18/04/2022, 14:28, CT Angiogram renal & abdominal

No vascular calcification.

No renal calculi.

The kidneys are symmetrical in size (right = 11.1 cm; left = 11.0 cm) and normal in morphology.

Single left renal artery; no early branches. Single preaortic left renal vein.

Single right renal artery, branching laterally to the cava. Single right renal vein.

No extrarenal abnormality.

The plan is for a left nephrectomy.

***

My family likes to joke about the time I threw my brother to the alligators. We were in our early twenties, and on our wayto the Everglades in Florida. The taxi driver taking us there from our hotel on a nearby island stopped at a swampy clearing off the freeway. “They only feed at night,” he said, not particularly reassuringly.  (This was also a man who swore on his children’s lives that he had seen the Florida “bigfoot” twice.) “In the daytime they’re as harmless as dogs.”

He encouraged us to take a look, but I itched for five minutes of silence. My brother tried to persuade me, but I declined, claiming that I could see them just fine through the window. He came back in under five minutes, the whole episode passing without incident, the sun-drunk gators barely twitching from their sleep. My brother’s telling—and my mother’s and my father’s—has the creatures lurching from the water, ready to snatch him in their jaws, while I lock the car doors from the inside with a defensive click. I always laugh. It’s a better story his way.

***

In July 2020, my brother, at thirty-one years old, was diagnosed with an extremely rare, chronic and degenerative kidney disease. Two weeks before, he had asked his long-term partner to marry him, and was several hours late to his engagement party because he’d spent the day being tested at Guys Hospital, near London Bridge. Once he arrived, fatigued and swollen in the legs and ankles, a symptom of his still-undetermined illness, a guest handed him a glass of champagne and the party, in his partner’s beach-front garden, resumed. Only my mother betrayed any hint of consternation. “It’s never a good sign when they request a biopsy straight away,” she mused, nervously chewing on her hair before I flicked her hand away.

The following week, I was walking home from yoga class when my mother called me to explain that my brother had been diagnosed with “IgA nephropathy,” also known as Berger’s disease.  Berger’s disease is a condition that occurs when an antibody called immunoglobulin A (IgA) builds up in the kidneys, causing damage and inflammation. Back then, my knowledge of the kidneys—their essential function to filter, drain, and rinse the blood of toxins— was unworthy of the most entry-level school biology. A friend innocently asked me over dinner why exactly human beings had two kidneys in the first place and I found myself totally unable to respond.

***

Last fall, I was teaching a seminar in Paris, renting a university flat with malfunctioning electricity, heating, and a highly erratic shower. I had come to the city because I wanted to cut off most Anglophone communications. In any case, I spent so much time in the bistrot on the corner that the waiters said that I should start giving them English lessons for free.

One Sunday morning in November, my brother called me while I sat at my preferred table to tell me that he was approaching what his doctors had called “renal endgame” and would very likely need, in the next year, either full-time dialysis or a kidney transplant. “I’ll do it,” I said, with the spontaneous ease that is often called gut instinct. Unlike almost every major or inconsequential decision I have ever made—whether to eat eggs for breakfast or to apply for a job in California or to get a bike or to leave a city where I lived in for a decade or to switch my dating-app preference to all genders—I did not overthink it.

***

The health and function of a kidney is assessed numerically, via what is called Glomerular Filtration Rate (eGFR). An eGFR of 60 or higher is in the normal range. When I reported to the renal clinic at Guy’s Hospital at the end of January, my brother’s rate was just above 20—still above the threshold for a donation, at around 15. Still, his nephrologist began us on the series of procedures, known as a “work-up,” that would determine if I was a match for him.

The first thing was to visit a designated bathroom, produce a urine sample, and deposit the vial via a small hatch at the rear of the toilet cistern. (“Please put your name and D.O.B. on the bottle before urinating, please,” a laminated sign advised). Then my weight and blood-pressure was taken. In the waiting room, I picked up an informational brochure which told of Hattie’s Transplant “Journey” and Bruno’s Donor “Story.” This literature impressed on me that recipients often wait decades on dialysis, and that thousands of people die on the waiting list each year due to inadequate supply. The title of the brochure was “Living Kidney Donations: the Gift of Life.”

In a study of the history of non-dependent forms of intimacy, the social anthropologist Julienne Obadia questions why the “rhetoric of both living and deceased organ donation is steeped in the notion of “the gift”—particularly “the gift of life.” She suggests that it is both because of the scarcity of living organs, and because such donations often are uncompensated. Yet, since the publication of Marcel Mauss’s 1925 The Gift, which argued that gifts and the practice of gift-giving are the origin of civilized, relational, and respectfully reciprocal societies, thinkers have debated whether there can ever be a “free” gift unencumbered by self-interest or social debts.  Jacques Derrida argues that the concept of a “kin