I started writing this book for several reasons. Partly it was for me, to write down all the strange and sometimes wonderful things that happened when I donated a kidney, and to remember how it has completely changed my life for the better.  Partly it was because I wanted to save other people from experiencing some of the things I did, many of which are completely preventable. 

I finished writing this book because of the emails I had from people asking for some real advice, to know what it was really like, and not the PR version.

As honest as doctors and nurses try to be there is a huge pressure to provide organs to people in kidney failure.  And that is nothing compared to the pressure you may feel just from watching someone you love go through organ failure.  I am a big fan of the French system of organ donation which requires people to opt out, rather than to opt in – but even a system like that might not be enough to help all the people who are in organ failure now, or those in renal failure alone.  It's terribly, terribly sad. 

I didn't choose to take a lot of advice before the operation, I didn't open up to many people, I just put my head down and shoved my way through the process.  I hope I have learnt now to maybe actually listen and take advice a bit more – I think my experience would have been better if I could have.  I was just too scared that I might chicken out if I knew all the details.

I'm sure that some people approach childbirth the same way.  But most will want to read a few books, talk to other people, maybe get some ideas to make it easier.  And I really, really hope that this book might make it easier for you, even if you are just reading this so that you can support someone else who is donating.

My brother is now back on the transplant list.  He's waiting.  Sad to say that even if you do donate a kidney one day you may be back in this situation.

A lot of the literature about kidney donation is actually produced by pharmaceutical companies who benefit from the sale of anti rejection medication – that seems like a conflict of interest to me, but then again I am profiting from this book and from people visiting my website, so you could argue there is a conflict of interest for me too.

The truth is that anyone you talk to has a different perspective to you – it's natural.  Your friends and partner may want to protect you, your family may be worried for you as well as the recipient, the recipient may be torn by both a desire to protect you and to have the new lease of life that a kidney transplant can bring.  The truth is that no one, even someone who has gone through this process, can understand how you really feel.  This is your decision alone.

You may feel both a huge pressure to donate and a huge pressure to run away and hide, because, no matter how statistically safe the surgery may be, you are still taking a risk by going ahead.  Very few things in life are risk free.

If you are reading this perhaps you are thinking of donating, maybe you already have, maybe you want to support someone, maybe you can't donate but want to understand, maybe you are even a recipient or potential recipient.  Whatever the reason; when you donate everyone tells you what a brave and wonderful person you are – and you are.  But you are not a brave and wonderful person because you are donating, you are already that person underneath – we all are.

I had an email from someone recently in a difficult situation regarding donation.  She wished that she could hand that decision over to someone else.  I wrote my reply and then talked to a few people about it – each one of them had a different opinion.  I don't think she will mind if I share a few of those words with you, and I'd like to leave you with them.

Please remember that I had "open" surgery and if you are able to donate via keyhole surgery it might be a lot less invasive and recovery time might be shorter.  And please accept my apologies if I have rambled on too long or if bits of this make no sense – I am not sure exactly what might help you so I have just dumped it all in there!

Just reading your email took me back to finding out that I was a match for my brother. I was overwhelmed.  I felt that nothing I would ever do or had done were anything compared to this huge gift that I was going to make, and it was only talking to my brother that calmed me down.  But I also know now that I am so much more than just being a kidney donor.  As much as my brother appreciated the kidney, he also appreciates all the small things I do for him, taking the time to be with him, letting him talk about dialysis, visiting him there (most of all he appreciated the iPhone that I got him to use in dialysis) and this is what it is easy to forget – that the little things are the big things.  I say all this, and I really hope I am explaining myself properly, because no one can promise you that the kidney will take – there are usually periods of rejection at the very beginning as they try to get the dosage of drugs right and that is very hard, I can tell you.

Please don't let the big things take over from all the good things in your life.  There are so many things you can give your loved one besides a kidney.

This decision is not your life, much as it probably feels like it, and it is really hard not to let the difficulties suck the joy out of your world.  People talk about kidney donation as a miracle, but the small everyday acts of love are miracles too.

When I made the decision to donate it was hard as I was 30, I didn't have a partner and part of me was thinking I should be out there dating, meeting someone to have kids with, and "will someone want me with a great big scar..." but after all that it was the positive emotional side effects that enabled me to have great relationships after the op. 

Please remember that you are enough all by yourself, whether you donate or not.  The most important thing in all of this is you and I am sure that your loved one would want you to know that.

Maybe you could even consider taking some time out for yourself, letting go of the need to decide and just enjoying what you do have right here and now, your loved ones, your life as it is.  Don't miss the wood for the trees.

I know you are looking for the right answer, but there isn't one.  Whichever path you go down you will never know what the outcome of the other would be. Whatever you choose is the right answer.

Love, Pearl