When Death Becomes Life

In last week’s post, I told you about a book I didn’t like. This week, I’ll tell you about one I liked. About a year ago, Russ Hobbie suggested I read When Death Becomes Life: Notes From a Transplant Surgeon, by Joshua Mezrich. Mezrich is a transplant surgeon at the Wisconsin School of Medicine and Public Health. The book starts

The following book is neither a memoir nor a complete history of transplantation. I am not old enough to write a memoir, and a few excellent complete histories of transplantation exist already (and are listed in the bibliography). My goal is not to provide a chronological depiction of my coming-of-age as a surgeon, but rather, to use my experiences and those of my patients to give context for the story of the modern pioneers who made transplantation a reality.

Russ and I discuss transplants briefly in Chapter 5 of Intermediate Physics for Medicine and Biology, when describing the artificial kidney.

The artificial kidney provides an example of the use of the transport equations to solve an engineering problem. The problem has been extensively considered by chemical engineers, and we will give only a simple description here… The reader should also be aware that this “high-technology” solution to the problem of chronic renal disease is not entirely satisfactory… The alternative treatment, a transplant, has its own problems, related primarily to the immunosuppressive therapy.

Mezrich describes the kidney in this way.

The kidney is an exquisite organ. I like to tell my residents that “the dumbest kidney is smarter than the smartest doctor.” In a healthy person with a working organ, blood flows into the kidney and goes through an ingenious system of glomeruli—that is, circular tufts of thin blood vessels surrounding the tubules of the kidney. Across the kidney’s membranes and structures, toxins, wastes, and electrolytes are filtered out into the tubules to be secreted as urine. Kidneys are also involved in controlling blood pressure and stimulating the production of red blood cells. It’s amazing how a working kidney seems to know exactly what to do with fluids and reabsorption, whereas we doctors have so much trouble regulating fluid in patients, no matter how many labs and vitals we check.

After Mezrich told of the challenges he faced in his first kidney transplant, he wrote

Since then, I have done hundreds of kidney transplants, and I promise much more smoothly than that first one. To this day, though, I experience the same feeling of amazement when the organ pinks up and urine squirts out. To this day, I still can’t believe it works—and not just for a few days or a few months. With a little luck, the little beans I successfully transplant into patients should keep pumping out urine for years.

Mezrich tells the story of Willem Kolff’s invention of the dialysis machine (the artificial kidney) in Nazi-occupied Holland. There’s a lot of physics in dialysis, but even more in Jack Gibbon’s development of the first heart-lung machine. Mezrich also reviews the discovery of the immunosuppressive drug cyclosporine (he calls it the penicillin of transplantation), which made long-term kidney, liver, pancreas, and heart transplants possible.

By juxtaposing the history of transplantation with his own career as a transplant surgeon, Mezrich makes clear both the historical development and the special challenges of his field. Anyone applying physics or engineering to medicine would benefit from his unique insights. His look at the human side of medicine contrasts with the more technical information found in Intermediate Physics for Medicine and Biology.

Somehow, Thanksgiving seems like the appropriate time to write about When Death Becomes Life. Certainly, we all owe a great debt to the doctors, nurses, support staff, researchers, organ donors, and their families for this lifesaving surgery. I urge you to sign up to be an organ donor at https://www.organdonor.gov/sign-up. 

I’ll give Mezrich the final word.

By illustrating what it took for me to practice transplantation, and by painting a picture, with the stories of my patients, of how the discipline has touched so many, I hope to highlight the incredible gift transplantation is to all involved, from the doctors to the recipients to those of us lucky enough to be the stewards of the organs. I also will show the true courage of the pioneers in transplant, those who had the courage to fail but also the courage to succeed.

How Death Becomes Life, by Joshua Mezrich. Talks at Google. 

https://www.youtube.com/watch?v=oA-EZ2Tsv1I