Keri Barham is always there for her little sister, Vicki Tomal.
Growing up, Tomal didn't need to worry about neighborhood bullies or unwanted suitors. Simply with a look, her tough sister could scare all of them away.
"Keri had a reputation," said Tomal, 37. "You don't mess with her."
Barham is there for Tomal even when they have their own families and are hundreds of miles apart. This time, Tomal needed a kidney. Barham gave her one of hers.
On Thursday, one year after the transplant, the two kidneys reunited.
Barham flew from Spokane, Wash., to Juneau to celebrate their first anniversary.
Tomal is lucky.
Every day, 17 people die while waiting for a transplant of a vital organ such as a kidney, heart, liver, lung or bone marrow. Although an estimated 10,000 to 14,000 people who die each year meet the criteria for organ donation, less than half of them become a donor, according to the National Kidney Association.
As of Nov. 29, the association estimates that 86,876 people are waiting for an organ donation. About 60,000 of them need a kidney.
Jessica Buck, the Alaska transplant coordinator for Virginia Mason Medical Center in Seattle, said people are reluctant to be a donor because of many misconceptions about organ transplants.
The medical center has performed 108 kidney transplants this year.
"Some people think doctors will not work as hard to save their life if they know they want to be a donor," said Buck, who was Tomal and Barham's coordinator. "That's not true. The doctors who are trying to save your life are separate from the doctors who will retrieve your organs. It takes two doctors to reach a consensus that the patient is beyond hope. Then the question of the gift of donation is asked of the family."
But Buck said that despite advances in transplant surgeries and anti-rejection medicine, whether to donate one's organ remains a big decision.
"There's still some slight risk involved," Buck said. There are risks of a general anesthesia surgery, a little post-operative pain controlled by medications, and activity limitations of no more than 10 pounds of straining or lifting to avoid complications with wound-healing during recovery.
Barham said it was difficult for her to agree at first. It took her a few months to convince her husband.
"My husband was very nervous," Barham said. "But we felt much better after talking to a counselor in the hospital. I also did research on the Internet. Just having more knowledge helped."
When Tomal went to Virginia Mason, the two sisters hadn't met for four years. When Barham saw Tomal, she regretted waiting so long.
"Vicki didn't look good," Barham said. "She was close to kidney failure."
The first day Tomal was in Seattle, her mother, Glenna Stensgaard, had to accompany her from one test to another.
"Vicki was barely awake," Stensgaard said. "She was next-door to be gone."
The doctors performed the surgery the second day.
"She is my kidney twin," Tomal said.
Tomal felt the strength from Barham's kidney immediately.
"I walked to her room before she walked to mine," Tomal said. "I told her to get her butt out of the bed."
One year after the surgery, Tomal said she feels like a different person. She can eat meat now. Her sons, Jack and George Grummett, said she is a much cooler mom because she doesn't get tired as easily and can play with them. She also exercises.
"I had been sick for a long time. I didn't realize how sick I was until the transplant," Tomal said. "I feel like coming out of a cloud."
The only thing Tomal jokingly complains of is her weight increase.
"Keri gave me the fat one," Tomal said. "I gained 25 pounds after the surgery. She lost 25 pounds."
Looking at Tomal talk energetically, Barham said she couldn't imagine seeing that a year ago.
"I feel blessed that I am healthy enough to donate one of my kidneys to Vicki," Barham said. "God gave us two kidneys. I am supposed to share one."
I-Chun Che can be reached at firstname.lastname@example.org.