Paul Cardinale is a 35-year-old financial consultant from Lakewood near Jamestown. William Thomas, 34, helps the homeless find housing in Kodiak, Alaska.

The two met online after Cardinale, who depends on dialysis three days a week to stay alive, posted an appeal for a kidney on a Web site. Thomas saw it and offered one of his.

With the demand for organs so much greater than the supply - and people dying as they wait - patients like Cardinale are increasingly searching the Internet to find suitable donors.

It's a controversial practice that works outside the existing system to allocate organs fairly from deceased donors based on who is sickest or has waited longest. Advocates counter that more lives can be saved by allowing patients to seek living sympathetic strangers willing to donate.

"It's not about jumping ahead in the line. Anyone who gets off the waiting list by finding a living donor is benefiting the people on the list," said Patti Merritt, a Grand Island woman who helped create www.wnykidneyconnection.com, a regional donation Web site that started this week.

Cardinale has relied on dialysis, which removes toxic waste from the blood when the kidneys are unable to do so, for the past two years after his body rejected a kidney he received from his father in 1995.

His search on the Internet for another living donor began in 2004, when his mother, Jeanette Ostrom, read a story about a man who received a kidney after posting a profile of himself on the Web site MatchingDonors.com.

MatchingDonors, based in Massachusetts, was launched in January 2004. Currently, it has more than 160 patients with active profiles and 3,490 potential donors on the site. Cardinale's is the 34th transplant in just over a year from a patient and donor who found each other on the site, MatchingDonors officials said.

Ostrom paid the $600 lifetime membership for MatchingDonors and posted a profile for her son, who was born with dysfunctional kidneys. A potential donor from Minnesota responded within an hour. But officials at Kaleida Health's Buffalo General Hospital would not accept a donor solicited over the Internet.

Like many transplant centers, it was reluctant to perform Internet-generated transplants because of the ethical and logistical issues.

Critics worry that the practice is potentially unfair, perhaps giving an advantage to individuals with money, those familiar with the Internet and others with the most sympathetic stories.

They also question if hospitals can discern whether strangers who want to donate organs are truly Good Samaritans or influenced by psychological problems. Even family members and close friends who contemplate donation may make decisions clouded by emotions, they say.

However, those concerns compete with the grim realities of organ transplantation.

There are 92,878 patients waiting for an organ transplant - most of them kidneys - in the United States, according to the United Network for Organ Sharing, the agency charged by Congress with equitably distributing organs from deceased donors to the sickest patients across the country.

But only about 28,100 organ transplants are performed each year in the United States. More than 6,700 Americans die annually while waiting for an organ.

Faced with these facts and tremendous lobbying by patients, hospitals are slowly changing their policies. Buffalo General and Erie County Medical Center, the only facilities in the region that perform transplants, late last year said they would perform transplants for patients who find live donors via the Internet or other media.

Ostrom, another founder of wnykidneyconnection, played a key role in persuading Kaleida Health to revise its policy.

"We came to have a tremendous appreciation for the number of people with end-stage renal disease and those waiting for a kidney," said Dr. Margaret Paroski, chief medical officer of Kaleida Health and chairwoman of the Upstate Transplant Services board of directors.

To Cardinale, a consultant with PNC Investments in Warren, Pa., the Internet sites will encourage more donations and improve the odds for those who need an organ.

He also has enjoyed getting to know Thomas and is talking about visiting Alaska to maintain their relationship.

To Thomas, the arrangement suited his desire to perform an altruistic deed.

He was a construction supervisor and director of a church drama ministry in Kansas when he saw a television news show about MatchingDonors and the controversy over living donation. He thought deeply about the arguments on both sides of the issue and came away impressed with the fervor of the patients trying desperately to save their lives.

Several days later, he checked out the Web site, posted a profile of himself and perused the transplant candidate listings until he came across one posted for Cardinale.

"I read his and it just felt right, like a calling," said Thomas, who recently moved to Alaska, where he works for the Brother Francis Shelter of Catholic Social Services.

He contacted Cardinale, and was approved as a donor after undergoing blood and psychological testing. The Cardinale family paid for his air fare and hotel in Buffalo for the surgery.

"I'm a little nervous now. This is a big commitment," he said. "But I'm going to feel really good about it when I'm done."