CLEVELAND, Ohio--On a frigid January day in 2014, Adam Shay lay in the Neurointensive care unit of the Cleveland Clinic, the rhythmic hiss of a mechanical ventilator doing the work his brain could no longer tell his lungs to do.
Two days before, the burly 21-year-old former high school football player had overdosed on heroin in his Mentor apartment, been found by his fiancee and a friend who performed CPR until paramedics arrived, and then been taken to the hospital, unconscious. Days of subsequent tests confirmed that Shay would not wake up again.
The young man's relapse came after a year of sobriety, a steady job delivering pizzas at Papa John's and an engagement to his high school sweetheart. It ended a three-year struggle with substance use disorder for the 2011 Mentor High graduate.
About a five-minute walk away on the 10th floor of an adjacent Clinic building, 42-year-old Karen Goodwin held out little hope of surviving the month. A decade of cocaine and heroin use, repeated suicide attempts, and neglect of her Type 1 diabetes beginning at age 18, had caught up with her.
She needed a new kidney and pancreas or she would soon die.
Goodwin, of Deerfield, didn't know Shay, but she knew his disease all too well. It had nearly killed her, and even with 13 years of sobriety, it still could.
Shay, his family learned at the hospital, was an organ donor, having checked the box while renewing his driver's license six months earlier. It wasn't a decision he'd made lightly.
"I could save a life one day," he'd told his fiancee, who was with him that day.
Goodwin, like the nearly 2,000 other kidney-pancreas transplant patients nationwide waiting for donors at the time, desperately hoped to be saved.
She was not first on the transplant list though. Someone else would be offered Adam's organs before her.
Goodwin didn't have much hope. Who, after all, would turn down a chance at life?
Adam Shay, age 5.
Out of growing tragedy, hope for many
Adam Shay was the first of 19 drug overdose victims to donate organs in Northeast Ohio in 2014, according to Lifebanc, the region's nonprofit organ and tissue recovery organization. That year, overdose victims made up 16 percent of total organ donors, more than double the percentage only two years earlier.
The tragic trend, fed by a statewide explosion of opiate abuse, has only grown since: Last year, 22 percent of organ donors died of overdoses in Ohio.
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With drug overdoses now the leading cause of accidental deaths in America -- surpassing car accidents and gun violence -- and most of the victims young and otherwise healthy people, it's a trend that's likely to continue.
The need for donor kidneys, livers and pancreases, the three organs that together make up more than 80 percent of transplants, is immense. More than 117,000 people nationwide are on the list for a transplant, and about 20 people a day die waiting for a donor.
For some on the transplant waiting list, however, the stigma associated with drug use and its small but real associated risks outweigh the specter of death.
That stigma worked in Karen Goodwin's favor when transplant doctors at the Clinic first offered Shay's kidney and pancreas to the patient ahead of her on the waiting list who also was a match. That patient refused.
"I thought they were nuts," Goodwin said. "Here I am just holding on day by day and here this person had a chance to have their life back and not do dialysis, and turned it down."
Although Shay's organs were healthy and had tested negative for all communicable diseases, the transplant was still labeled "increased risk" due to his intravenous drug use and because tests can't completely rule out very recent infections with HIV or hepatitis, Goodwin's doctors told her.
Transplant centers don't have to disclose previous drug use (only the increased risk), but Goodwin was glad to know.
It was a sign, she said.
"They told me he was a heroin addict and right then I knew I was meant to have [his organs]," Goodwin said.
She'd nearly died herself, more than once, by the time she was Adam's age, she said. By age 28, she'd lost track of how many times she'd been brought back by paramedics after trying to kill herself during withdrawal from cocaine and heroin.
"I should have been in Adam's shoes," Goodwin said.
A time to heal
When Goodwin woke from the transplant surgery, she immediately felt better. Diagnosed with Type 1 diabetes at age 10, she barely remembered when she didn't need insulin shots. She'd felt achy, tired and sluggish for decades.
"It was like a blanket had been over me for so long, and I was lighter" after the transplant, she said. After a frightening surgical complication and six weeks of recovery, she was able to live without insulin and the four-times-daily dialysis she'd needed before the surgery.
It took her a full year, though, to reach her "pre-dialysis strength," she said.
While Goodwin healed, Adam Shay's family reeled from his death.
At his wake, more than 800 people came to say goodbye, including Adam's former fellow Boy Scout, garage band and football team members, classmates, teachers, and members of the Alcoholics Anonymous community he'd joined, said his mother, Marlene Shay.
