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The rewards of sacrifice

Tara Cottle didn’t need the doctors and lab technicians to tell her she qualified. She knew she would all along, eventually. And when the time came to decide, she didn’t need a few days to consider it, either.

Since the moment she found out in February that her oldest brother, Scott Pyper, after three years of dialysis, had finally relented to the possibility of a kidney transplant, Cottle had a feeling where that kidney would come from.

So when her brother, Mark Pyper, sent an email to Cottle and her eight siblings explaining Scott’s recent decision and asking those who would consider making the sacrifice to respond, Cottle did so knowing deep down what the end result would look like: her, lying on an operating room attached to monitors and surrounded by a team of physicians, a surgeon’s knife trained on her side. And she couldn’t wait.

“From the very first email that Mark sent out, I knew that I was to do it,” Cottle said, fighting back tears. “It was mine. We looked at (the email) and never looked back. Other people would say to me, ‘I don’t think I could do that.’ I couldn’t understand it because it was so strong in my heart that I was supposed to do this.”

Following a battery of tests that spanned months, Cottle, 51, who works for the Ashland School District as a computer technician and test coordinator, donated a kidney to her brother Aug. 16 in a surgery that lasted about three hours and instantly improved Pyper’s quality of life. A leukemia and prostate cancer survivor, Pyper had been driving to a hospital near his home in Salt Lake City, Utah, three days a week for dialysis treatments, procedures which sapped his energy and made holding down a job impossible.

Now, after Pyper completes a series of follow-up examinations in the coming months, he’ll be free of that burden. A more true measure of what Cottle’s contribution really means, however, was apparent only minutes after the surgeons finished putting him back together. Indeed, even before his 10-inch incision was closed, Pyper’s new kidney began excreting urine, and not long after that the color in his eyes, formerly a sickly Dijon mustard cast, gleamed an off-white.

“And for a quiet guy, you couldn’t shut him up those first couple days, he was feeling so good,” said Morgan Cottle, Tara’s husband. “And his wife, she’s just rolling her eyes like, ‘I’ve got my husband back.’”

Growing up, Pyper and Cottle always had a special relationship. Pyper was the oldest, but Cottle was the oldest girl and “the oldest of the six little kids,” as she put it.

“Major levels of dynamics there,” she said with a laugh.

Though Cottle’s confidence never wavered, her odds of being the first in her family to qualify as a possible donor were long. For one, Cottle’s not a blood relative — she was adopted into the family — and her two older brothers, both of whom were related by blood, were first in line to be tested. But after a previous blood clot eliminated Mark as a possibility and another issue crossed out the next natural brother in line, Greg, Cottle stepped forward.

That’s when Cottle’s suspicions were confirmed. She knew her blood type was O-negative, which makes her a universal blood donor and increased her chances to matching the University of Utah Hospital’s strict criteria for organ donors. What she didn’t know was that her blood antigens were almost a perfect match, so close to Pyper’s that even the surgeon in charge had a hard time believing she was adopted.

Still, from March to July Cottle took a series of tests designed to determine not only whether she was a viable candidate, but also whether her own quality of life would be in jeopardy post-surgery. Urine tests, blood tests, even a psych evaluation, for which a doctor asked her, over and over again, questions like: “Are you being coerced?” and “Are you being paid for this?”

Eventually, Cottle had passed all but one test, a crucial hurdle that measured the levels of protein in her blood. Her white blood cell count and platelets were too low, her creatinine levels slightly elevated. After three fails nudged her to the brink of rejection, Cottle begged a liaison between herself and the hospital named Sarah for another chance.

“I just said, ‘I think I failed, but Sarah, just give me one more try,” Cottle said. “And so I did all this research, I took every natural supplement that I could find. And I passed.”

She still had to fly to Utah on July 5 for final confirmation, which she received. While she was there, she met the surgical team. The surgeon told her he’d take her left kidney because the right one was fueled by two arteries instead of just one. Less cutting.

She also was able to visit Pyper in Utah. It was Cottle's first visit in some time and she was shocked at his appearance.

“He couldn’t stand up without holding onto a wall,” she said. “He fell into chairs instead of lowering himself. His skin was a funky color. He was so ill, he wasn’t himself anymore. It was dramatic, and it was another confirmation to me that we need to do this and we need to do it as soon as possible.”

Still, Pyper called his little sister every other day, asking her if she was sure, whether she really wanted to go through with it. The answer was always the same.

