KEY POINTS:
They call the kidney Zac. It used to belong to Alex Milne but now filters the blood of his friend Bain Duigan.
The nickname comes from Anzac Ave, the Auckland street the friends were walking down when Duigan finally prompted his friend to offer himself as a potential donor.
The idea had hung silently between them for six months, since Milne, then 23, had wondered out loud why there wasn't a way for people to donate to strangers. He'd consider donating to someone.
It was February last year, days before Duigan's 40th birthday. He'd been diagnosed with nephrotic syndrome, an incurable kidney disease, almost two years earlier, but the illness had only recently become debilitating. A short uphill walk would exhaust him. He'd started needing afternoon naps. His thinking was clouded, causing a "floaty doziness".
His kidney function had plunged to around 10 per cent of normal. He couldn't put off dialysis much longer, and he faced a five-year wait for a suitable kidney from a dead donor. Two family members and a family friend had offered to be donors, but they were either not blood matches or unsuitable.
"I said to Alex, 'You know how you mentioned donating to someone?" recalls Duigan. "Well, I'm someone."
So began Zac's journey from Milne to Duigan. En route were numerous tests and delays, including three postponements of the surgery; anxiety and frustration; a postponed OE for Alex; interrogations by professionals, friends and strangers; delicate negotiations between the friends and a deepening bond unlike anything either had experienced before.
On June 25, 16 months after that day on Anzac Ave, the transplant finally went ahead. Surgeons extracted Milne's left kidney, stored it in a sterile chilly bin, then opened up Duigan and attached the organ in Duigan's pelvic area, below his own defunct pair.
According to Kidney Health, an estimated 192,000 New Zealanders suffer chronic kidney disease. Just under 2000 New Zealanders are on dialysis; 570 on the waiting list for a kidney from a dead donor. Because of the specific conditions of death required - brain-death in intensive care - only about 1 per cent of deaths a year produce a candidate donor. Around 110 kidney transplants are performed in New Zealand every year, with about half using live donors.
Milne, now 25, asked for a photo of the kidney. "It's a bit gross but it's all right. It looks a bit like a chicken breast." Two weeks after the surgery, he says he feels ridiculously well. "It's almost a non-event."
Duigan says having an ingrown toenail removed was more painful than his surgery. "I woke up in intensive care, I didn't feel at all distressed. I felt really calm and happy."
And his relationship with Milne changed in an unspoken way. "I do feel an innate bond with him, beyond before."
DUIGAN AND Milne met at a Rainbow Labour function at Auckland bar Shanghai Lil's three years ago. Their paths kept crossing through mutual friends. They share political leanings, an interest in fashion and emotional frankness, but are quite different in other ways.
Duigan is super-analytical and, by his own admission, given to control freakery. He's tall, slim and rather angular, with intellectual-chic glasses and a wry, quick sense of humour.
A former real estate agent and graphic designer, he was finishing a property degree when he was diagnosed. He arrives five minutes early for everything; Milne is generally late. The friends call each other "Gen X" and "Gen Y" because of their age difference.
Milne has a compact build, rosy cheeks and a penchant for sharp suits. His movements are fluid and dreamy, his speech considered and unhurried. He plans a career in marketing, but for now works in retail and waiting jobs.
He'd bought a one-way ticket to London for last November for his OE, but had to cancel because of delays with the transplant. (With some help from his father, he persuaded his insurance company to reimburse him for the ticket.)
Milne insists he's no altruistic hero. At one point, he says, "I felt I was becoming known as 'the guy who was giving away a kidney', and my middle name was Jesus."
His decision to be a donor, he says, was a friend's pragmatism.
"My friend here is sick, the only way of him getting better is for this to happen. It's like, if a friend has fallen over on the street you put your hand out and pick them up. You get a real good feeling when you help somebody else.
"It's not like I'm a particularly generous person, or particularly brave. It just" - he pauses, shoving a menu around at the restaurant table - "comes down to doing what you think is the right thing to do."
"The most amazing thing," says Duigan, "was Alex said to me, 'You don't need to take this so personally; I'm actually donating to help someone, and that someone is you.' It was: 'I'm gifting you hope but I'm not going to make it too heavy.' It makes it a very unloaded situation, that's why I haven't found this too psychologically complicated."
The psychologist who assessed Milne for the transplant also grilled him about his motivations. Duigan wasn't even a long-term friend, she said.
Milne replied, "In some ways my decision to do this goes beyond our friendship. I wouldn't do it for anybody but I'd do it for any one of my friends."
It was made clear that Milne could change his mind right up to the surgery, and the medical team would invent a medical excuse to cover for him if he wished. When Milne first received results of a positive blood cross match; he waited two weeks to think it over before telling Duigan.
Each was assigned to a different transplant co-ordinator, and the two co-ordinators weren't allowed to discuss the case.
Milne underwent 10 assessments. The criteria for live donors in New Zealand is stringent; far more so than in Australia. Ian Dittmer, medical director of the Kidney Allocation Scheme, says it's not unusual for family members or friends who offer to donate a kidney to be rejected because they have a medical condition such as high blood pressure, or a BMI of more than 30 ("obese").
After delays because of queues, the friends were given a surgery date in February, only to be put off by a misread x-ray.
Their next date fell during the April doctors' strike; the third date, in June, was cancelled when a back injury of Milne's flared up.
The delays shredded Duigan's nerves; in the last weeks he took to wearing ear muffs during his dialysis sessions because he couldn't stand the background noise.
Milne was warned that some donors suffer depression after the surgery. "Because prior to the operation they're built up as doing such a great thing, then afterwards it sort of all flatlines, and all the focus is on how much better the recipient is getting. You can't do it for the fame because you're only going to fall."
SOME PEOPLE were incredulous when Milne told them what he planned to do. The man he was seeing at the time said he could never be a live donor. "He said, 'My body is mine; it's the one thing I'm selfish about,"' remembers Milne. "I found that quite hard to deal with. But, it's hard to make a call on these things unless you're put in that situation."
His parents' first reaction was to be protective. "It was a sense of, why are you doing this? We gave you this brilliant kidney that works so well!" says Kevin Milne. "My own selfishness, I tried to slide on to Alex."
Once his son explained his reasoning, Kevin came round. "He made a really straightforward point: 'Bain needs a kidney and I don't need two.' He almost sounded naive, in a beautiful sort of way. You can think about it from a million different ways but in the end that's the whole sense of what he's done."
Still, the gesture surprised him. "Alex is the sort of guy who always puts a price on things; he's no Mother Teresa. So why has he got this wonderful attitude to this? I think I underestimated my son."
Milne says the experience had its own rewards. "It made me feel really good about myself - good that you feel you can build such close friendships that you can do something like this."
The friends felt well-served by the system, but believe live donors should be fast-tracked through tests rather than having to wait in the general queue.
Milne's part is finished; he's back in Wellington with his boyfriend.
Duigan faces months of monitoring and must take immuno-suppressant medication for the rest of his life to stop his body rejecting Zac.
But clarity has returned to his thoughts. The future has opened up. "I feel like I've got lots of options and I don't have to panic, I don't feel in a rush," he says. "I feel like I've got more autonomy, and a sense of freedom that you don't have to be strapped to that [dialysis] chair."
