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“I just want to tell you how thankful I am for the last two years of my life, the gift that you gave me,” Jeff Schmitt told his son shortly before the Oct. 31, 2018 cardiac arrest that led to his death. “I can never repay it. I am so happy.”
Those were among his final words.
“I couldn’t be any luckier,” Jay said. “I reiterated my love for him. I got to work by his side.”
Less than an hour after that conversation, emergency medical technicians were fighting to revive the older Schmitt on the floor of J. Alexander’s restaurant in Washington Twp., to no avail.
He was gone.
Mounting health challenges
From the time Jeff Schmitt was a child, he wanted to sell automobiles.
Selling cars can be unhealthy work. Hours are long, stress is high, meals are carryout and opportunities for exercise are few.
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Typical days for Jeff involved working from nine to nine — sometimes longer.
“You lose your sunrises and sunsets,” said Laura Schmitt, 66, Jeff’s wife of nearly 44 years and Jay’s mother.
“He would always make it a priority to come home for dinner,” Jay said. “But he still worked nine to nine every single day. That took its toll on his health, as it would on any of us.”
By his early 40s, Jeff was dealing with diabetes.
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Diabetes stresses the kidneys, the body’s filtration system. High blood sugar levels can harm those vital organs. Kidneys clean the blood, and if they’re not functioning properly, waste builds up in a body instead of leaving.
Time was not Jeff’s friend. He found himself in the beginning stages of kidney failure a little more than a decade ago, at age 54.
“Your color goes, you run out of energy,” his son recalled. “It’s just a domino effect on a lot of other bodily functions.”
Jeff reached the point where he required dialysis, a time-consuming, uncomfortable process to filter one’s blood.
When the older Schmitt was forced to submit to home dialysis, he moved to a downstairs bedroom, connecting to a dialysis machine every night.
“He’s a very proud man, and that was hard,” Jay said. “But he did it.”
For most dialysis patients, the process takes about 12 hours each week, being attached to a machine which takes blood out of one’s body, filtering and returning it.
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“People on dialysis, unfortunately it does keep them alive, but it keeps them alive with a lower quality of life,” said Dr. Todd Pesavento, a transplant nephrologist at the Ohio State University Wexner Medical Center.
Jeff Schmitt needed a healthy kidney. He was on a recipient list hoping to be matched to a donor, but that process was uncertain at best.
Medical centers are selective, declining often to match a younger patient’s kidney with an older, battered body, pushing Jeff further down a lengthy list.
“It was obvious that a cadaver (donor) wasn’t going to come up,” wife Laura recalled. “There are just not enough kidneys.”
Nationally, there were 103,196 people waiting for kidney donations in 2018, according to the Organ Procurement and Transplantation Network. That's by far the lion's share of all the more than 124,000 patients on a waiting list for any kind of organ donation last year.
In Ohio last year, 2,356 people were waiting on kidney donations. Again, that’s most of the 3,344 Ohioans hoping to receive an organ donation of any type.
The median wait time for an individual’s first kidney transplant — more than three-and-a-half years.
More than 3,000 new patients are added to the kidney waiting list each month, according to national statistics. Every day, 13 people die waiting on a donation.
The stage was set for Jay and his sister Stefanie to step forward.
Most people are born with two kidneys, a pair of bean-shaped organs nestled beneath the ribs. Sister and brother raised the idea of beginning testing to see if they could donate one of their kidneys to their father.
The older Schmitt’s reaction was immediate.
“He just outright refused,” Jay said. “He said, ‘I just will not take from my own children.’”
“We couldn’t even finish the sentence,” he added.
‘A risk of death’
Ashley Schmitt, Jay’s wife, recalls that the idea of her husband donating a kidney initially made her nervous.
“Once I spoke with the doctors, I felt a lot better about it,” Ashley said. “But at first, I was very scared. Jay is my everything.”
In the meantime, Jeff continued to suffer.
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It would take him an hour to get dressed in the morning. After driving to work, it would take 10 minutes simply to walk from his car in the parking lot of his 1001 N. Broad St. dealership in Fairborn to his office, just off the lot.
When he got to his desk, he collapsed from exhaustion.
“He would still come in every day,” Jay said. “But he would fall into this chair. It was hard to watch.”
His mind remained active. Jeff had the vision, and Jay had the energy to execute that vision. He passed on his business acumen to his son, who put it into action, as Jay described their relationship.
But enough, finally, was enough. Jeff reached his breaking point.
Said Jay: “Finally, finally, my sister and I convinced him to accept one of my kidneys.”
Living kidney transplants today are routine. But they’re still considered a major operation.
“It is a major surgery,” Pesavento said. “There’s a risk of death from it. There are risks of other major complications, like bleeding.”
