Review of When Death Becomes Life by Joshua D. Mezrich

When Death Becomes Life Book CoverIt is an underappreciated fact that today a surgeon can, if needed, rip open your chest, remove your heart, replace it with another one, and if all goes well, have you discharged in 10 days. This amazing feat of modern medicine, one we may rarely think about, was at one point thought to be nothing more than a science fiction fantasy—and rightly so.

The number of hurdles standing in the way of successful transplantation was enormous. These included figuring out how to suture together blood vessels without leakage or damage to the inner lining, how to keep patients alive by temporarily taking over the function of failed organs (dialysis for kidneys and cardiopulmonary bypass for the heart and lungs), and developing anti-rejection medication to prevent the host immune system from attacking the donated organ. Throw in the ethical and logistical issues associated with procuring and coordinating donated organs and recipient transplant lists and you have one of the most complex and daunting issues in the history of medicine.

If you’re like me, at some point you’ve pondered the details of the first transplantation, when and where it was performed, and who was bold enough to carry it out, along with the details about how they could have possibly figured all of this out. In When Death Becomes Life, transplant surgeon Joshua D. Mezrich answers these questions and more, telling the story of his own development as a transplant surgeon along with the history of the subject and the pioneers that made it all possible. Mezrich also catalogues the incredible stories of courageous patients and heroic donors that risked everything for a chance to live life and save life.

The journey to successful transplantation was anything but easy, both in general and for Mezrich in particular. The success rates, while higher today, were extremely low for most of the history of transplantation (and particularly before the development of immunosuppression medications). Mezrich tells the stories of not only the successes but also of the disappointments and deaths, and how emotionally taxing the profession can be. (Mezrich particularly drives home the point when he recounts the first patient he killed.)

But far from being a demoralizing book, When Death Becomes Life is a testimony to human perseverance, both individually and collectively. Every failed experiment, unsuccessful operation, and accidental death brings with it the opportunity to learn and advance, and we are living during a period of time where we can witness the culmination of this sacrifice. Today, for example, the one-year survival rate for heart transplant recipients is 85 to 90 percent, compared to about 30 percent in the 1970s. Just imagine the emotional toll of having 7 out of 10 of your patients die within a year of you working on them. Today you can successfully extend the life of 9 out of 10.

This drives home a larger message; namely, that the conveniences and privileges we take for granted today were intensely and passionately fought for, and that future progress depends on the application of the same passion and perseverance. Constant vigilance—in medicine as in all areas of life—is the only way forward to a future that is better than the present.

Mezrich ends the book by contemplating the future of transplantation, including the possibility of xenotransplants (transplants between species). Pigs represent the most promising donor, and with advances in genetic engineering, we may be able to one day manipulate a pig’s genes to create organs compatible with our own immune systems. If this sounds like science fiction, so did the prospect of heart transplantation between two humans, not that long ago.