The Cottles arrived in Salt Lake City two days before the surgery, a Sunday. Pyper’s Medicare covered everything but the cost of their plane flights and 11 nights in a hotel. When they checked into the Marriott, the receptionist asked them why they were staying.

“When Tara mentioned (the surgery), the woman just stopped,” Morgan Cottle said. “She goes, ‘Well, you can’t just stay in a regular room. What if you want to watch TV and she wants to sleep? We’ve got to upgrade you to a suite and we need to knock the price off. And here’s the concierge breakfast and lunches. So you don’t need to worry.’”

The unexpected gesture, combined with a GoFundMe drive which raised $3,050, turned out to be just enough to cover the trip, almost to the dollar.

The Cottles arrived at the hospital the morning of the surgery, which was set for 11 a.m. It was one of six kidney donations scheduled for that day. As in all live donations, their beds were positioned close to each other for a quick transfer. Pyper’s five kids were there, too. By then, the anticipation was almost unbearable. Pyper and Cottle had been texting back and forth for weeks, messages like, “10 more days!” and “Five more!” A digital countdown.

When the time came, Pyper, who up until then kept his emotions in check, finally let down his guard.

“This man, he keeps everything so close,” Cottle said. “But he gave me this big, huge hug and just said, ‘Tara, I love you so much.’ I started crying, he started crying, his wife started crying. My heart still is full of joy from that moment, and when we gave our last hugs heading into different operating rooms I still knew this was perfect.”

Even though she watched a YouTube video which condensed the three-hour surgery into seven minutes of “highlights” the night before, Cottle was not nervous about the operation. The University of Utah Hospital is considered one of the best places in the country to trade kidneys, and besides, after weeks of praying and fasting with family and friends — the Cottles have seven kids — she had no doubt. It was meant to be.

Confirmation came quickly.

Two hours after the surgery, Pyper was transferred from recovery to a hospital room, and 30 minutes after that his new kidney had filled up its first urine bag. That first day, the kidney was hard at work, for a while filling a bag about every half hour. Eventually, he made his way to Cottle’s room. Cottle was still nauseous from the anesthesia, but Pyper couldn’t help himself. He had to see his little sister. He had to say "thank you," again.

“And we hugged and loved and he’s thanking me and his wife is crying, saying, ‘Scott is peeing on his own,’” Cottle said. “And every time they empty that bag Scott’s eyes become clearer, his skin improves, he’s becoming himself again, that we haven’t seen.

“His kids came to thank me and to cry with me in celebration in what they’ve seen as their dad coming back to them. And he really was. His voice. I’m still amazed at how alive he sounds because he was so ill for so long, we got used to that voice. To talk to him now, it’s like I have my brother back.”

In another example of how drastically things had changed for Pyper, he enjoyed a rare treat the next morning: steak and eggs for breakfast.

Now, the whole experience has turned the Cottles into strong advocates for live donations. She claims the surgery left her almost completely pain free and there are no side-effects. She was taking Tylenol initially, nothing stronger. The long-term risks for her are virtually nonexistent. Utah University has a 100 percent one-year success rate, and as the doctors told her before the surgery, a person can get by using only 5 percent of one kidney, making it possibly the most redundant backup organ in the human body. In short, she said, live organ donations are win-win propositions, and it was one of the best decisions she's ever made.

Sitting in her back porch Tuesday, Cottle said she would be back at work already if not for the doctor’s orders (in truth, she admits, she may have cheated on that one, just a little). Her only restriction is lifting: no more than 10 pounds, or about a gallon of milk. When she returns to work this morning, those who don’t know what she’s done will likely notice only one thing different about Cottle: she's missing much of her blonde hair after she chopped off 10 inches and donated the bundle to Locks of Love.

For somebody who's not used to sitting around, it's been a long break.

“How many episodes of NCIS can I watch?” Cottle said with a laugh. “And I’ve read four novels.”

Walking through her house Tuesday, Cottle noticed a small, purple pillow she wanted to show off. It was one of several gifts she received from the hospital on check-out day. It’s shaped like a kidney and marked with a black sharpie. The script is messy and somewhat smeared, but Cottle would know the handwriting anywhere.

It reads: “Thanks for saving my life! Love you my sis!”

Joe Zavala is a reporter for the Ashland Daily Tidings. Reach him at 541-821-0829 or jzavala@dailytidings.com. Follow him on Twitter at @Joe_Zavala99.