Over the three years before, Adam had been through rehab multiple times, she said. His heroin use was a shock to the family.
"I think he started like any other teenager experimenting with alcohol and drugs," his mother said. "There's a component where there are people who have a chemical imbalance that can make them physically addicted very quickly. Whereas you and I might not have that gene, Adam did."
His parents say they still don't really know how his heroin use started.
"The worst of the bad memories are those years of trying to help him and wrestling with, as parents, why this happened. There is no good answer, I think," said Greg Shay.
- Read more: How organ donors are matched
As soon as they knew what was going on, Adam was in rehab. They were sure he'd recover quickly.
"He's from a strong background," his mother said. "I wish I knew then what I know now -- that two, three, four or even 10 times in rehab is not unusual," his mother said.
His death was even more unexpected, she said, because Adam had been sober a year at the time, and seemed to be happy and stable.
"We'll never know what prompted him [to use] that last time," his mother said. "That's the crux with this disease, is that it doesn't take much to relapse, and it's very dangerous when they do."
Shay's parents didn't know about his decision to be an organ donor until a Lifebanc representative told them at the hospital.
Despite their grief, Marlene and Greg didn't hesitate in honoring their son's wishes.
Adam would have been deeply saddened if he'd missed out on the chance to donate, Marlene Shay said.
Three weeks after Adam's death, his mother received the news from Lifebanc that she'd been desperately hoping for: both his kidneys and his pancreas had been transplanted and saved the lives of two area women.
"I knew I was clinging to this hope of a bright spot here. This is the only glimmer of positive in that. There's nothing else that makes sense."
Shortly after, Adam's other kidney recipient, Renee Plesia, 52, of Louisville, contacted the Shay family to express her thanks.
Months passed and they did not hear from Goodwin, though.
"I think most donor families just want to hear a thank you or an acknowledgment of the gift," Marlene Shay said. "I was kind of angry and frustrated -- [I wondered] did she not get this or appreciate it?"
When the letter finally arrived, a year after Adam's death, it was clear just how much Goodwin did care.
'There's just too much there'
Goodwin's letter to the Shays, and Adam Shay's 1-year sobriety coin.
"This terrible disease of addiction took [Adam] too soon. [M]aybe I could bring some sort of solace to his family to know that a part of him did not die in vain," Goodwin wrote to the Shays. "Thank you to the moon and back for my new opportunity to live."
Goodwin waited a year to get in touch, she explained, because she felt she was carrying Adam along with her and wanted to help him achieve a year of sobriety.
She was also a little afraid of meeting -- and disappointing -- the Shays, who had already lost so much to the disease of addiction.
"One thing about recovering addicts is that we're always recovering," Goodwin said. "There's always a 'yet' in there. You haven't gone back out, yet. I didn't want to disappoint [Marlene] in wondering when my 'yet' would be. Or if I'd go out and overdose and she'd lose Adam -- or at least part of him -- again."
She needn't have worried. The Shays know the stigma people with substance use disorder, and their families, face.
"In the early days you'd tell people how your child died and you'd get this look," Marlene Shay said. "They were horrified. If my child died of cancer or a car accident, the reaction would be different."
"We just refused to be ashamed when we knew it was a disease he was battling."
Adam's parents came to hear Goodwin tell her recovery story at an AA meeting in Painesville soon after her letter arrived. At that meeting, Goodwin presented them with a one-year sobriety coin, for Adam.
She now marks two sobriety dates: hers and his.
Goodwin believes Adam Shay was meant to save her life.
Her belief has been confirmed in small coincidences and signs she's uncovered: She and Adam and won the same art show in Lake County, the Andrews Invitational Art Show, 21 years apart. (A piece of Adam's artwork now hangs in Goodwin's living room.)
At the time of the transplant, Adam was 21 and Goodwin was 42.
"21 years between us," Goodwin said. "Two people became one person. There's just too much there."
Marlene Shay also believes that there was some element of fate in her son's death and connection to his transplant recipients, who both have young sons with special medical needs.
"They both needed to be here for their boys. I think it was divine intervention that they were both perfect matches," Marlene Shay said.
Telling her son's story in the community has helped Shay make sense of her son's death, and to keep her him alive, she said. She was recently honored with Lifebanc's Legacy of Life award for her work promoting organ donation.
"The fear of any parent is that your child will be forgotten. So you speak their name, you talk about them, and you want others to say their name," Shay said.
"Adam did more in those moments as a donor than some people do in a whole lifetime -- and maybe more than he would have done in his whole lifetime. Maybe that was his purpose."