The BookBrowse Review

Published January 22, 2020

ISSN: 1930-0018

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When Death Becomes Life
When Death Becomes Life
Notes from a Transplant Surgeon
by Joshua D. Mezrich

Paperback (7 Jan 2020), 384 pages.
Publisher: Harper Perennial
ISBN-13: 9780062656216

A gifted surgeon illuminates one of the most profound, awe-inspiring, and deeply affecting achievements of modern day medicine - the movement of organs between bodies - in this exceptional work of death and life.

At the University of Wisconsin, Dr. Joshua Mezrich creates life from loss, transplanting organs from one body to another. In this intimate, profoundly moving work, he illuminates the extraordinary field of transplantation that enables this kind of miracle to happen every day.

When Death Becomes Life is a thrilling look at how science advances on a grand scale to improve human lives. Mezrich examines more than one hundred years of remarkable medical breakthroughs, connecting this fascinating history with the inspiring and heartbreaking stories of his transplant patients. Combining gentle sensitivity with scientific clarity, Mezrich reflects on his calling as a doctor and introduces the modern pioneers who made transplantation a reality - maverick surgeons whose feats of imagination, bold vision, and daring risk taking generated techniques and practices that save millions of lives around the world.

Mezrich takes us inside the operating room and unlocks the wondrous process of transplant surgery, a delicate, intense ballet requiring precise timing, breathtaking skill, and at times, creative improvisation. In illuminating this work, Mezrich touches the essence of existence and what it means to be alive. Most physicians fight death, but in transplantation, doctors take from death. Mezrich shares his gratitude and awe for the privilege of being part of this transformative exchange as the dead give their last breath of life to the living. After all, the donors are his patients, too.

When Death Becomes Life also engages in fascinating ethical and philosophical debates: How much risk should a healthy person be allowed to take to save someone she loves? Should a patient suffering from alcoholism receive a healthy liver? What defines death, and what role did organ transplantation play in that definition? The human story behind the most exceptional medicine of our time, Mezrich's riveting book is a beautiful, poignant reminder that a life lost can also offer the hope of a new beginning.

While I'd been on planes many times, I'd never experienced the full power of a thunderstorm at ten thousand feet. The small King Air, a six- passenger dual prop, was bouncing around uncontrollably. Every few seconds, it would go into free fall and then hurl itself back up violently. The two pilots in the cockpit were hitting knobs and dials, trying to silence the various alarms that sounded as we rocked violently back and forth. It didn't help that our physician's assistant Mike, who had been on hundreds of flights in small planes before, was screaming uncontrollably, "We're gonna die! We're gonna die!" Given that Mike was such a seasoned member of our team, I could only assume that this particular flight was going badly. When the pilots glanced back to see the source of the screaming and cursing, I could make out the fear in their eyes. I looked at the spinning altimeter and noted that our plane was popping up and down as much as a thousand feet at a time. Outside the window, the lightning was shooting horizontally. The rain was constant and loud, and I was sure I heard pieces of hail hitting the windshield.

IT WAS THE third month of my transplant fellowship at the University of Wisconsin. I hadn't chosen transplant surgery so I could fly through thunderstorms in the middle of the night over the fields of central Wisconsin. Hell, I'd grown up in New Jersey, spent most of my life in the Northeast, and had never known anything about the Midwest. I had been drawn to Madison because it is one of the best places to be a transplant fellow. I was learning how to perform kidney, liver, and pancreas transplants, and how to take care of these complicated patients while they waited for organs and then recovered from their surgeries. One unique part of the discipline of transplantation is the procurement of organs from donors. While we do perform transplants, particularly kidneys, with organs from living donors, the majority comes from people who have just died. Rather than transporting donors, who typically remain on a ventilator, brain dead but with a beating heart, we send a team out first, to meet with their families to thank them for their gift and then to perform the surgery to remove their organs. We then take those organs back for transplant into waiting patients.

On this particular day, I'd received a phone call at around 5:00 p.m. telling me to come to the OPO (organ procurement organization) at 9:00 p.m., for wheels up at 9:30. The thirty-minute flight from Madison to La Crosse had been without incident. We arrived at the donor hospital at around 10:30. The donor was a young man (almost a boy) who had died in a motorcycle accident. That detail is easy to remember, as Wisconsin, being the land of Harley (not to mention a state where wearing a helmet is frowned upon), produces a never-ending supply of donors who've died in motorcycle accidents. In the winter, it's snowmobile accidents, the snowmobile being the vehicle of choice for bar hopping in the evenings' - which sounds like fun but is also incredibly dangerous, given the power of those machines.

Excerpted from When Death Becomes Life by Joshua D Mezrich. Copyright © 2019 by Joshua D Mezrich. Excerpted by permission of Harper. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

In this debut memoir, a surgeon surveys the history of organ transplantation, recalling his own medical education and the special patients he's met along the way.

