, I was on my feet, walking around the hospital ward, albeit clumsily with a catheter lodged in my urethra and grasping the arm of my nurse for support.

As I gained stamina during my three-night hospital stay, I took longer walks around the corridors, wondering vaguely whether any of the other patients I encountered was the new owner of my kidney. I didn’t actually want to know the answer, though. Knowing implied more responsibility than I could bear. What if I didn’t like them? What if they didn’t like me? What if my kidney didn’t work for them? What if they had other troubles beyond the transplant I couldn’t solve?

My second night back at home, I took one of the painkillers the doctors prescribed, and became so nauseous and high, I lay still, gripping onto the end of my couch until morning, terrified my body would fly away. Each time I retched, a stabbing pain ripped through my guts, threatening, it seemed, to tear open my surgical wounds. That, however, was the worst of it. After that night, I couldn’t bring myself to touch another pill, and found the pain was actually more manageable than the effects of the medication.

Over the next few weeks, my torso, which had bloated to resemble that of a drowned corpse, gradually deflated, so that I could wear proper pants again, as long as they were my Thanksgiving pants. Three weeks after surgery, I was well enough to return to work.

A year later, the only visible sign the surgery ever happened is four small puncture scars across the left side of my abdomen, where the laparoscopic arms entered my body, and a four-inch scar above the waistline of my underwear, where they moved the kidney and took it out. What’s not visible, and never has been, is the lingering, low-register sting of the daily struggle I have between the best parts of myself and the worst, the parts that know I could offer more, but stubbornly resist.

The hardest part isn’t giving, but living with yourself after you stop.

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