Transplant surgeon Amy L. Friedman, M.D., brings more than professional knowledge to the room when she checks on a kidney transplant patient or a living donor. Friedman herself came close to donating a kidney to save her mother’s life.

Friedman’s aunt proved to be a better match, donating a kidney that kept Friedman’s mother alive for 17 years following the transplant. “She saw her three daughters married to men they loved and she held seven of her eight grandchildren,” says Friedman, an associate professor of surgery who came to Yale in 1992 from the University of Pennsylvania. Her mother died in 1997 at age 61 from complications of type 1 diabetes.

Friedman, now 44, was in medical school at the time of her mother’s surgery. She had no inkling that she’d become a surgeon herself. “I had never considered it. I thought that I would be unable to deal with the blood-and-guts aspect. To my total shock, I loved surgery. What I liked was the immediate need to be absolutely decisive. … Surgery combines art, judgment and technical skills. It’s possibly the ultimate in problem solving. You can’t find a problem with the abdomen and leave [sew the abdomen closed] without resolving it.”

Decision-making for a transplant surgeon sometimes occurs far from the operating room: Friedman has to move quickly when she gets a call about a kidney or pancreas available for transplantation. Within one hour, she has to evaluate how good the match is with the potential recipient (who is chosen from a centralized list), whether the person needing the organ is strong enough to endure surgery and whether he or she can be reached and hospitalized on short notice. “You have to be decisive even if you’re freezing, sitting outside watching your son’s football game.” Usually the organ comes from an accident victim who has just died. “Not only is it being on call for living people [those awaiting an organ] but also for deceased donor organs … because you can’t postpone.” The chances of success increase if the transplantation is done quickly.

Friedman and her colleague, Marc I. Lorber, M.D., professor of surgery, also remove kidneys from living donors—from a family member or friend of a patient willing to give up a kidney, as Friedman’s aunt did. Since June 2001, Yale has offered laparoscopic donor nephrectomy, a less-invasive surgery for removing a donated kidney. Friedman removes a living donor’s kidney by making only small incisions, inserting a miniature camera in one opening and watching their work on a video monitor. Patients recover faster and have smaller scars, so many who qualify for the new technique choose it.

Because of her demanding schedule, Friedman counts on her husband, engineer Simon Meguira, to “fill in the gaps” in raising their three children. Photos of her two sons and her daughter, ages 15, 9 and 11, fill a shelf in her crowded office. Friedman decided to have her first child during residency, an unusual decision in the 1980s. She’s glad that she started relatively young, at 29, because she later encountered some fertility problems. She is grateful to the surgeon who guided her in deciding whether to have children during residency. She still remembers the woman’s words: “ ‘Amy, 20 years from now, when you look back, are you going to be sorry you didn’t have the kids or that you didn’t have the ultimate academic career?’ The answer was I needed to have the children.”