It's been nearly three years since Howard Smith received his new liver. Today, he finally meets the widow of the organ donor who saved his life.

Smith and Terry Ann Toland have spoken by phone about her husband, Greg, who died of a heart attack in 2005 but helped save lives when his wife donated his heart, liver and other organs.

"In her mind her husband is still alive in the recipients' organs," Smith said yesterday from his hotel room in Pittsburgh.

Smith, 58, is one of eight athletes on Team Hawaii who are in Pittsburgh today through Wednesday competing in the U.S. Transplant Games. All athletes — about 2,000 from across the nation — are organ recipients at least six months past their transplant surgery.

"There is a real need for organ donors in Hawai'i and across the nation," said Diana Pinard, a director at the National Kidney Foundation Hawaii. "A big reason for the games is to bring attention to becoming a donor, to let people see how people can survive and be active if they can find a donor."

Most organ donations are for kidney transplants.

Most members of Team Hawaii have had kidney transplants. The exceptions are Smith, with his new liver, and Anne Zimmerman, who had a bone marrow transplant in 2000.

Les Malala, who will be competing in several events, had a kidney transplant in February 2005 after 7 1/2 years on dialysis.

"I had been called before three other times, only to be denied," said Malala, who has three children and four grandchildren. "I was given a second lease on life. I am truly blessed."

Kidney disease is often called "the silent killer" because symptoms often don't appear until 70 percent or more of the kidney function is lost. When it is down to 15 percent functional, the options are dialysis or transplation, said Victoria Page of the National Kidney Foundation of Hawaii.

"Not everyone who has CKD (chronic kidney disease) needs dialysis or a transplant," she said. "But there are 2,300 kidney patients on dialysis in Hawai'i. A lot of times it doesn't even get to that point. They die from it."

DECIDING TO DONATE

Terry Toland said harvesting her husband's organs wasn't an easy decision or something they had thought of before his heart attack. Greg Toland was making homemade spaghetti with about 30 people in their New Jersey home when he collapsed.

"I thought he'd be OK," she said. "He was a one-in-a-billion guy. Always on the go. Small, thin, a workaholic."

Complications developed, Toland said, and two weeks after the heart attack a doctor approached her at the hospital to ask about donating his organs.

"I had my niece and nephew with me and thought, 'What if they needed one?'" she said. "I had to do it, as tough as it was."

Toland donated five of his organs. She has since learned that the person who received her husband's lungs didn't survive, but the family wrote they were grateful for the extra time they got together. She's written letters to all the recipients, but Smith, she said, is special.

"Howard will be the first I will meet," Toland said. "I'm probably going to hug him to death. I was too depressed to meet anyone for a long time, but Howard responded back.

"My husband and I had been to Hawai'i 28 times," she said. "We were planning to go for our 30th wedding anniversary when he had the heart attack. Hawai'i was special."

'IT CHANGES YOU'

Howard Smith will be swimming in four events this weekend. Where he finishes, he doesn't care. He's at the Games to share his story and to hear others tell theirs.

"It's inspirational," he said. "You get kind closeness with the people who've gone through it."

Smith said he swims every other day as a part of his therapy, a way to cope with facing death. Transplant recipients, he said, have a different view of death than most people.

"It changes you," he said. "I never accepted it but I was ready. You have to stay positive when you're fighting something like this."

Smith was first diagnosed with liver cancer in 1991. For 13 years after the initial treatment, the cancer was in remission, but on New Year's Eve, 2004, doctors told Smith the liver cancer had returned and was inoperable.

Smith considers every athlete at the Transplant Games a kindred soul.

"These games are inspirational. People need to know what organ donations can mean. It saved my life."