Kennedy Institute of Ethics Journal

Joshua Mezrich is a practicing transplant surgeon who draws on his experiences, and those of his patients, to provide a "here's where we're at" moment in the story of transplant medicine. In so doing, he explains what it is like to practice while telling the stories of his patients, donors, and the pioneering surgeons who persisted in the face of failure to make what Mezrich does a work of healing. Written for a popular audience, When Death Becomes Life is perhaps the most accessible work yet on the modern history of organ transplantation and what the current "standard of care" actually looks like. Indeed, it rounds out a "trinity" of quality books about the transplant experience, this one from the surgeon's experience—the other two being Kidney to Share (the living donor's experience), and The Power of Two (the recipient's experience).

The opening chapter provides a snapshot of the practice today. The teams get an evening call about a young motorcycle accident victim who died from a traumatic brain injury. On site, the competition between the "chest" and "abdomen" teams manifests in protectiveness over their "turf"—an ample portion of the inferior vena cava, for example. The donor's chest is opened "stem to stern" and the abdominal organs are removed first, each of which is flushed with a cooling solution while buckets of ice are poured into the donor's body along the way. After departing, Mezrich and his team find themselves flying in conditions that have grounded all other commercial aircraft. Although it threatens to end in catastrophe, their flight has emergency authorization to deliver the liver and kidneys to a sick diabetic who, meanwhile, is being prepped for surgery. That is just the beginning of a remarkable project that is not only useful for informing the public about how transplant medicine actually works (which is its [End Page E-8] primary value), but also illuminating for the history of research ethics as a case study about how the risks taken by the pioneering surgeons ended up being rewarded.

The book is a mix of history and memoir divided into six parts. Part one explains how today's routine procedures were made possible by Alexis Carrel's breakthroughs in stitching blood vessels together. Part two surveys the history of renal transplantation beginning with Willem Kolff's early dialysis methods, continuing with Peter Medwar's tissue-type discoveries, and ending with the first successful transplant performed by Joseph Murray between identical twins. Part three moves through the familiar story of heart transplants and the less familiar story of lung and pancreas transplants; the treasure in this section is the material drawn from the author's interview with the late Thomas Starzl who reflected on his stubborn ability to continue attempting liver transplants despite catastrophic failures and personal self-doubt. Those familiar with the observations of Renee Fox and Judith Swazey that the early transplanters had "the courage to fail"—or in Mezrich's view, "the courage to succeed"—will appreciate the fresh perspective on this theme from an insider's point of view. Parts four through six explain what transplant medicine is like today as it relates to the recipients, donors, and surgeons (practicing and aspiring). This half of the book, which I focus on below, is invaluable for making a more informed decision to donate in general. As a whole, it is an oasis of expert testimony in the desert of knowledge the public mind has wandered through the last forty years.

Unlike other surgical areas, transplant surgeons develop long-term relationships with their patients. While the operation is the most consequential event in that relationship, the bonds of care are formed long before and after the graft is sewed in. These bonds can lead one to say some shocking things: "I had been hoping to get Jason a perfect liver," says Mezrich, "maybe from a twenty-two-year-old who'd died in a motorcycle accident or from a gunshot wound to the head." To get a liver, the patient has to be sick enough to be prioritized, but...