Literary Insights

BOOK LINK:

Here is a summary of the dedication section:

The dedication is dedicated to G, S, K, and P as well as the donors, both living and dead. They are called “true heroes.”
The contents section then lists out the various parts and chapters in the book, diving it into sections on transplantation milestones, the transplant procedure, different organ transplants, patient stories, donor stories, complications, future directions, and advice for aspiring transplant surgeons.
There is a short note from the author explaining that this is not intended to be a memoir or complete history, but rather uses their experiences and patient stories to provide context about the pioneers who made transplantation a reality.
It provides a brief background on the author’s training path and current role performing organ transplants and research in Madison, Wisconsin.
The goal is to highlight transplantation as an incredible gift through stories of donors, recipients, and those involved in the field. It also aims to show the courage of early pioneers who helped establish transplantation despite failures.

So in summary, the dedication is a short introduction dedicating the book to donors and recipients, outlining the book’s contents and structure, and providing context about the author’s perspective and aim for the book.

The passage describes a liver transplant operation performed by the author on a patient named Cindy.
In the middle of the night, the author received a call about an available donor liver that looked in good condition. It was from a 44-year-old male who died of a drug overdose after 20 minutes of CPR.
Cindy was at the top of the transplant list for this liver due to her high MELD score of 40, indicating her liver was severely dysfunctional and she was at high risk of dying without a transplant.
The MELD score predicts how sick a patient’s liver is and their risk of death without a transplant. Scores range from 6 to 40, and those below 15 typically do not qualify for a transplant due to risks outweighing benefits. Higher scores indicate greater liver dysfunction and risk of death.
The author approved moving ahead with using this liver for Cindy’s transplant surgery since it appeared to be in good condition based on the information provided.
The passage describes the extremely complex coordination required for a liver transplant, from identifying potential donors and recipients, to conducting medical tests, to scheduling flights and operating rooms. There is immense pressure as any delay can have life-threatening consequences.
It focuses on a patient named Cindy who is critically ill from liver failure. The surgeon assesses her condition and decides to proceed with the transplant despite risks.
When the organ becomes available after many scheduling changes, Cindy’s surgery is performed. It goes well initially but complications arise later.
The passage conveys the emotional challenges surgeons face in making choices that can determine whether a patient lives or dies. It also highlights the anxiety transplant recipients endure as they wait for a lifesaving organ to become available. Precise coordination is essential to optimize outcomes for both donors and recipients.
The passage describes the early history of organ transplantation and challenges surgeons faced in connecting blood vessels.
In 1894, French President Sadi Carnot was assassinated, renewing surgeon Alexis Carrel’s interest in improving treatment for severe injuries. Surgeons at the time could not reconnect severed blood vessels.
In 1901, Carrel began experimenting on dogs to develop a technique for joining blood vessels. He recognized the need for better needles, thread, and a way to protect the vessel lining during surgery.
Carrel obtained finer needles and thread from a haberdashery and practiced embroidery to improve his surgical technique. He coated the thread with paraffin jelly to ease suturing.
In 1902, Carrel published the first paper describing his technique for reconnecting blood vessels. This was a major breakthrough, laying the foundations for modern vascular surgery and transplant surgery. It allowed organs to be transplanted by reconnecting their blood vessels.
The passage describes Carrel as a gifted natural surgeon who wasted no motions and could clearly demonstrate high skill after just a short time operating. His innovations were crucial to advancing transplant surgery.
Alexis Carrel was a pioneer in organ transplantation and vascular surgery in the early 20th century. He had exceptional physical skill and precision in sewing blood vessels together.
In 1906, working with Carl Guthrie at the University of Chicago, Carrel perfected the technique of vascular anastomosis (reconnecting blood vessels). They published many papers describing experiments transplanting organs like kidneys, hearts, and lungs between dogs.
This was a breakthrough period for Carrel. He gained expertise in the technical skills needed through repetition. Publications from this time on transplantation techniques and concepts like immune rejection were remarkably prescient.
Carrel presented his work to prominent surgeons in Chicago and Baltimore. Though transplantation initially failed after a week, he hypothesized inherited factors and planned future experiments to understand rejection and potential immunization techniques.
Impressed by his work, Rockefeller Institute recruited Carrel in 1906. There, his transplantation experiments continued and advanced the field significantly.
Alexis Carrel was a pioneering French surgeon in the early 20th century who performed some of the first organ transplants between animals. This included spleens, thyroids, intestines, kidneys, and more.
He perfected techniques for sewing blood vessels together and nailing bones in place during limb transplants. His work on kidney autotransplants and allotransplants helped lay the foundations for modern transplantation.
His research suggested that something about close genetic relationships between donors and recipients could improve graft survival, anticipating the role of immunogenetics in transplantation.
He also hypothesized that conditioning recipients through radiation or chemicals like benzol could help prevent rejection, anticipating the concept of immunosuppression.
Unfortunately, his promising transplantation work was interrupted by WWI and largely forgotten until the 1950s due to barriers like acute rejection that were not understood at the time.
After WWI, Carrel turned towards less productive pursuits like eugenics and pseudoscience. He published a popular but controversial book promoting eugenics theories.
During WWII, Carrel supported the Vichy government in France and collaborated with the Nazis, destroying his reputation after the war.
While his early transplantation experiments were groundbreaking, Carrel’s later views have significantly overshadowed his scientific contributions to the field.

