Your stake in my kidney

Chris Smit gave his wife, Thea, an unusually precious gift. Claire Keeton witnessed the switcheroo

Thea and Chris Smit share a visceral bond as deep as their wedding vows: they share his kidneys. He donated one of his to her last month, after they found they had a close enough genetic match for a viable transplant - a rarity for couples.

They allowed me and photographer Raymond Preston to observe this intricate process - the harvesting of his kidney and implantation into her body - at the Wits Donald Gordon Medical Centre in Johannesburg.

It was a riveting spectacle. First, the smoking-hot scalpel slicing through the abdomen towards his kidney to free it up for donation. Then the meticulous stitching of the organ into her body - and the critical moment when it "pinked up" and started passing urine.

Wits Donald Gordon Medical Centre is the only hospital in South Africa where living-donor liver transplants are performed. Twelve children and one adult have received livers there since the programme began in March last year.

The youngest living-donor liver transplant recipient is a toddler whose mother donated about a third of her liver to him last June.

Moments before their kidney transplant, Chris, 51, and Thea, 45, sit side by side in their blue-striped and pink fluffy gowns, and tell their story. "It's like a soapie," he says.

A devout Christian, Chris met Thea through a support group for her when she was ill. A romance began between the civilian and the military man. He recalls: "I had an inner fight with myself that my feelings for her were not pity."

They had both been married before and when he proposed, her response was: "As jy my jammer kry, ek gaan nie (If you're sorry for me, I won't)." By the time of their wedding in May 2010, dialysis machines were keeping her alive again. Thea needed dialysis three times a week for four hours at a time. Chris decided to give her a kidney.

Thea, who has endured kidney problems since she was eight, had received a cadaver kidney transplant in 2006. The kidney did not work properly and finally failed.

"She was clinging to that kidney like a puppy dog you don't want to put down," says Chris. Last year it was removed and, once again, their lives were ruled by dialysis.

Finally, on 20 May, the couple were ready. Before being wheeled away, blowing kisses to Thea, Chris said: "I feel quite at ease, like I was going to the movies or a braai."

The next time we met them, after a week's recovery, Thea and Chris were at the Transplant Unit, ready for discharge. Chris was less breezy but confident that he had done the right thing.

"I'm still very glad about what happened. The kidney is working and this will be a big change in our lives," he says, while Thea offers a double thumbs-up.

When she came round after the operation, she was relieved to hear that Chris was safe - and then overjoyed to have a working kidney for the first time in a year. She says: "I feel so lucky that Chris has given me a second chance in life."

Her first wish is to see the spring daisies in Namaqualand. "Secondly I would like to do the Paralympics. I want to do something like high jump. Both Chris and I want to do this together. We want to get fit and stay fit."

Longevity with one kidney is possible. The oldest related living kidney donor in Joburg, Johannes "Sweetpea" Liebenberg, celebrated his 90th birthday in April, with the daughter who received his kidney 28 years ago. The party at the hospital was planned around his twice-a-week golf games. "I was fine after the transplant and playing golf after about 10 days. After the surgery I walked up and down the corridors with a drip to keep fit. I told the 'Dokkie' to release me or I'd break out," he says, referring to Professor René Botha, known as "Dokkie", who was one of Joburg's pioneering transplant surgeons.

Harvesting the kidney, about 10.30am to about 12.30pm:

Chris lies on his side under anaesthetic. A probe with a camera is inserted through a hand-width incision into a cavity to guide Professor Jerome Loveland, who will do a hand-assisted laparoscopic nephrectomy. This minimally invasive style of surgery allows the patient to recover faster and takes longer to perform.

"You're working with a healthy guy so you want to be sure you put him at no risk," says Loveland.

When he begins the operation, a screen shows him meticulously guiding the scalpel inside the belly to avoid major blood vessels and organs. Its tiny silver jaws snap through tiny vessels in the fat, cauterising them to prevent severe oozing or bleeding.

Intra-abdominal fat is normal and protects the organs. The kidney is encased in fat and Loveland dissects this away, identifying the renal artery, vein and ureter to attach to the recipient.

On the screen, the scalpel passes the spleen, the diaphragm moving in and out, the stippled adrenal gland and pulsing aorta and renal artery. Loveland eventually reaches the kidney and loosens up the tissue around it, ahead of extraction.

After nearly two hours - Loveland said this was his most difficult harvest to date - he takes out the kidney and puts it in sterile ice slush, which slows the cells' metabolism to prevent them dying. The organ is double bagged and placed in a blue cooler-box labelled: "Human organs in transit".

Implanting the kidney, 12.30pm to 13.20pm: The cargo is wheeled to the next theatre, where Thea lies with a brick-sized hole in her lower abdomen. Her external iliac artery and vein have been tied off, ready to be sewn to the renal artery and vein of the donor kidney.

The surgeon, Professor Russell Britz, works silently. He lifts the kidney from the bag and systematically carves off the fat until it is about half the size. It's now as smooth as a litchi pip.

With a blue thread, he stitches the renal artery from the kidney to the iliac artery and the vein to the iliac vein. It's harder to follow the progress, since this is open surgery with no screen and the two surgeons are huddled over the operating table.

Once attached, the clamps are released and the greyish kidney turns a shade of purple. Britz attaches the ureter - which drains urine from the kidney - to the bladder and the kidney starts to work, passing blood-tinged urine into a bag.

"A transplant is like the birth of a child, but the organ doesn't cry," says Professor Botha, who recently retired from fulltime surgery.

The transplant team

Lou Aucamp: This vigorous 73-year-old sister arrives at the hospital at 6.30am and doesn't want to stop working after 40 years in transplants. "When I started I knew nothing, but I learnt with Dokkie. I knew from the start this is where I want to be."

Kim Crymble: One of the transplant co-ordinators at Donald Gordon, Crymble finds organ donors in Gauteng and counsels donor families. "With their permission, we try to retrieve as many organs as possible." Crymble is one of five co-ordinators in Joburg, and 12 in South Africa.

Jerome Loveland: A senior consultant in transplant, he is a fulltime professor of paediatric surgery at Chris Hani Baragwanath Hospital. Berndt Strobele helped him to harvest the kidney.

Russell Britz: Co-director of transplant at the medical centre and Wits University professor of transplantation, Britz performed the implantation. René "Dokkie" Botha assisted Britz

• To contact the Organ Donor Foundation, call their toll free number: 0800 22 66 11. It is illegal to trade in human organs.