Relying on a spouse to be a donor depends on their being a good match. Opening up the pool of potential donors to friends increases the chances. And this raises an even more radical idea – donation by strangers. Some doctors think financial inducements should be offered to encourage people to donate their kidneys.Women who rent out their wombs to others in surrogacy arrangements are permitted by law to charge expenses (but not a fee).

The idea of similarly compensating kidney donors for their time, suggested by some specialists, is being considered by a Government committee set up to review the transplant system.For Marshall and Brough, money did not enter into it. Indeed, under the rules, careful checks are made to ensure that Marshall has not been put under any pressure to make his donation. The two men have known each other since primary school in Middlesbrough where they both still live. They were inseparable as children and their relationship survived into adulthood. Marshall was best man at Brough’s wedding and is godfather to his two daughters.Brough runs a shipping business and had just returned from a trip to Mexico in 2001 when he developed Legionnaire’s disease. He was in intensive care for three weeks and when he recovered he was told his kidneys were permanently damaged.

When Marshalllearnt of his friend’s predicament he wrote a long and “very touching” letter to the hospital, offering one of his own kidneys to his friend, according to consultant Stephen Kardasz.A battery of tests were begun to check that Marshall was medically fit, under no coercion and that his kidney was compatible with Brough. This is less critical than was thought in the past – matching blood groups is usually sufficient. Each man was allocated a separate consultant and then the case was referred to a third consultant before being sent to the Unrelated Live Transplant Regulatory Authority (Ultra) which vets all such applications.Although he is apprehensive about the surgery, Marshall says his decision was unavoidable. He talked it over with his wife, a nurse, and two grown-up sons before volunteering “Kidneys are in short supply. Bill’s condition would deteriorate over the years, but I can fix things with one of mine,” he said Brough is tearful when asked about Marshall’s gesture “It is simple, really. Derek is giving me my life back.”The main task at each stage of the assessment is to ensure that no pressure is being applied and that the relationship between the friends is genuine.