How many people would lend a helping hand to an ex-spouse? What about a body organ? Rosanna Brown donated her kidney via daisy chain to ex-husband Adam Brown, who had been living without kidneys for more than two years. Michael de Vera, head of transplant at the Loma Linda University Health Transplant Institute in Loma Linda, California, United States, performed Adam’s transplant. He said the Institute is forever grateful for selfless donors who give others the opportunity for renewed life.

Adam was diagnosed with genetic polycystic kidney disease (PKD) in 2007, after his mother grew sick with PKD and told her two children to get tested. Both Adam and his sister tested positive for the disease. Adam unknowingly had been experiencing symptoms, and they gradually got worse.

PKD is a genetic disorder that causes fluid-filled cysts to grow in the kidneys. The disorder causes the kidneys to enlarge and lose function over time. The cysts can sometimes rupture, causing extreme pain, and even bleed.

“I was miserable,” Adam said. “I started getting anxious because I never knew when the next cyst would rupture. It was scary taking too deep of a breath at the risk of one rupturing.”

Adam began losing too much blood and needed blood transfusions to make up for the loss. His doctors decided his cyst-riddled kidneys were doing more harm than good to his body. After Adam struggled to find a surgeon who would take his case, a local doctor removed one kidney in March 2019. The remaining kidney grew larger with painful cysts, causing it to eventually weigh a whopping 37 pounds (17 kg). A little over a year later, Adam had that kidney removed, and it surpassed the previously reported largest kidney ever removed. During the surgery, doctors found renal carcinoma and said it would have stayed undiscovered and eventually caused Adam’s death. The removal of his kidneys allowed them to find the cancer and clear it out.

So, in May 2020, Adam began living with no kidneys and could not urinate until he found a donor.

Since the kidney’s job is to cleanse the blood of toxins and transform waste into urine, how was it possible to survive without them? Dialysis.

“Have you ever been in a dialysis clinic?” Adam asked. “I was miserable at every session and despised every second. It put my life on hold.”

He began various types of dialysis in 2017 when his condition worsened but relied heavily on it after both kidneys were removed. Adam went to a dialysis clinic four to five times a week for four years. Each session lasted up to four hours.

He was placed on the national transplant list in a search for a donor, but obstacles including the COVID-19 pandemic caused the search to grow weary and stretch on for years.

Though no longer married to Adam, Rosanna continued receiving tests and being involved in the search of treatment for Adam.

“I served in the military for 22 years, [and] I’m a guardian by nature. I would easily lay down my life for someone I don’t know. To donate a kidney to someone I love and care for … there’s no hesitation,” Rosanna said.

Though she wasn’t a direct match for Adam, Rosanna was able to donate her kidney to a stranger, creating a domino effect of donations that led to Adam finding a match and getting a kidney. This process is called a daisy chain.

Kidney donation chains occur when two or more people are willing to donate a kidney to a loved one but are not compatible with that person because of factors such as age, size, blood type, and immunology.

The Browns’ chain included a mother-daughter pair who found themselves in a similar situation. Both recipients received working kidneys through successful donations by their loved ones and a team of strangers.

“After we split,” Rosanna said, “[Adam] told me not to feel obligated to donate anymore. It was never an obligation. He’s someone I’ve loved for years, and I wasn’t going to back out just because our marriage didn’t work. Our friendship, however, still did.”

With both of his own kidneys removed, Adam is essentially free of PKD, and the disease will not attack his new kidney. He will likely need another transplant in the future, as the donated kidney should last up to fifteen years in Adam’s body, according to de Vera.

“Our mindset has always been, ‘Nothing’s going to get us down. We are never going to give up,’ ” Adam said. “Regardless of what happened between us, I’m grateful [Rosanna] never gave up.”

The Loma Linda University Health Transplant Institute is the only comprehensive multi-organ transplant center in the Inland Empire region of Southern California.

The original version of this story was posted on the Loma Linda University news site.