Lucas Loriman's focal segmental glomerulosclerosis (FSGS)

Lucas Loriman's focal segmental glomerulosclerosis (FSGS) is a serious kidney disease that leaves him in desperate need of a kidney transplant. His condition drives an increasingly urgent search for a donor, while tests expose a secret about his parentage and complicate the distinction between biological ties and the family that has raised him.

Diagnosis and Medical Stakes

At ten years old, Lucas is already facing the prospect of a kidney transplant. Mike Baye, one of the country’s leading kidney transplant surgeons, knows him personally but has handed the case to his partner Ilene Goldfarb, head of transplant surgery at NewYork-Presbyterian and, in Mike’s view, the best surgeon he knows. Mike’s connection to Lucas makes the illness especially difficult to treat as an ordinary case: Lucas is the sweet, bespectacled boy who would watch Mike practice hockey shots with Adam Baye and supply an enthusiastic play-by-play instead of taking a stick himself.

The donor search makes compatibility a matter of immediate consequence. Ilene explains that the team ideally seeks a six-antigen HLA match. Dante Loriman’s test results make him a poor candidate, while Susan Loriman is a better match but not an ideal one: her match is two. Ilene explains that a closer match makes rejection less likely and may reduce the need for a lifetime of medication and constant dialysis. The team places Lucas on the cadaver-kidney transplant bank, though Ilene considers finding a better candidate there unlikely. The news about Lucas’s younger brother Tom is also bad, but the evidence does not specify the exact result of his typing.

Donor Search and Family Ties

The medical tests reveal that Dante is not Lucas’s biological father. This changes the donor question as well as the family’s understanding of Lucas’s origins: Dante cannot be counted on as a suitable donor, and Ilene’s account of HLA typing gives biological relationships a direct clinical significance. When Ilene later asks Susan who Lucas’s father is, Susan answers that she does not know. The uncertainty remains unresolved in the available account; it does not identify another biological father.

Susan continues looking for ways to help her son. After receiving no new information from the donor banks, she and Dante plan a major donor drive at Lucas’s elementary school. Teachers support the idea, and Susan proposes getting people to register with the donor bank the following Saturday. Jill Baye attends the same school, linking the campaign to the wider circle around Lucas without guaranteeing that it will produce a suitable match.

The search eventually reaches Joe Lewiston. Susan has a donor nurse with her and offers to have Joe’s blood taken immediately. She urges him to help Lucas, framing his willingness to try as a step toward rebuilding after the events in his own life. The scene establishes an opportunity for donor testing, not a successful match or completed transplant.

Significance

Lucas’s FSGS remains an urgent medical condition rather than a problem solved by the revelations about his family. Each possible donor is measured against the practical requirements of a transplant, and the best available match described by Ilene is still imperfect. The disease therefore gives the secret about Dante’s biological relationship to Lucas concrete consequences, while Susan’s campaign and appeal to Joe show the search widening beyond the household. The evidence records efforts to find a kidney, but does not establish that Lucas receives one.