The passage describes a kidney transplant surgery performed by the author. It details the process of prepping the donor kidney on the back table by cleaning it and dissecting the arteries, veins and ureter. Multiple arteries require deciding how best to attach them to the recipient.

Once prepared, implantation begins. The recipient’s iliac vein and artery are opened to attach the donor kidney vessels via continuous sutures. When blood flow is restored, the kidney turns pink as it receives blood - a beautiful sight. The ureter is then stitched to the bladder.

The surgeon emphasizes that every step must be perfect, as any mistakes could have severe consequences for the patient and donor. A kidney transplant is an incredible medical achievement that extends lives. Until the 1960s, kidney failure was fatal as dialysis did not exist. The complexity of the kidney and significance to life makes transplant surgery highly important.

The summary briefly outlines the passage describing the author’s transition to surgery during medical school, with long hours and being on-call constantly. It set the author on the path to becoming a transplant surgeon.

Here is a summary of the key events and ideas from the passage:

The author describes feeling dizzy and faint while assisting with a bowel obstruction surgery after not eating all day. They continued on to assist with a kidney transplant late at night.
The kidney transplant was a transformative experience, seeing the donated kidney turn pink and start functioning. This sparked the author’s fascination with organ transplantation.
The author realized dialysis was crucial for enabling kidney transplantation to become a clinical option. Dialysis keeps patients alive but is an unpleasant process, confining them to lengthy sessions multiple times a week.
Willem Kolff invented the first dialysis machine while hiding from the Nazis in occupied Holland. He was inspired by a patient who died of kidney failure, and wanted to develop a way to temporarily filter the blood and give the kidneys a chance to recover.
Kolff used a sausage casing and cellophane membrane to filter blood in a rocking bath, successfully removing urea. This proved dialysis was possible, though many technical challenges remained in developing it as a treatment.
Willem Kolff moved to a small hospital in Kampen, Netherlands in 1941 to escape scrutiny over his controversial views from Nazi supporters in Groningen.
In Kampen, Kolff had two main goals - treat as many patients as possible, including those with kidney failure, and save people from the Nazis by faking illnesses or making their skin yellow to fool Nazis.
In 1942, Kolff invented the first dialysis machine using simple components like a spinning cylinder and cellophane tubing to filter toxins from patients’ blood.
Kolff tested his machine on critically ill patients and saw some early improvement but his first few patients still died from kidney failure.
Over two years, Kolff secretly treated 16 patients at night with ongoing improvements to his machine. Only one survived but Kolff was convinced dialysis could work if used early enough.
In 1945, Kolff successfully kept a patient named Sofia Schafstadt alive using eight days of dialysis, proving the concept and paving the way for dialysis to become a chronic treatment later on.
Kolff continued innovating dialysis and kidney transplantation, making major contributions to the fields of organ replacement and artificial organs. His persistence established dialysis as a lifesaving therapy.
The advent of dialysis allowed certain hospitals to become centers for treating renal failure patients, buying time for physicians to consider more permanent solutions like transplantation.
Before transplantation was possible, someone had to overcome the barrier of the immune system rejecting foreign tissues/organs.
The passage describes the author’s experience as a medical student working for a skin bank that harvested skin from deceased donors to use as temporary grafts for burn victims.
