Although in his introduction to this 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 setbacks, 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 1980s, success rates now exceed ninety percent.

Interspersed with this history are 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 lifestyle 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.

Linda Hepworth 5/5

How Death Becomes Life by Joshua Mezrich
Atlantic Books 9781786498861 hbk May 2019