For most people, surgery is something to avoid unless it’s absolutely and completely necessary. For Julie (who prefers to withhold her last name), who is 46, it was a voluntary way to help a stranger.

Years ago, she was inspired after reading an article about kidney donation. Julie has no kids, healthy nieces and nephews, and had major surgery before, so she says she wasn’t intimidated by the notion of kidney donation surgery.

Though she made an initial phone call to get information about kidney donation after reading the piece, ultimately she waited several years before moving forward with donation. In July of 2017, she underwent the surgery.

To make it more interesting, Julie’s kidney recipient’s sister then donated her own kidney to someone else. That donor’s mother donated to another person, creating a kidney exchange chain.

Here’s what giving a stranger your kidney is like.

You may or may not meet the recipient of your donation.

Julie: Because of privacy laws, all I knew about him going into the surgery was that he was a middle-aged man. Months later, the hospital set up a meet and greet for us.

I met his wife and his mom. He was a correctional officer, obviously he was grateful, he was reserved. We weren’t going to become best friends or anything from it.

But there was also a chance that the person wouldn’t want to know who I was and wouldn’t want to meet me. The hospital puts donors through their paces ahead of time to let them know all of the possible scenarios and make sure that you’re going to be okay emotionally no matter what. They asked me, “How would you feel if the recipient wasn’t what you expected?”

There’s just so much unknown. Really my only wish about it was that it was somebody nice.

The pre-surgery process is extremely thorough.

Julie: The pre-surgery process was well-organized. They have regular educational sessions for people who are considering being a donor. It’s two days, all-day, with interviews, information sessions about what your kidneys do for you, and what to expect from surgery and life after surgery.

You meet with the transplant surgeon and a psychologist and others.

You start screening, you do every test imaginable on your blood, chest x-rays, and kidney filtration rate tests.

They’re really emphasizing over and over that they don’t want to put the donor in any undue risk, they want to make sure that I will be okay with one kidney for the rest of my life.

They were very reassuring and they also kept repeating to me and my husband, who had to go as my caretaker, “At any time, you can back out. There will be no pressure, down to the very morning of the surgery.”

They made it as enjoyable as surgery can be.

Caretakers get pre-surgery support, too.

Julie: My husband was worried about me, and wanted to make sure that I would be okay.

He felt better after he went to the sessions with me and heard firsthand what it was like and talked to the doctor and asked questions himself.

If he had not wanted me to do it or had not been supportive I wouldn’t have done it. He was probably more worried than he let on, but he was supportive at the same time.

You do think about the implications of being without a kidney.

Julie: I definitely thought about the implications of being down a kidney. But between all of the information the hospital and the National Kidney Foundation gave me and everything I looked up, plus all of the screening, tests, and they computed the probability I’d go into kidney failure at some point in my life, so with all that, I was completely comfortable with the idea.

I don’t think about it anymore, but I did have to think about if I was in a car accident and my one remaining kidney gets damaged. There’s such a small chance of that happening, but there’s still a chance, and I just had to be okay with accepting a little bit of risk.

I got to a point where I thought, “It’s worth the risk.”

Obviously you don’t get money to donate an organ, but you may get extended time off to recover.

Julie: I work for the State Department of Environmental Quality, and they give you 30 days of paid leave to donate an organ.

Surprisingly, you may not think about the donation daily.

Julie: Once a year on Facebook the kidney recipient will post something like, “This is my anniversary with my new kidney!”

Other than that, on a daily basis, I actually don’t really think about it.

The one limitation that I have is that I can’t take aspirin or Ibuprofen. I just have to be careful when I get prescribed medication and tell them that I only have one kidney.

People’s reactions run the gamut

Julie: Sometimes they’re like, “Oh, that’s amazing!” And sometimes the reaction is more of, like, you know when a woman– and I have really short hair so I know this– when a woman gets a really short haircut, other women will call them “brave”?

It’s like, “I know what you’re really saying.”

I feel like there are some people who are like, “Why would you do that?” It’s kind of like, “Are you a moron? Why would you put yourself through that?”

No one’s ever come out and said that, but I just feel like not everyone’s like, “That’s cool!”

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[Note: Looking for more information on donation? Check out the National Kidney Foundation. Agenda related stories: In incredibly unselfish move, Tyler chooses to donate kidney to his co-worker Austen and What do you say to your mother-in-law when she gives her kidney to your mom?]