The new kidney would cost the Tetikoglu family $50,000. It was more than the working-class family from Turkey could afford, but it was a bargain price from one of the world's top transplant centers.
And it was the only way to save their 15-year-old daughter.
With the help of the Turkish government, the Tetikoglus raised the money, rushed it to UPMC Health System and flew to Pittsburgh. That was five months ago.
But in a story that is as much about the complications of medicine as it is about the limits of charity, Dilek Tetikoglu never got her kidney.
Instead, Dilek, a dark-haired teen-ager with a delicate 4-foot frame, finds herself at odds with the world-renowned medical system that has given her thousands of dollars of free care.
Her family says UPMC has not acted in good faith and at one point demanded an extra $190,000 to do Dilek's transplant. They say UPMC only offered to honor the $50,000 price after the family notified the media and only on the condition that Dilek wait for her organ in Turkey.
UPMC is just as miffed. Officials at its international patients relations center, which reaches out to sick people all over the world, say the Tetikoglu family withheld key details about Dilek's medical condition. Before clearing her for the transplant, doctors had to reconstruct her bladder, operate on her thyroid and give her dialysis treatment three times a week.
UPMC officials said the cost of that care is more than three times what the family paid. Though they have agreed to do the transplant, UPMC has asked the family to pay for any additional care.
UPMC officials would not say why it offered to do Dilek's transplant at less than half the cost. A typical kidney transplant could cost anywhere between $100,000 and $125,000, according to the United Network for Organ Sharing known as UNOS, which contracts with the U.S. government to distribute organs across the nation.
"It's certainly not our practice to cut deals," said UPMC spokeswoman Jane Duffield. "We have a lot of experience with international patients who pay the full cost of their care."
The Tetikoglus, who have been staying for free at the Ronald McDonald House in Shadyside, aren't sure what to do. Despite UPMC's offer to pay for the transplant, they fear that waiting for the organ in Turkey would not give them enough time to travel back when the organ becomes available.
They say they are trying to figure out how they could pay for Dilek's treatment should they stay in Pittsburgh and wait out the organ, a process that could take over a year.
"I'm in a very tough situation because I came here to save a life," Dilek's mother, Ruveyde Tetikoglu, said through a translator. "We had a fund-raiser in Turkey that had to be sanctioned by the government and now it looks like we have to go back empty-handed."
The Tetikoglus' long journey started with a simple letter from UPMC, written both in English and Turkish and signed by Enigul Sonmez-Alpan, director of UPMC's International Patients Relations Center. The letter said doctors had agreed to take on Dilek's case for $50,000 - so long as she was medically cleared.
The Tetikoglus said they sent UPMC details of Dilek's medical history: a urine infection so harsh that heavy doses of antibiotics damaged not just her kidneys but also her bladder. Her condition spun off growth problems and altered her heart rhythm, forcing her to need a pacemaker.
When UPMC doctors conducted their own evaluation in May, the family says, doctors gave no indication they couldn't do the transplant.
Sonmez-Alpan said that's not true.
"I got quite patchy medical records," she said. "It wasn't a complete medical history."
Sonmez-Alpan said Dilek was examined by specialists that included an endocrinologist, a cardiologist, a nephrologist and a urologist.
"It became quickly obvious that thyroid surgery and bladder reconstruction were going to be prerequisites to her transplant," she said.
The Tetikoglus, who said they didn't know about Dilek's thyroid problems, say UPMC asked them to return to Turkey before any treatments were performed - without their money.
Pointing to the letter, they said they thought Dilek's entire treatment would be covered.
Dilek's plight for a kidney became front-page news in Istanbul. The Turkish government agreed to help raise the $50,000 and held it in a trust fund.
Serdar Eraslan, vice president of the Turkish Kidney Foundation, said in a telephone interview that UPMC demanded full payment for the transplant before the Tetikoglus arrived in the United States.
He said the Turkish government agreed after UPMC refused an initial $10,000 to be followed by the rest after the transplant was completed.
"What I cannot understand is how such a big university hospital would offer something like that and afterwards say they're sorry and the transplant is not going to happen," Eraslan said.
Though Dilek could get a transplant in Istanbul, Eraslan fears the family's problems will escalate if they go back home to Istanbul without the transplant - and without the money.
"If she comes back without transplantation, they are going to be charged for spending the money that was for the transplantation and was used for something else," he said.
UPMC officials said 95 percent of its international patients waiting for a transplant do so in their country. Sonmez-Alpan said UPMC staffers carry beepers around the clock and immediately notify the patients when an organ becomes available.
Duffield said Dilek's case is an isolated incident and there are no plans to change the way they review the medical records of patients from outside the United States. She did not immediately know how many of the 1,000-plus transplant patients at its Oakland campus every year are foreigners.
But UNOS spokesman Joel Newman said the government limits the number to no more than 5 percent of the total caseload. Of 64,524 kidney transplants performed in the United States in the last five years, less than 1 percent - 515 - were done on nonresident aliens, according to UNOS.
"UPMC has been extremely generous to this family," Duffield said. "This is a one-time, special arrangement that we made with the Turkish government. Certainly, if we had the benefit of the hindsight, we would have probably made other arrangements."
Dilek, who spends her time surfing the Internet and communicating with her sister in Turkey, said she only wants to get better so she can achieve her goal of becoming a doctor.
She likes the United States because people here smile.
"I feel safe and happy here," she said.
She's just not sure what to do.