Print Article Publisher's View   

Though it happened more than ten years ago, Joshua Mezrich still clearly remembers setting out in a six-seater plane – during a thunderstorm, in the middle of the night – to bring back the organs harvested from a young man who died in a motorcycle accident. The weather was so violent that he wasn't sure he was going to live to tell the tale. The incident makes for a dramatic opening to his wide-ranging book about the practice of transplanting organs, confirming that this really is a life and death business.

Mezrich grew up in New Jersey and now works in Madison, Wisconsin; he's been practicing surgery ever since his time at Cornell medical school in the late 1990s. In When Death Becomes Life, he intersperses stories from his career as a transplant surgeon with snapshots from the history of the science behind these procedures. For Mezrich's purposes, this history begins in 1894, when medical student Alexis Carrel, distressed at French president Marie-François-Sadi Carnot's death after being stabbed by an anarchist, began experiments to try to reconnect blood vessels in the hope that one day victims of similar injuries could be saved. The book leaps through time to focus on vivid scenes from the advancing research. Many of these cluster in the 1940s, when Dutch doctor Willem Kolff developed the first dialysis machine, British biologist Peter Medawar advanced the study of tissue culture, and American doctor David Hume grafted a kidney into a patient's thigh.

The history of transplantation – which is chiefly centered around the kidneys, heart, and liver – has been rocky. In the 1940s and 1950s, patient after patient was lost due to rejection of the transplanted organ, post-surgery infection, or hemorrhaging. The first successful kidney transplant wasn't until 1954, and that was between twin brothers. For a while, radiation and bone marrow transplantation were used as pre-treatments for transplant patients (the former to suppress the immune system's reaction against a foreign body; the latter to boost the immune system after the transplant), but usually they would die of infection anyway. We mostly have English researcher Roy Calne to thank for developing the drug cyclosporine from fungal spores. It provides highly reliable immunosuppression – keeping a patient's immune system from attacking the new organ.

Even though transplanting organs is now routine for him, Mezrich marvels at how few decades passed between transplantation seeming like something out of a science fiction future and becoming a commonplace procedure. His aim is to never lose his sense of wonder at the life-saving possibilities of organ donation, and he conveys that awe to readers through his descriptions of a typical procedure. In one early chapter he takes us through a kidney transplant step by step. Although it can be a little hard to picture what's going on (especially if, like me, you don't know your anatomy and medical terminology all that well), it's still a privileged insider's look into an everyday miracle.

My favorite sections of the book focus on the transplant patients and organ donors the author has known. Organs come either from cadavers (after circulatory or brain death) or live donors. Live-donor kidneys last nearly twice as long as those from cadavers, but Mezrich notes that it's important to ensure that donors know what they're getting into in terms of pain and recovery, and aren't being coerced in any way. Altruistic donors can participate in a nationwide paired organ exchange program – the longest-ever chain linking non-matching donors to suitable recipients, organized by the U.S. National Kidney Register, involved 34 people!

There are many touching stories here. One that stood out for me was that of Michaela, a young white woman who got a liver transplant from C.L., a young black man who died in a gang-related shooting, and then woke up wanting hamburgers – C.L.'s favorite food. (Science on cellular memory suggests a possible explanation for this phenomenon.) I was also invested in the story of Nate, one of Mezrich's colleagues. As a surgery trainee, Nate needed a liver transplant himself – performed by Mezrich – but he experienced the full gamut of complications. While he awaited a redo transplant, he gave an inspirational speech about hope at his medical school graduation, even though he was desperately ill.

Occasionally I lost interest in the historical material, especially because I'd already read quite a bit about the development of heart transplantation recently in Sandeep Jauhar's Heart: A History. I also bristled at the occasional frat-boy jokiness of Mezrich's tone (i.e. when he is listening to Tupac Shakur and cracking jokes, referring to surgery as "ballsy"). All in all, though, I found this to be a valuable account of a key chapter from medical history. Mezrich moves smoothly between the different strands of his narrative, with the historical material as accessible as the autobiographical. I recommend this to anyone who enjoys medical-themed reads, though it may well mean the most to those who have a personal connection to organ donation. For instance, I have polycystic kidney disease, a progressive genetic condition that often leads to kidney failure. Many members of my extended family have benefited from kidney transplants, and one day I will likely need a donated kidney to save my life. How grateful I am to live at a time when this is a possibility.

Reviewed by Rebecca Foster

New York Journal of Books
This monumental and enthralling history of one of modern medicine's most rousing triumphs is a definitive testament to that hope, and to the brave physicians and patients whose sacrifices made it possible.

Publishers Weekly
Success through perseverance is this book's main theme, and Mezrich does a commendable job sharing his death -to-life experiences in a vital field.

Kirkus Reviews
Starred Review. Medical memoirs have become a significant genre over the past two decades, and this one ranks near the top, in a class that includes the best.

Library Journal
Starred Review. A great read for fans of narrative nonfiction, medicine, and real-life suspense stories.

