just couldn't get into it. ( )

Interesting book on the history and progress of organ transplant interspersed with anecdotes of the author's patients. Well-structured. The only flaw is Mezrich's description of the surgeries. Most of the time, I didn't get what he is trying to describe. I have read quite a number of medical books, and the other authors were able to make the surgical process easy to understand. Nevertheless, Mezrich endears with his devastating honesty. He said he wished a difficult patient would just die (but he tried his best of course). I was shocked. What guts does it take to write that? Half a star more. ( )

A nice combination of organ transplant history and surgical memoir. A bit specialized (for my interest), and I would have appreciated more details on xenotransplantation, but overall it was a very worthwhile read.

> The good news is he has just been awarded a MELD exception. This means that we wrote a narrative about him, discussing his horrible pruritus (itchy skin), his inability to continue with his job, and his frequent admissions to the hospital. The regional review board, which consists of surgeons and hepatologists from all the transplant programs in our region, agreed to grant him a 22. This means that a majority of liver specialists in the region agrees that the MELD system does not adequately represent Nate's mortality (or need for a liver) and is willing to have him move up the line to receive a liver in the region.

> withdraw support by the removal of the ventilator and the shutting off of the pressors (the medications supporting blood pressure). Only if the patient dies quickly are we able to procure his organs for transplant. At our program, we will wait thirty minutes for the patient’s lungs, liver, and pancreas, and up to two hours for his kidneys. We typically will not use the heart from these types of donors, as we think that waiting for the heart to stop beating prior to its removal will irreparably damage the organ.

> In 1980, the Uniform Determination of Death Act passed in the legislatures of all fifty U.S. states, declaring brain death legally equivalent to death. This legislation has been critical to the success of organ transplantation.

> when a humanitarian decides to donate a kidney to help a stranger in need, this can start a chain. One woman's kidney can go to a recipient whose incompatible donor then donates to someone else, whose donor donates to someone else, and so on. The chain can go back and forth, crisscrossing the nation for weeks on end, until it finally breaks. The longest chain the NKR has had to date included thirty-four donors and thirty-four recipients

> It was courage that sustained them through the dark years of the 1970s, when outcomes were as bad as 20 to 50 percent chance of one-year survival, with many of the patients suffering miserable deaths secondary to infection and overimmunosuppression—a period that didn’t end until cyclosporine became a clinical reality in the early 1980s. ( )

In this non-fiction book, When Death Becomes Life: Notes from a Transplant Surgeon, Joshua D. Mezrich gives the reader a comprehensive, and personal look at transplants. But this is no dry medical memoir. He looks at the history, the medical techniques used, personal stories of some recipients and donors, cross-species attempts, and even some of the mistakes and failures including his own. He is passionate about his field but he shows a great deal of empathy towards the suffering of both donors and recipients. This is a highly readable, often deeply moving, and, in the end, hopeful look at an important field of medicine.

Thanks to Bookshout and the publisher for the opportunity to read this book in exchange for an honest review ( )

Although in his introduction to his book transplant surgeon Joshua Mezrich claims “the following book is neither a memoir nor a complete history of transplantation”, in fact it encompasses elements of both. In the first couple of hundred pages he highlights key moments in research and experimentation, from the late nineteenth century through to the remarkable work being done today. He expresses his admiration for the early pioneers of transplant surgery, doctors who were determined and courageous in their continuing efforts to experiment and to find solutions to set-backs, even when faced with a very high death rate; he also admired their determination to persist in the face of being surrounded by colleagues who thought they were crazy, as well their willingness to face the very real threat of ending up in prison. I found it fascinating to discover that in the 1960s and 70s, when versions of anti-rejection drugs were in their infancy, the death rate for patients was approximately fifty percent. However, since cyclosporine, the first truly effective immunosuppressant was approved for routine use in the 1980’s, success rates now exceed ninety percent.
Interspersed with this history were some of the author’s own experiences and I found this helped to put the history into an understandable, human context. There was a considerable amount medical terminology but, partly because I do have some knowledge of this terminology, but mainly as a result of the eloquence and clarity of the author’s writing, I never felt that I couldn’t understand it. Neither did I feel that it unbalanced the flow of the story he was trying to tell.
However, I must admit that the book really came to life for me in its final third, when he described individual cases in much more detail. Some of these accounts are quite upsetting, some are inspiring but all are intensely moving in the ways in which they capture the life and death situations transplant surgeons face on a daily basis. Another aspect of the book which fascinated me was the author’s exploration, a narrative which weaves its way in and out of the individual cases, of the range of ethical questions which surround the question of transplant surgery. For example, should alcoholics be eligible for scarce livers? Should patients whose life-style has made no contribution to their need for a transplant be given priority? How sick do people have to become before they “qualify” for a donated organ? It is clear from his reflections that whilst the author has no easy answers, he constantly considers these dilemmas using a combination of clinical judgement and compassionate caring. What also becomes very clear from his writing is the huge respect he has for his patients and the courage they show in agreeing to transplant surgery. However, his especial admiration and respect for all donors, whom he describes as “the heroes, the ones who make it all happen”, is apparent throughout his writing. I also admired the author’s willingness to admit to his mistakes and fallibility, something which isn’t always a given in the medical profession!
I found this an impressively accessible, engrossing and very moving account of the complexities of this life-changing area of surgery. The frequent moments of tension in the life and death situations described are sometimes leavened by some humorous moments. However, this is a humour which never felt inappropriate or dismissive, but rather one which reminds the reader that Joshua Mezrich retains huge respect for each and every one of his patients and their families, as well as the donors and their relatives. It is quite clear that he never loses sight of the fact that most transplant surgery is dependent on the death of a donor and his compassion for the surviving relatives is always apparent in his accounts of his interactions.
I’ve been on the donor register for many decades but, had I not been, I’m sure that having read this book and been made aware of how this “gift of life” really does transform the lives of dying patients, I would have made it a priority to register as soon as possible.
My thanks to Atlantic Books and Real Readers for a copy of this book in exchange for an honest review. ( )