Judith “Judy” Hansen O’Toole is in a familiar place.
For the past 15 months, the Greensburg resident has undergone kidney dialysis three days a week while awaiting a kidney transplant — 24 years after receiving her first one.
“I’m generally an optimistic person,” said O’Toole, 72, who served as the Richard M. Scaife Director and CEO of The Westmoreland Museum of American Art in Greensburg from 1993 to 2018.
Her optimism has grown because her younger sister, Kirsten Janowicz, 69, of Michigan, was approved by the Starzl Transplant Institute in Pittsburgh last week as a suitable donor, after undergoing what Janowicz described as an in-depth battery of tests over three days.
While O’Toole remains on the national kidney transplant list for a deceased donor, this development opens a new door for her to get a kidney.
The review session Janowicz underwent ensures the prospective donor is a healthy candidate who can function well with one kidney, said Dr. Amit Tevar, surgical director of the UPMC kidney and pancreas transplant program.
“My daughters have been on this journey with me,” O’Toole said. “And as they have grown into wonderful young women, their support and the joy in this great news will make being with them on Mother’s Day even more special.”
The paired exchange
Because O’Toole has Type O blood and her three sisters are all Type A, a direct donation isn’t possible.
Instead, O’Toole hopes to get a kidney from a live donor through the National Kidney Registry’s paired exchange program. This system allows non-family recipient pairs to “swap” donors so that each patient receives a compatible organ. In these cases, transplant teams manage the logistics of matching pairs within the registry.
O’Toole would receive her transplant at a UPMC hospital in Pittsburgh, while Janowicz would donate a kidney through the pool to someone with whom she is a good match.
“When people have end-stage renal disease and are undergoing dialysis, the better option is a living donor,” said Tevar.
Despite the medical clearance that both she and her sister underwent to become a kidney transplant recipient and a donor, the emotional weight remains.
“I’m feeling guilty because my sister is going to make a big sacrifice,” said O’Toole, a mother of two and a grandmother.
For Janowicz, it was an opportunity to help her sister.
“I definitely want to give her a better quality of life. I knew it was something I wanted to do,” Janowicz said of the chance to be a donor that helps her sister get a new kidney.
A growing need
O’Toole’s current kidney, which she received in 2002 just as she was turning 49, has been failing since late 2024. Her blood creatinine levels — a waste product from muscle breakdown that serves as a primary marker for kidney health — were found to be too high.
The sisters could technically act as donor and recipient simultaneously through the exchange. O’Toole said her transplant coordinator was hopeful they would find a match within several months.
“They could get it done immediately,” Tevar said.
The urgency is underscored by national data. Most people on the national transplant list wait five years for a cadaver kidney, according to the American Kidney Fund. Wait times for those seeking a living donor are not listed by the National Kidney Foundation.
O’Toole is far from alone; one in seven adults in the U.S. has kidney disease, and one in three are at risk. As of May 5, she is among roughly 103,200 people on the national waiting list, according to the Health Resources and Services Administration. In Pennsylvania alone, about 5,840 people are waiting.
Last year, about 35% of Pennsylvania transplant recipients — or 290 people — received their organ from a living donor, said Katelyn Metz, a spokeswoman for the Center for Organ Recovery and Education in O’Hara.
“It is amazing the generosity of spirit that is out there to undergo an operation like that,” O’Toole said.
A family legacy
The struggle is a familiar one for the Hansen family. O’Toole’s father, Chadwick Hansen, had polycystic kidney disease (PKD), which is a condition marked by fluid-filled cysts that damage the organ. He didn’t realize he had the condition until it affected his kidney function; he died in 2011 after 13 years of dialysis.
O’Toole learned there is a 50% chance of a parent passing PKD to their children. She was diagnosed in the 1980s and started dialysis in 1998, the same year as her father. Despite the grueling schedule, she continued to work full time at the museum, undergoing treatment in the morning and heading to the office in the afternoon.
The condition affected her sisters as well. Her older sister, Cynthia Guntharp of Lancaster, also was diagnosed with kidney disease. In 2002, their youngest sister, Kathy Ashby of Iowa, donated a kidney to Cynthia.
O’Toole’s own journey has been a marathon. She received a cadaver kidney in 1999, but it failed within two years. That forced a return to dialysis until Barbara Jones, whom O’Toole had hired as a curator at the museum, volunteered to be tested.
“She (Jones) was as close a match as a sibling,” O’Toole said, joking that she hired Jones for her blood type.
The longevity of living donation
O’Toole has lived with Jones’ kidney for 24 years, which Dr. Kalathil K. Sureshkumar calls the “upper range of longevity.” Sureshkumar, medical director at Allegheny General Hospital’s kidney and pancreas transplant program, noted that the average living donor kidney lasts 12 to 15 years, while a cadaver kidney averages around 10.
“The kidney transplants using a living donor … have the best outcome in the long run,” Sureshkumar said.
He added that donors can usually return home within days thanks to laparoscopic surgery, and they can go on to lead normal, long lives.
For the recipient, however, the gift requires a lifetime of taking immunosuppressant drugs to prevent organ rejection. Those drugs can create their own complications; O’Toole noted her own bouts with skin and colon cancers were likely due to the drugs’ effect on her immune system.
Despite the challenges, O’Toole hopes her family’s history of sisters stepping up to be donors will inspire others.
“We hope to inspire other people to make a lifesaving donation and also increase the public knowledge of the need,” O’Toole said.