A compelling and insightful look into organ transplantation—including its history and associated ethical quandaries—with an evocative personal touch.
Title: When Death Becomes Life: Notes from a Transplant Surgeon
Author: Joshua D. Mezrich
Genre: Nonfiction (Medical)
Originally published: 15 January 2019
Finished reading: 1 May 2020
Just as with Bryan Stevenson’s Just Mercy, I was hooked from the very first word.
To open his book, Joshua Mezrich describes a harrowing near-death experience in a small plane caught in a violent thunderstorm over the hills of La Crosse, Wisconsin. What on earth was he doing in a six-passenger dual prop at 2am in the middle of the night?
It would soon be revealed that this is, in fact, a routine part of his job—not nearly dying in a thunderstorm at ten thousand feet, but rather, the procurement of organs from recently deceased donors.
Throughout the book, Mezrich delves into the history of organ transplantation, interspersed with real stories of patients and their families, told through his own experiences at the operating table and his personal interactions with both the donors and recipients of this extraordinary gift of life.
For anyone put off by the word ‘history’, not one bit of it is dry or reminiscent of a history textbook. Through Mezrich’s writing, it all transforms into the most fascinating dive back in time to witness how rapid medical advances had revolutionised the field.
As Mezrich summed it up in very plain terms in an interview,
In the 1930s and 1940s, people thought that transplant was science fiction. In the 1950s and 1960s a few people were trying to do it, but it still seemed kind of ridiculous. From the 1960s to 1980s, it suddenly became this reality.
Many innovations of that era form the very foundations of transplant procedures today. Most unimaginable to me is how the pioneers persisted despite the seeming impossibility, the scepticism and blatant opposition, and above all, having to watch patients die in their hands. In spite of it all, “they never questioned for a second that they should persevere”.
None of it comes without sacrifice. And organ donation is, in itself, a tremendous act of sacrifice.
In every other area of medicine, we spend our lives trying to fight off death, defend our patients from the ravages of disease, alleviate suffering brought on by cancer and heart attacks and trauma. Transplant is different. In this field, we take from death. Death is our starting point.
Aside from his deep reverence for the trailblazers in his field, one can also feel Mezrich’s immense respect for organ donors—both living and deceased. True stories of donors and recipients—and the surgeons standing between them as the “stewards of these organs” illuminate how life-changing this gift can be. At the same time, it reminds us that surgery is never without risk. A single operation can be riddled with a myriad complications.
Sometimes in surgery things happen even though you did nothing wrong. And these cases test you like nothing else in our field.
When Death Becomes Life also engages in thought-provoking debate on the ethical as well as philosophical dimensions that are oft-discussed with regard to organ transplantation: Should we perform liver transplants for alcoholics—potentially ‘wasting’ this scarce resource? How much risk should a healthy individual be permitted to take to save a loved one? What defines death, and how does that definition impinge on the procurement of organs for transplant?
Mezrich artfully weaves medical history with ethics, patients’ stories as well as personal insight. It is an enlightening read for anyone who wishes to journey into the lesser-known field of transplant surgery.
My favourite quotes from this book
No matter how tired I am, the interaction with the donor family always reminds me how wonderful and cathartic the donation process is.
― Joshua Mezrich, When Death Becomes Life: Notes from a Transplant Surgeon (Chapter 1: A Perfect Organ)
“Your patients will be looking to you to offer hope in their darkest moments. … And when the options for treatment run out, hope need not.”
― Joshua Mezrich, When Death Becomes Life: Notes from a Transplant Surgeon (Chapter 12: Nate)
Many of us will have tears in our eyes, but we’ll also feel energized, elated even. We are the stewards of this donor’s organs, the ones tasked with helping him or her make these supreme gifts possible. It is a heavy responsibility, but one we take on with the utmost respect and pride.
― Joshua Mezrich, When Death Becomes Life: Notes from a Transplant Surgeon (Chapter 14: As They Lay Dying)
In every other area of medicine, we spend our lives trying to fight off death, defend our patients from the ravages of disease, alleviate suffering brought on by cancer and heart attacks and trauma. Transplant is different. In this field, we take from death. Death is our starting point.
― Joshua Mezrich, When Death Becomes Life: Notes from a Transplant Surgeon (Chapter 14: As They Lay Dying)
Sometimes in surgery things happen even though you did nothing wrong. And these cases test you like nothing else in our field.
― Joshua Mezrich, When Death Becomes Life: Notes from a Transplant Surgeon (Chapter 16: Complications)
No doubt courage is at the heart of what drives a surgeon. But is it the courage to fail? I would argue that what separates the pioneers from the rest of us is the courage to succeed. Despite all the failures, despite the people around them telling them they were crazy, that they were murderers; despite the threats of dismissal, loss of their medical license, and even imprisonment, they never questioned for a second that they should persevere.
― Joshua Mezrich, When Death Becomes Life: Notes from a Transplant Surgeon (Chapter 18: So, You Want to Be a Transplant Surgeon?)