The Unearned Gift

I never planned to be a transplant recipient.

So when I heard a snap and felt my leg give way beneath me, mid-pivot on a dance floor, when I limped through orthopedic tests and received the news that my anterior cruciate ligament—the cord that connects the thigh bone to the shinbone and stabilizes the knee, often called the ACL—had torn completely, I anticipated rehab, a permanent limp, and an end to my athletic pursuits (most recently, roller derby). When my orthopedic surgeon announced that my mobility could be restored by receiving a tissue transplant, I was shocked.

“Do not be afraid,” he might as well have said, for I heard the pronouncement of a miracle.

“The outcomes from an ACL replacement with an allograft—or donor tissue—are really excellent,” the surgeon said. “It’s a common, outpatient procedure, and you’re an excellent candidate to make a full recovery.” The surgeon was clear-eyed and calm, with silver hair that shone, I swear, like a halo. “Do not be afraid,” he might as well have said, for in his words, I heard the pronouncement of a miracle. 

My own, less articulate response was: “I had no idea that was even a thing.”

To this point, I’d only considered donor tissue from the perspective of a potential donor. If my own life ended and my body could benefit another’s wellbeing, I’d offer myself willingly. I supposed in a matter of life and death, I would be open to receiving a transplant. But a knee ligament wouldn’t tip the balance on my immediate mortality. One misstep on the dance floor had landed me in an ethical heap: did I deserve to receive donor tissue?

Did I deserve to receive donor tissue?

The surgeon laid out the physical ramifications: without a transplant, my knee stability would always be lacking, likely causing issues as I aged. With it, I could expect to run, to bike and hike with my daughter, to move my body in ways that brought me health and wellbeing. A knee ligament wouldn’t keep me alive, exactly, but it could make my life more abundant. I scheduled the surgery, but in the intervening weeks, I limped around in pain and with no small amount of shame, knowing that from someone else’s death, I might gain so much. 

Once harvested and cleaned, an ACL ligament and attached bone plugs can be frozen in a sterile, plastic package, waiting to be transplanted for up to three years. On the day of my surgery, the frozen ligament that would live in my knee thawed in a saline bath. Once I went under anesthesia, the bone plugs of the transplant were shaped into pegs that would fit precisely into holes drilled into my own leg bones. These would anchor the ligament once it was stretched through my joint.

I awoke from the surgery dazed and sore, and upon seeing my knee swaddled and braced, I cried. Only a whisper of pain reached my mind, but it was enough to signify that my body had undergone something profound. As I received a printed stack of care instructions and prepared to go home, a nurse drew my attention to one card in particular, “This has all the information about your donor tissue,” she said. It included a way to anonymously contact and thank the donor’s family. I gripped the card with both hands all the way home, as if, in my hazed thinking, it were the precious tissue itself.

I approached recovery with an existential grit.

The surgeon promised pain in the early days of recovery, and that proved true. I took meds, rested, and began rehab, assuming the discomfort would wane as I grew stronger, but it didn’t. Each day, I undertook my prescribed exercises with an intensity that matched the deep aches I felt. The purity of this pain, unlike anything else I had experienced, seemed clarifying. With my lingering uncertainty about whether I truly deserved the tissue transplant, pain provided a clear distraction, even an obstacle to overcome. My mind unconsciously created a tidy equation of my physical and ethical suffering: if I could conquer the pain, it would prove I was worthy of the transplant. And so, I approached recovery with an existential grit.

At my six-week post-op checkup, the surgeon checked my scars and tested the joint.

“You’re doing really well,” he said as he manually extended and bent my leg, checking my flexibility.

I nodded with the enthusiasm of an overachiever intent on earning an A in recovery. I admit to feeling proud.

“You’re still early in recovery, though,” he added, gently laying my leg on the table. “Right now, there is no blood supply to the transplanted ACL,” he explained. “That’s why stretching and physical therapy are important—they keep the tissue supple.”

