I guess 57 is still considered middle age. It better be or else I’m redefining it. At any rate, the 50s is a transitional decade. One can get to 40 and even 50 and still be very youthful in appearance. It’s very difficult to get to 60 without looking — dare I say it? — old? — or at least more “mature.”

(I guess at this point I should gallantly interject and say that the above is in reference to men only.)

One’s general appearance that will be carried into old age is pretty much evident by the time one turns 60. Not only that, the 50s are a transitional decade health-wise. A lot of bad things seem to happen to a lot of people in their 50s, and there’s this sort of vague feeling out there that, if you can get to 60 in reasonably good health, you should be good to go in terms of a normal life expectancy.

We see it all the time in the medical community, but one of the ailments that lay people don’t expect to hear too much of in their 50s is kidney problems. Many people in my extended group of friends and acquaintances are buzzing with the reality that two people we all know — both women — have required kidney transplants.

Kidney transplantation is generally very successful and provides a way for people to avoid the pain, pitfalls, confining lifestyle and tedium of dialysis. Interestingly, The New York Times had a story last year about a California gentleman, Rick Ruzzamenti, who was told by a desk clerk at his yoga studio that she had recently donated a kidney to an ailing friend she had bumped into at Target. He was so captivated by this act of kindness and generosity that he called a local hospital to ask how he might do the same thing.

Fast forward several months. Someone on the other side of the country desperately needed a kidney transplant and received precisely that. While the donor was not the yoga practitioner, there was a connection between the two in that they were the first and last patients in the longest chain of kidney transplants ever constructed, linking 30 people who were willing to give up an organ with 30 who might have died without one.

Here’s how it worked: The domino chain of 60 operations was made possible through the willingness of a good Samaritan — in this case Ruzzamenti, who expected to give the initial kidney, with nothing in return. Momentum was then fueled by a mix of selflessness and self-interest among donors who gave a kidney to a stranger after learning they could not donate to a loved one because of incompatible blood types. Loved ones, in turn, were offered compatible kidneys as part of the exchange.

Ruzzamenti ended up giving a kidney to a 66-year-old recipient whose niece, a 34-year-old nurse, wanted to donate, but couldn’t due to blood type incompatibility. She agreed instead to have her kidney shipped to the University of Wisconsin Hospital in Madison for somebody else’s transplant, whose former boyfriend, agreed to donate a kidney on her behalf despite their acrimonious split.

The husband of the recipient of the latter kidney donated one of his own on her behalf to a young father of two at Sharp Memorial Hospital in San Diego. And so on and on the chain extended, from one coast to another, with kidneys iced down in cardboard boxes equipped with GPS systems and stowed on commercial aircraft, awaiting transplantation.

According to the Times article, about 90,000 people are lined up for kidneys. Fewer than 17,000 receive one each year, and about 4,500 die waiting. Only about a third comes from living donors, but they are coveted because they typically last longer than cadaver kidneys. Among organ transplants performed in 1999, 60 percent from living donors were still functioning after 10 years, compared with 43 percent from deceased donors.

And yes, it saves money. According to The Times, the federal Medicare program, which pays for dialysis and most treatment costs for chronic kidney disease (but not necessarily other organ dysfunctions), saves an estimated $500,000 to $1 million each time a patient is removed from dialysis through a live donor transplant.

Remarkably, the Times story tells us that until recently, hospitals regularly turned away good Samaritan donors on the assumption that they were unstable. Ruzzamenti, who was described as having “flat affect and an arid wit,” was not only tested medically, but quizzed extensively about his motivation and expectations. He was quoted as saying he felt his decision was rather obvious. “People think it’s so odd that I’m donating a kidney. I think it’s so odd that they think it’s so odd.” Ruzzamenti did say he might have been influenced by a Tibetan meditation known as Tonglen. “You think of the pain someone’s in, and imagine you take it from them and give them back good.”

Which raises the question: Would you? (Would I? Please give me some time to think about it!)

Edward M. Gilbreth is a Charleston physician. Reach him at edwardgilbreth@ comcast.net.