Author Blurb Pauline Chen, author of Final Exam: A Surgeon's Reflections on Mortality
With When Death Becomes Life, Joshua Mezrich has performed the perfect core biopsy of transplantation - a clear and compelling account of the grueling daily work, the spell-binding history and the unsettling ethical issues that haunt this miraculous lifesaving treatment. Mezrich's compassionate and honest voice, punctuated by a sharp and intelligent wit, render the enormous subject not just palatable but downright engrossing.

Author Blurb Danielle Ofri, M.D., Ph.D., author of What Patients Say, What Doctors Hear
A fascinating examination of our bodies' organs and the intimacy of their placement and replacement. Joshua Mezrich weaves in the history, ethics, and technical grit of how doctors and patients navigate this miraculous second chance at life.

Author Blurb Allan D. Kirk, M.D., Ph.D., Chairman of Surgery, Duke University and Editor-in-Chief, American Journal of Transplantation
With When Death Becomes Life, Mezrich succeeds in giving the reader a glimpse of how a cacophony of human experience can become a harmonious triumph of medical science.

Author Blurb Nancy Ascher, M.D., Ph.D., Isis Distinguished Professor of Transplantation, University of California San Francisco
Dr. Mezrich clearly loves the field he has chosen and wants us, his readers, to love it too. Although he has "demystified" the complicated issues, he has left us with the wonderment and incredible humanity that shine through in the transplant field, and crafted an incredibly down-to-earth read through his own journey of doubts and triumphs.

Print Article Publisher's View  

An Organ Donation Reading List

Artistic rendering of a heart transplant featuring two hands holding one heartReaders curious to learn more about organ transplantation after finishing surgeon Joshua D. Mezrich's memoir on the subject have a wealth of options to choose from; here are five recommendations, two fiction and three nonfiction:


The Tell-Tale Heart by Jill Dawson
Fifty-year-old Patrick is a philandering professor with a failing heart. He's saved by a teenage boy's fatal motorbike accident near Cambridge, England. By accident he learns the identity of his heart donor and is haunted by the thought of Drew Beamish, who died on his 16th birthday. He even seems to intuit things about the boy's ancestry through his dreams. The novel explores the idea that a donor heart might carry its original owner's memories and personality, and somehow transmit them to the recipient; there are certainly some eerie connections here.

The Heart by Maylis de Kerangal
19-year-old Simon Limbres is declared brain dead in a French hospital after a car accident, but his heart lives on: metaphorically through the love of his parents, sister, friends and girlfriend; but also literally, in the recipient of his organ donation. The novel spends time with Simon's family, especially his mother, but also with the transplant coordinator, the surgeons, the nurse and others. Originally published in French in 2014, this went on to make the Man Booker International Prize longlist in 2016 and won the 2017 Wellcome Book Prize for literature that engages with medicine and health.


Hundreds of Interlaced Fingers: Kidney, Dialysis, Transplant—and a Love Story by Vanesa Grubbs
Grubbs is a nephrologist and assistant professor of medicine at San Francisco General Hospital. Well before she made the kidneys her clinical area of expertise, a personal encounter made them special to her. In 2003 she met Robert Phillips when she was an attending physician trying to get support for her Office of Diversity Affairs; he was a hospital trustee. She learned after they started dating that his kidneys had failed in his 20s and he'd been on dialysis for years. In 2005 she donated one of her kidneys to him, and he proposed to her soon afterwards.

The Reluctant Donor by Suzanne Ruff
In Ruff's memoir, she explains how polycystic kidney disease has affected her large, Irish Catholic Chicago family. Describing a family photograph from the 1950s, she notes that six of the eight family members pictured died of PKD, starting with her aunt, a nun called "Sister Mike." There has always been a long waiting list for transplant kidneys, but Ruff explains that dialysis machines used to be rare too; demand far exceeded supply, and the procedure was not covered by Medicare until 1973, so people like Sister Mike who could have benefited from dialysis died while waiting for it. Things had improved by the time Ruff's mother Joan needed dialysis and a transplant, and in October 2004, Ruff, the only one of her sisters without PKD, donated a kidney to her younger sister JoAnn.

Heart: A History by Sandeep Jauhar
Jauhar directs the Heart Failure Program at Long Island Medical Center. His family history – both grandfathers died of sudden cardiac events in India, one after being bitten by a snake – prompted an obsession with the heart. In this illuminating dive into the intricacies of cardiovascular disease and treatment, Jauhar explores major medical advances of the last six decades, including the heart–lung machine, cardiac catheterization, heart transplantation and artificial hearts. Interspersed with this timeline of events are scenes from Jauhar's own academic and professional experience, experimenting on frogs in high school, dissecting his first cadaver at medical school, and cataloging body parts in a makeshift morgue as a 9/11 first responder.

Artistic interpretaion of heart transplant, courtesy of Cosmic Series

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