ROCHESTER — Tim Suby never hesitated when he donated a kidney to his brother, Peter, in 1982. But he can admit something now he couldn't 40 years ago: He was scared.

Peter Suby, then 25, was admitted to Mayo Clinic in February 1982 with kidney failure. Doctors asked whether Tim, then 19, would voluntarily donate a kidney. He would be helping his brother avoid spending the rest of his life hooked up to a dialysis machine, they told him.

Their father made it even more clear: "'You've got two options: You can do this, or he dies," the younger brother recalled on Friday, the 40th anniversary of the transplant. "But it was true. I saw him on dialysis, and said, 'Well that's not fun.'"

Mayo doctors say it was an exceptional transplant. Neither brother has needed further kidney operations since. A 2021 study in the New England Journal of Medicine on long-term survival rates of transplanted kidneys shows kidneys inserted into another body are lasting longer compared with a few decades ago, based on medical advances. But only about 30% of kidneys lasted 20 or more years.

The Suby brothers, who grew up in Rochester, met with and thanked Mayo Clinic staff Friday afternoon. The group included Dr. Sylvester Sterioff, the retired surgeon who transplanted Tim's kidney into Peter on April 22, 1982.

While there are examples of long-term transplant patients who never need another kidney, brothers who go 40 years without needing an operation are an anomaly.

"We're in rare air," Sterioff said.

Kidney transplants were much harder on donors and patients in the 1980s than they are today.

A transplant operation now takes about two hours and involves laparoscopic surgery, where doctors make small cuts and use camera-assisted tools to conduct minimally invasive procedures. It takes donors and patients anywhere from one to three days to recover.

In the 1980s, surgeries would involve long cuts — like the one Tim has on his left side. Surgeons had to take out one of Tim's ribs to safely remove his kidney, which was flushed with toxins, then carried across the hall to Sterioff, in Peter's operating room.

Sterioff removed both of Peter's kidneys as well as his spleen — something surgeons don't do today — before attaching Tim's kidney to Peter.

The end result was a weeklong hospital stay for Tim, and three weeks for Peter. Tim had left his studies at St. Cloud State University in order to prepare for and recover from the surgery.

Peter wasn't surprised to learn he needed a kidney transplant in 1982. He came down with a particularly nasty case of strep throat when he was in middle school, and a biopsy in eighth grade showed he had kidney problems. A doctor told him in 1981 he would probably need a new kidney by the time he was 40. It took less than a year for that prediction to come true.

Peter said he was feeling sick for a while before he went to the doctor. He had felt crummy the previous Christmas, and threw up on the job as a liquor store clerk before his mother, a surgical nurse at Mayo Clinic, scheduled an appointment.

It took a handful of hours from the time Peter walked in to the time he was admitted into intensive care because of kidney failure. Doctors told him he was near death.

"I came in at toxic levels," Peter said. "I was close to going out then."

Both brothers have tough memories of their recovery. Tim remembers trying to get on a bike and having to practically lie down to get off the seat as he learned to adjust to life without his 12th rib. Peter remembers walking 2 miles from his house to get to dialysis and walking back, though Tim disputes Peter's version of traveling to and from on his own after his appointments.

"You did not walk back!" Tim told Peter. "You walked there, you did not walk back."

But Peter survived and thrived. He has three children and several grandchildren. The 40th anniversary of the operation didn't occur to him until Tim brought it up earlier this year.

Kidney transplants make up the majority of organ operations in the U.S. Mayo Clinic performed 279 kidney transplants in Rochester alone in 2021; 24,669 kidney transplants took place in the U.S. last year, according to the United Network for Organ Sharing.

Yet more than 106,000 people in the U.S. are on waiting lists to receive an organ transplant. The majority need new kidneys.

Dr. Carrie Schinstock, an internist and nephrologist at Mayo, said demand for more live donors is growing.

"That is this huge resource that is untapped, so that's one of the only ways we're going to be able to address this issue," she said.

Peter continues to be thankful for the time Tim gave him. He sits in his truck every morning before driving to work, praying for his family and friends.

"And then I say thank you very much for this," Peter said.