In their prayers every night, 16-year-old Katie Bonner of Westminster, her parents and sister remember a family they have never met.
The Bonners know only that the other parents live in New Jersey, and when their 4-year-old child died in January 1990, they donated the child's kidney. Katie received it.
"My husband and I personally never forget that family. They're in our thoughts and prayers," says Carol Bonner, Katie's mother.
Kidney transplants are the most common organ transplants. In 1991, the most recent year for which information is available, 101 Marylanders received transplanted kidneys. But the Transplant Resource Center of Maryland, the state's federally certified organ and tissue procurement agency, always has a waiting list.
"The majority of our list is people waiting for kidneys," says Joyce L. Tarrant, public affairs manager for the transplant resource center. Approximately 500 of the 600 Maryland residents on the center's waiting list are awaiting kidneys, she says. Ms. Tarrant estimates that the average wait for a kidney transplant at about seven months.
Kidney failure was the last thing the Bonner family expected when Katie broke her arm in March 1986. After an X-ray, the physician suggested that the arm be set by an orthopedic surgeon and Katie was scheduled for a routine blood test.
The results were anything but routine. Katie's blood contained high levels of creatinine, colorless alkaline impurities in blood and urine. All human blood and urine contains some creatinine; the amounts are elevated in those with kidney disease.
"It was just a complete shock," Mrs. Bonner says. Dan Bonner says his daughter was "healthy and fun-loving and she rode her bike that day [when she broke her arm]."
Katie didn't fit the profile of most kidney disease victims.
Diabetes is the leading cause of kidney failure in the United States, the National Kidney Foundation-Maryland reports, and high blood pressure accounts for about 25 percent. Heredity is also a factor.
Katie didn't have diabetes or high blood pressure, and Mr. and Mrs. Bonner were unable to find evidence of kidney disease in their families. Katie's kidneys were undersize, but she was able to get along through the fifth grade without dialysis or a transplant. Blood and tissue tests showed that her father was a compatible donor, so in June 1987, surgeons at Georgetown University Hospital transplanted one of his kidneys to her.
About a week later, Katie lost the transplanted kidney to infection. The night that surgeons removed the infected kidney, "Carol and I were just crying in each other's arms for about half an hour," Mr. Bonner says.
The medical team had been optimistic, telling the family that transplants from relatives had a 93 percent success rate and that a special psychological bond would be forged between Katie and her father.
"We were primed and programmed that we were in the 93 percent," Mr. Bonner says. "Nobody talked about those faceless people who make up the 7 percent."
The transplant's failure meant that Katie had to go on dialysis. She was able to use peritoneal dialysis rather than the more confining hemodialysis, which requires individuals to be hooked up to a machine for several hours. In peritoneal dialysis, cleansing fluid is pumped into the blood through an abdominal catheter and wastes from the blood pass through the peritoneal membrane into the cleansing fluid, which is then removed.
It took about 15 minutes at a time, four times a day, "so that wasn't too bad," Mrs. Bonner says.
Katie was able to go to school, with help from the school nurse, who handled the midday dialysis. She was also able to spend summers in the Sullivan Heights pool -- her mother jokes that she's part fish -- where she gives swimming lessons to 3- and 4-year-olds.
The emotional pain of the transplant's failure healed slowly, but eventually Katie agreed to go on a waiting list for a donor kidney, since no other member of her family was a compatible donor.
A call came from Johns Hopkins Hospital just before the end of the 1988-1989 school year.
Katie was less than thrilled.
"I ran outside because I didn't know how to feel. Those words just kept ringing in my head. I was crying and it was like, 'This is my summer. Come on,' " she recalls.
It turned out that Katie was a poorer match than another transplant candidate, so she got her summer back, but dialysis remained part of her daily routine.
The next call from Hopkins came at 5:30 a.m. in January 1990.
"I don't think any of us went back to sleep," Katie says. She stared out the window until it was time to get up and dress.
That time, they were told to stay. Other people's food tormented Katie through the wait in the emergency room. She hadn't had breakfast and couldn't eat because of the impending surgery. And then, she recalls, the emergency room staff ordered pizza for lunch.