I nodded again, feeling righteous about every uncomfortable step, stretch, and leg lift I had forced myself to perform thus far.

“But you need to make sure you don’t over-do it. The tissue can’t heal or repair itself until there’s a blood supply,” he said. He sat down, drawing his chair near to me, pacing his words so that I would hear them. “That can take between three and nine months. Some people think they can move things along faster by working harder, but there’s no hurrying the healing process.” He tilted his head and raised his eyebrows at me. “From here it’s slow going, but it’ll be worth it.”

I knew he was right, and yet my heart sank as I took in his words. As I dressed, I felt heavy, directionless. I wanted to recover, yes. But I also wanted to earn it, to pay my own way to mobility through effort and hard work. How else would I know I was worthy of the gift I had received? As soon as this thought arose, my despair blossomed into embarrassment. For the first time, I saw my motivations clearly. 

No amount of work could earn me worthiness.

Of course I couldn’t prove I deserved the transplant. No amount of work could earn me worthiness. As a clergyperson, I knew this in a spiritual sense. Grace, after all, is never earned. As I left the office, I knew that my recovery would be about more than regaining mobility. There was a spiritual component, too. I would need to release my guilt and shame, would need to relate to pain not as an obstacle, but as a teacher. Could I learn how to experience grace, not as an intellectual idea or fuzzy spiritual feeling, but with my body? Through my body? Though unsure of how to go about it, I scrounged up enough hope to try.

In an effort to listen to the pain without trying to defeat it, I began to take walks. Short ones, at first, adding a few steps each day. I tired quickly, from mental fatigue as much as physical, as I concentrated on the mechanics of every other step: leg extension, heel strike, foot roll, and toe press.

         “This is it,” I thought wearily. “This is my body now.”

         The words echoed in my mind, rippling with a memory. I paused.

         This is my body…broken for you…Take. Eat.

         I’d said these words hundreds of times, held bread above my head, tore it, then handed the ragged parts to others, knowing that none of us had earned these morsels of grace. And yet, it was enough to simply, humbly receive. Pulsing with this sacramental muscle memory, I took a step. Perhaps I could simply receive the transplant. What if that were enough?

         I took a few more steps, and words continued to float to the surface of my mind.

         This is my blood…poured out for you and for many…

         I thought of my donor, of all they had given, of all the others who had likely received from them. Organs and tissue bringing life to myself and so many others. I remembered the surgeon’s words and imagined my own blood reaching out toward the transplanted tissue: capillaries wending their way through my knee, bearing new cells which would gradually reconfigure the collagen structure of the ligament until it would become, quite literally, something new within me. My body already knew how to do the work of transformation that came from receiving. It already knew how to heal. 

As I finished my walk, the wavering pain in my knee came as an invitation to attend, not to guilt or shame, but to the holy mystery of being made whole. Not to control it. Not to earn it. But to simply receive it and give thanks. I trusted my body and spirit to know what to do with the grace I received through Communion. And I could trust them to know what to do with the grace I received through the transplant.

The wavering pain came as an invitation to attend to the holy mystery of being made whole.

Five months after my surgery, I sat down at my computer and entered the information from my donor card into a website. Faced with the blank field where I could type a note to my donor’s family, I knew my words would fall short of all I wanted to say. I kept my message simple: “Every other step I take is possible only because of the holy sacrifice of someone I will never meet. Because a part of them lives in me, I move with strength. In honor of them, I give thanks and offer my best to the world. I pray that knowing this lifts your heart.”

As I continue to heal, I think less about my knee, the donated tissue, or my donor. But I know that I have not taken the experience for granted. Along with the gift of tissue, as a donor tissue recipient, I also received, again, the gift of grace. Grace that enables me to move without shame or guilt. Grace that strengthens me to walk, to run, and even to dance. Carefully, of course. But with no shortage of praise.

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To learn more about organ and tissue donation, visit organdonor.gov.

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