The author describes participating in his first skin harvest, which involved inflating the donor’s body with saline, harvesting strips of skin using a dermatome, and processing/packaging the harvested skin.
Though initially uncomfortable being so directly involved in handling deceased donors, the author became accustomed to the process over subsequent skin harvests.
The passage reflects on how skin transplantation paved the way for later advances in organ transplantation by demonstrating techniques to overcome immune rejection of donor tissues.
Peter Medawar was a zoologist working in cell culture and studying embryonic chicken hearts when he was asked to help treat a burned British pilot in 1940. His initial work focused on antibiotics for burn wounds.
He began experimenting with skin grafts to expand coverage for burned patients. His key insight was that skin from other donors (homografts) were rejected, while a patient’s own skin (autografts) was accepted. This suggested an immune mechanism of rejection.
Medawar pioneered the use of skin grafts in animal experiments to study rejection. He found that a second graft from the same donor was destroyed rapidly, showing acquired immunological tolerance. This established immune rejection as the barrier to organ transplantation.
A chance encounter led Medawar to use skin grafts to determine if cattle twins were identical or fraternal. The grafts being permanently accepted revealed the possibility of inducing immune tolerance that could allow transplantation.
Medawar’s work revolutionized the field by proving transplantation was biologically possible if immune rejection could be controlled or prevented through acquired tolerance. This paved the way for future immunosuppression approaches enabling clinical organ transplantation.
Owen published a study in 1945 describing a surprising finding in cattle twins with different fathers - each twin had a mixed blood type containing antigens from both its mother and both fathers. This was the first documented case of cellular chimerism.
Medawar and Billingham realized this meant the twins must have developed immune tolerance to each other’s tissues while sharing a blood supply in utero.
They conducted experiments transplanting skin between genetically unrelated mouse strains and found fetal exposure allowed for tolerance and graft survival, demonstrating immune tolerance as a solution to transplant rejection.
This was a breakthrough finding, proving transplants between unrelated individuals were possible if tolerance could be induced. It revolutionized the field and inspired many to work on making clinical transplantation a reality.
The author recounts his nervous experiences performing his first kidney transplant as an attending surgeon. It took extra long and was challenging due to the recipient’s large size, but the transplant was ultimately successful.

In 1947, Dr. David Hume performed the first successful kidney transplant in Boston. A patient was dying of renal failure after an illegal abortion. When a surgical patient died, Hume obtained one of their kidneys and transplanted it into the woman’s arm. Remarkably, the kidney functioned immediately, producing urine. While it only lasted a few days, it bought the woman’s own kidneys enough time to recover.

At that time, kidney transplantation was in its infancy and highly experimental. Surgeons had some success transplanting kidneys in dogs but knew human transplants likely wouldn’t last long. Techniques for organ preservation, immunosuppression, and donor matching were still being developed.

In the late 1940s and 1950s, transplantation pioneers like Hume, Joseph Murray, and transplant centers in Boston and France continued performing experimental transplants and advancing techniques, though most transplants initially failed. The development of dialysis in the 1950s allowed supporting more transplant patients. Over time, advances in organ preservation, surgical methods, immunosuppression drugs, and understanding of rejection enabled longer-term transplant success and the eventual routine use of kidney transplantation to treat end-stage renal disease.