Donations can be physically challenging, especially for the donor, who loses a kidney. Donors transition from whole kidney function to 50 percent function. The recipient, by contrast, gets a boost. Risks include infections, blood clots and more.
Recovery can take up to six weeks.
Those risks are assessed and weighed. Donors are rigorously tested to ensure they are healthy. The Wexner Medical Center has never suffered a donor’s death, Schmitt said.
OSU’s Comprehensive Transplant Center performs about 75 to 100 living kidney donor transplants every year. About a third of all kidney donations today in the United States are living-donor operations.
‘It was worth it, Dad’
The testing process was arduous. Vial after vial of drawn blood, scans, dye tests, more tests, more consultations.
“We need to make this operation as safe for the donor as possible,” said Pesavento. “They get a very thorough medical and surgical evaluation to make sure that, No. 1, that they can undergo the surgery safely.”
Physicians also want to ensure that donors can thrive long-term, that they won’t be at higher risk for developing kidney-related problems, he said. There exists a long-term risk that donors may need transplants or eventually dialysis themselves.
“That’s sort of the foundation,” Pesavento said. “We do as much as we can to make this as low a risk as possible for the donor.”
“It was a lot,” Jay Schmitt said of the testing process. “The good news is: I turned out to be as healthy as a horse.”
More good news: Father and son were a good donor-recipient match, as familial relatives often are.
The surprising news: Wexner physicians wanted to perform the transplant right away.
“It came way too quick,” Jay recalled with a laugh. “We can go in tomorrow.”
Ashley Schmitt felt as prepared for the day of surgery as she could be.
“By the time that day arrived, it was scary, but there was a lot of excitement as well,” she said. “It was like this thing that had been talked about, this idea that had been talked about, was finally here.”
Surgery took about two hours for each man.
“I literally did a dance in the waiting room when they both came out OK,” Laura Schmitt remembered.
The transplant renewed Jeff: His color and energy level improved almost immediately. His sense of humor sharpened. The old Jeff was back.
“Jeff, you could tell, he felt lucky,” Ashley Schmitt said. “And he just felt good. He would laugh more. He would just enjoy being in the moment more.”
Fearing dependence, Jay avoided pain medications in the surgery’s aftermath, gritting his teeth and deciding to live with any lingering discomfort.
“It’s really, really rough on the donor,” Laura said. “My son has never even had a torn toenail. He’s never had much pain.
Jay pushed through. Slowly, he lengthened prescribed daily walks — out of the bedroom to the den, then to the driveway, beyond the driveway, down the block.
Jay was ordered to stay home for six weeks, but less than a month after the surgery, he told his physician he had walked nearly six miles in one outing.
The doctor gave him a cautious green light to return to work.
“Every day, Jeff would ask Jay: ‘Was it worth it?’” Laura recalled. “‘Jay — of course, this is sarcasm — would say, ‘Not yet, not yet.’”
Then after eight months: “Jay looked at his dad and said: ‘It was worth it, Dad.’”
Said Laura: “Sometimes the pain you go through, it just makes you a better person.”
‘It’s an honor’
Jeff Schmitt’s final two years were good ones. “He was at the top of his game,” his son said.
The older Schmitt completed estate arrangements and his will two weeks before he died. He leaves eight dealerships and a thriving business. The last three or four months “have been our best ever as a company,” his son said in a mid-October interview.
At Schmitt’s dealerships, employees “put their boots back on” after Schmitt’s death. Jay took on the leadership role. Industry publication Automotive News selected Jay as a member of its “40 under 40” class for 2019.
“I went from feeling bad to being thankful,” he said. “To sit in that chair that you’re sitting in, every single day, across from my dad and just learn — to have this legacy that he built and to be able to carry it on … it’s an honor.”
Those who are approved to be donors tend to be healthy people. Pesavento said Jay Schmitt should live a normal life.
About three months after a kidney transplant, the donor’s remaining kidney takes up to 70 percent of a donor’s pre-donation kidney function. That is sufficient to keep one alive and doing well for decades, the doctor said.
Donors don’t have to be “exceptionally healthy,” Pesavento said. If you have a interest in donating, don’t “self-exclude,” he said. He advised those interested to call a transplant center and let the center do the work of determining whether you’re eligible.
“Do it,” is Jay Schmitt’s advice to would-be donors. “The life that you can give somebody — it’s a gift that can’t be quantified.”
Kidney transplants, by the numbers
113,791: The number of people awaiting kidney transplants, as of 2018
21,167: Kidney transplants in the United States
11,570: Of those transplants came from deceased donors
5,537: Of those transplants came from living donors
Source: National Kidney Foundation