DURHAM — Brad Dean is in perfect health, but just after 7:30 a.m. today, Duke University Medical Center surgeon Deepak Vikraman-Sushama will press a scalpel against his abdomen and slice.
That cut will kick off a cascade of four operations on four patients - and perhaps a new era for kidney transplants in North Carolina.
Dean, 43, president of the Myrtle Beach, S.C., Chamber of Commerce, is a so-called "altruistic donor." He offered to give a kidney to an unknown recipient simply because he thinks it's the right thing to do.
His kidney will go into Sue Gommer of Holly Springs, a 67-year-old former Navy nurse who has suffered from genetic kidney disease for decades.
Sue's daughter, Jennifer, 39, a Duke pharmacist, had offered one of her kidneys, but she was the wrong blood type to match her mom. So Jennifer Gommer's kidney will go into Jeffrey Rogers, 42, a former construction worker who lives in Robeson County.
These sets of operations are becoming more common, but Duke officials believe that this will be the first done all at the same hospital in North Carolina.
Technically the procedure is called a kidney paired donation. It's often known as a domino transplant, and it's becoming more common around the country since the first was performed in 2001 at Johns Hopkins Hospital in Baltimore.
The idea is to build a list of incompatible donor-recipient pairs like the Gommers - a patient who needs a kidney paired with a willing donor whose blood or tissue type isn't compatible. They are mixed and matched with similar pairs so that all the recipients in a chain of operations get kidneys that match.
Officials at Duke and other transplant centers around the state are hoping that publicity about the operation today will attract more pairs to sign up. The longer these lists are, the easier it is to make the intricate matches.
Transplant centers at other hospitals across the state are also gearing up for the operations. One involving six people is scheduled for later this month at Pitt Memorial Hospital in Greenville, and UNC Health Care also is among those interested.
Altruistic donors like Dean aren't required to make the process work, though they can act as catalysts.
The waiting list for kidney donations is the largest for any organ, more than 90,000 across the country, including more than 3,000 in North Carolina, according to the United Network for Organ Sharing, which tracks organ transplant data.
Some patients have to wait years for a kidney, and many die while waiting.
By some estimates, an efficient nationwide domino system would allow 3,000 additional transplants a year than are now performed, said Dr. Matthew Ellis, medical director of Duke's kidney transplant program.
"It wouldn't completely fill the void. But, boy, it would make a dent in it," Ellis said.
And the paired donations would not only boost the number of transplants but also raise the percentage that come from live donors, Ellis said. Most transplanted kidneys now come from dead donors, but these organs often don't last as long or work as well as those from living donors.
There is a pilot program linking transplant centers across the nation to facilitate paired donations, which can be performed in strings involving dozens of people at several transplant centers.
Dr. Robert Harland, chief of the division of transplant surgery at East Carolina University's Brody School of Medicine and director of transplantation at Pitt Memorial, said he hopes today's Duke operations and the three-pair version his team plans to perform soon will boost interest in creating a statewide consortium.
A central state databank of potential donor-recipient pairs would make the complex matches easier and quicker. It also would open the door to more such chains that use operating rooms in multiple hospitals.
That's important because it's hard to free up several operating rooms in the same hospital.
The procedure today was scheduled for three operating rooms and expected to last well into the afternoon.
Dean said in an interview last week that his decision to give a kidney to a stranger was inspired by two acquaintances, one a close friend, the other an important mentor. Both had received transplants, and Dean said he felt he had benefited from their transplants, albeit indirectly.
He felt an obligation to repay those donors' good deeds.
He said he studied the ins and outs of donating a kidney for more than a year. His research led him to Duke.
Dean has a family, including two children, and said he didn't make the decision lightly. He talked with his wife and other family members and prayed over it.
After all that and several months of contacts and screenings with Duke, he was sure about his decision.
"If I'm ever able to meet one or both of the (recipients), I'd welcome it, but even if I don't just knowing I impacted one or more lives this way is enough for me," he said. "I don't know of many things you could do in life that could top that."
Jennifer Gommer is a pharmacist for the abdominal transplant team, which includes the surgeons involved in the operations today. She didn't know about the new paired donor program, though, until by chance she read about it on a Duke website, she said.
It didn't take much thought to sign up, Gommer said, because her mother would probably have died while waiting for a traditional donation.
"When it comes down to my own mother, how could I not do this?" she said.
Sue Gommer lives with Jennifer and another daughter. They all hoped that today's operations would free them all from a life that revolved around her mother's four-hour dialysis treatments, three days a week, Jennifer Gommer said.
Sue Gommer had a stroke years ago and can't speak well. But, like her daughter, she's an upbeat sort and declared that she was excited to be getting the new kidney.
Rogers said that he, too, looked forward to a renewed life, after 10 years on life-saving - but life-dominating - dialysis and without a job.
"I'll get to go back to work, go on vacation when I want. I'll get to eat what I want," Rogers said. "Oh man, I can't want to get back to being normal."