In the early 1950s, pioneers like Charles Woods in India and David Hume in Boston were experimenting with kidney transplantation without immunosuppression.
Hume conducted a series of 9 kidney transplants in Boston from 1951-1954, placing the kidneys in recipients’ thighs. All eventually failed, but one patient survived for almost 6 months, giving hope that longer term success was possible.
Woods was a pilot in World War 2 flying supplies over the Himalayas (the “Hump”). In 1944 his plane crashed on takeoff in India and burst into flames. Woods suffered severe burns over 80% of his body but remained calm, hoping to survive. His experience with burns and recovery provided insights that later benefited transplantation research.
Despite the failures, pioneers like Hume demonstrated kidney transplants were technically possible in humans. The relatively long survival of one patient in Hume’s series convinced the medical team that success was on the horizon with further research.
A pilot named Charles Woods had a plane crash and suffered severe burns over 70% of his body. He was treated by Dr. Joe Murray at Valley Forge General Hospital. Murray used skin grafts from a deceased donor and Woods’ own skin over many months and operations to help Woods recover.
Murray then joined research on kidney transplantation at Boston led by Dr. Joseph Murray. They performed experiments transplanting dog kidneys to practice techniques.
In 1954, twin brothers Richard and Ronald Herrick were identified - Richard had kidney failure and Ronald was willing to donate. Murray knew this was an opportunity to attempt the first successful human kidney transplant since the twins would be genetically identical.
On December 23, 1954, Murray and his team conducted the transplant surgery - Harrison removed Ronald’s kidney and Murray sewed it into Richard. The transplant was successful, with the kidney functioning immediately. This was a major breakthrough as the first successful organ transplant between living humans. Richard lived eight more years with the transplanted kidney.
Joseph Murray performed the first successful kidney transplant between identical twins in 1954. This paved the way for further research into organ transplantation and immunology.
In 1958, a woman named Gladys experienced renal failure after having her only kidney removed during an emergency appendectomy. She became one of the first recipients of a kidney transplant from a non-identical donor.
For this transplant and others that followed, Murray used total body irradiation to suppress the immune system, allowing the transplant to occur without immediate rejection. Bone marrow was also transfused to restore the immune system.
Gladys initially did well but ultimately died from infection, as the bone marrow transplant failed. The next recipient also died of infection before receiving a kidney.
For the third case, Murray lowered the radiation dose and used kidneys from fraternal twin brothers without bone marrow transfer. This transplant was initially successful, though rejection issues later occurred.
These early non-identical transplants helped advance the field but also demonstrated the risks of total body irradiation and the need to develop better immunosuppression protocols to prevent rejection and infection.
John received a kidney transplant from his identical twin brother. Eleven days after the transplant, he fell ill from a kidney infection and had to have his native kidneys removed. He slowly recovered with treatment.
Over the next 29 years, John had normal kidney function with no immunosuppressive drugs. His death was unrelated to the transplant. This was considered the first successful kidney transplant.
However, the other 11 patients in the trial all died relatively quickly, from rejection or infection. This was discouraging but Murray remained determined and continued the trials, learning from each failure.
Roy Calne was inspired by Medawar’s work on tissue transplantation but Medawar said human transplantation was not possible. Calne went on to perform early successful kidney transplants in dogs using immunosuppressive drugs like 6-MP.
Calne’s work gained recognition and he was able to work with Murray in Boston. They tested drugs and found azathioprine (Imuran) improved outcomes in dog trials.
The first transplant using azathioprine immunosuppression in a human was in 1962 and lasted over a year, proving the concept could work. However, early success rates remained low, around 50% one-year survival.
In the 1970s, cycolsporine was discovered and showed very strong immunosuppressive effects. This drug greatly improved outcomes and transformed transplantation success rates.
Dr. Starzl began his internship and residency at the University of Chicago, where he gained experience caring for sick patients but became desensitized to their experiences as a human being.
During his training, he killed his first patient by accidentally puncturing her lung while placing a central line. As her condition deteriorated into a tension pneumothorax, he realized his mistake and tried to remedy it by inserting chest needles, but was unable to save her.
A code was called. Dr. Starzl started chest compressions as other medical staff entered the room and took over resuscitation efforts, but the patient could not be revived after the lung puncture complication.
This was a formative early experience for Dr. Starzl that showed him the risks of medical procedures and how easily things could go wrong, even for routine tasks he had done many times before. It highlighted the importance of treating patients as human beings despite the detachment sometimes required in medical training.

The resident had to place a line in a patient’s lung but accidentally punctured the lung, collapsing it. Despite performing CPR and placing a chest tube to drain air, the patient died. The Chief Resident and attending surgeon tried to reassure the resident that it was probably for the best and she was likely already dead, but the resident knew he had directly caused the patient’s death. He felt incredibly guilty.

