I donated a kidney when I was 70.
After decades working in nephrology and transplant medicine, I realized I was in excellent health, and that I had the chance to help someone in a way I had long encouraged others to consider. I underwent a full series of evaluations by teams from two different hospitals. When I was cleared, I volunteered.
The surgery was performed in complete anonymity. I don’t know the recipient, nor do they know me. And neither of us will ever know about each other. Later, the Portuguese Ministry of Health asked if I would share my story publicly, to help build confidence in the safety of living donation. I agreed. It felt important.
For me, it was an expression of what I’ve always believed: giving is not a sacrifice – it’s a privilege. Giving takes many forms - from a smile or a kind word to a gift of an organ, and each carries a quiet joy that endures.
My journey with transplantation began nearly five decades earlier, in a very different Portugal.
In the mid-1970s, Portugal was a nation in transition. Healthcare was evolving and advanced specialized services were still being established. Hospitals lacked modern technology, and patients with complex conditions, especially chronic kidney and heart disease, were sometimes referred abroad for treatment. It was costly, both emotionally and financially.
The government made the decision to reopen a shuttered hospital building, upgrade it, and build a new center for specialized care. At 27, I was invited to join the project. I was teaching immunology at the time, and it was unusual for someone so young to take on such responsibility. But within six months, the hospital was up and running. From 1980 onward, patients no longer had to leave Portugal for this kind of care. It was a turning point – a symbol of progress and national self-sufficiency.
We were a group of young doctors who called ourselves “the unsatisfied group.” Not because we were unhappy, but because we pushed for better tools, better processes, and better care, and often, we succeeded.
We were the first hospital in Portugal to offer continuous ambulatory peritoneal dialysis. Later, my focus turned to transplantation, managing both living and deceased donor programs. For many years, every kidney donor in the hospital passed through my hands. It was deeply personal and meaningful work.
That hospital stood out as a center of progress in a still-developing system. In time, it became a model for others to follow.
Chronic kidney disease is a difficult disease to detect. Symptoms often don’t appear until a person’s kidney function has already dropped below 10%. Many patients arrive at diagnosis too late for early interventions. That’s why regular testing of blood pressure, urine, and kidney function, especially after the age of 40 or 50, is so important.
At present, there are approximately three million patients on dialysis, but it is estimated that there are more than 800 million people worldwide with kidney disease, in many cases not fully diagnosed.
Fortunately, significant advances have been made in the care of renal patients. For example, Portugal now has a strong network of dialysis centers, most of them private but fully embedded into the national system. Today, no patient lives more than 50 kilometers from a treatment center, unlike in the past when treatment was often available only after extensive travel. Transport costs, even by taxi, are fully covered by the government, ensuring universal access to care. This, for me, is a point of quiet pride. Our country has become a European example of equitable kidney care, and it was hard won.
Dialysis is life-saving, but it is not ideal. Transplantation, when possible, remains the gold standard for patients with end-stage renal disease. The greatest challenge worldwide is the shortage of donor organs. Demand always exceeds supply. That is why reducing barriers to organ donation, particularly from deceased donors, is so critical. We must strive to improve the system for identifying donors and harvesting organs. Organs must be collected quickly after death, or they will be lost forever.
But living donation is even more powerful. We must spread the idea of organ donation across cultures, despite the taboos that still persist. When people are informed and properly assessed, many can safely become donors. Public education plays a crucial role in encouraging this, and I have spent much of my career trying to increase awareness among healthcare professionals and society at large.
As president of the Portuguese Transplantation Society, I saw firsthand how attitudes could shift. I remember organizing a major international meeting and approaching dialysis providers for sponsorship, even though some colleagues warned that they would refuse. To the surprise of many, one company – Diaverum - not only accepted but donated generously. That moment stayed with me. It reminded me not everything is transactional. Patients’ wellbeing comes first.
Every country has its own systems, strengths and shortcomings. But the barriers to transplantation, whether due to access, awareness, or infrastructure, are nearly universal.
Globally, we still face disparities. In many countries, access to transplant evaluation depends on geography or income. In others, people don’t know that living donation is even an option. Even in high-resource settings, conversations about eligibility happen too late, or not at all.
That’s why I believe every person should feel empowered to ask a simple question: “Am I a candidate?”
And every system should be able to offer a clear, honest answer.
My decision to become a living donor didn’t come from heroism. It was shaped by years of experience, direct observation of altruism, trust in science, and a personal belief in the power of giving – as a value, a habit, and source of meaning.
If there is one lesson I carry from my professional life, it’s that medicine is not just about saving lives. It’s about seeing people. It’s about care. And sometimes, it’s about stepping forward when you have the health and means to give something back.
For me, donation was a gift, not only to someone else, but to myself.
And I hope others will discover that joy too.
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