The resident then called the patient’s son to inform him of the complication and death. The son thanked the resident for trying but recognized his mother could now rest. The resident was upset about being put in this situation but also felt very guilty for killing the patient. Learning you caused someone’s death is not something you get used to quickly as a resident.

In 1930, Dr. Jack Gibbon witnessed a patient die during surgery due to a blood clot blocking her lung arteries. This inspired him to invent a device that could oxygenate and pump blood outside the body, allowing surgeons to bypass the heart and lungs during operations.
Over the next decade at Mass General Hospital and the University of Pennsylvania, Gibbon developed the first “heart-lung machine”, successfully keeping cats alive by pumping and oxygenating their blood externally.
In 1953, Gibbon performed the first successful open-heart surgery using cardiopulmonary bypass on an 18-year old woman with an atrial septal defect at the Jefferson Medical College Hospital in Philadelphia.
However, the technology of cardiopulmonary bypass was still in its early stages. A later story describes a traumatic experience of a surgical resident during a lung resection surgery on a 17-year old patient, where a stapler line on the pulmonary artery ruptured, drenching the surgeons in blood. This highlighted the risks still involved with such bypass surgeries.
The invention of cardiopulmonary bypass by Jack Gibbon was a major breakthrough, enabling open-heart surgery to become possible. But further improvements were still needed to reduce risks and complications from using the new heart-lung machines.

Here is a summary of key points about eternity from the passage:

The passage describes a pioneering open-heart surgery performed by Dr. C. Walton Lillehei at the University of Minnesota in 1954, which was one of the first times heart surgery was done using another human as the “bypass machine” to pump and oxygenate the patient’s blood during surgery.
Lillehei thought existing bypass machines were too complex and risky, so he invented a technique called “cross-circulation” where they connected the arteries and veins of another person (usually a father) to the patient to serve as a living bypass pump during the operation.
This was a daring and innovative idea at the time, as it posed risks to both the patient and the person serving as the bypass, but Lillehei believed it allowed more control over the bypass than a mechanical device.
The passage describes Lillehei using this cross-circulation technique successfully to perform one of the first open heart surgeries repairing a ventricular septal defect in a young child, paving the way for open-heart surgery to become more common and save more lives.

So in summary, the passage focuses on Dr. Lillehei’s pioneering work at the University of Minnesota in the 1950s that helped establish open-heart surgery and cardiac surgery as a viable field through his invention of using human-to-human bypass techniques.

The surgeon, Lillehei, needed to check the blood types of Gregory and his parents to find a match for a cross-circulation surgery, where one person’s blood would oxygenate the other’s during open heart surgery.
Gregory’s father, Lyman, was a match and agreed to the risky procedure. Lillehei successfully used cross-circulation to open and repair a defect in Gregory’s heart.
Sadly, Gregory later developed an infection and died. However, Lillehei continued performing cross-circulation surgeries, with around a 55% survival rate. He pushed the boundaries by repairing more complex congenital defects.
One of the most dramatic cases involved using a volunteer, Howard Holtz, whose blood matched a 10-year-old boy in need of surgery when no family member’s blood type matched. The surgery was successful.
There was one disaster where a woman serving as the “pump” suffered brain damage due to an IV error, leaving her severely disabled for life.
Surgeons like Gibbon, Kirklin and Lillehei worked to develop cardiopulmonary bypass machines to replace cross-circulation and help advance open heart surgery. But it took time to optimize the machines and achieve consistent results.
Norman Shumway arrived at the University of Minnesota for his surgical internship in 1949, initially thinking he would become a lawyer but ended up in medical school due to the military’s needs during WWII.
At Minnesota, he experimented with hypothermia on dogs and assisted in open-heart surgeries using cross-circulation and early bypass machines.
By 1957 when he finished his training, he wanted to start his own cardiac surgery program applying what he learned about hypothermia and bypass.
Another young surgeon, Richard Lower, also trained at Minnesota in the 1950s and the two would go on to perform the first heart transplant in 1967, making open-heart surgery a reality.

So in summary, Shumway and Lower’s training under pioneers like Lillehei in the 1950s at Minnesota equipped them with the skills and knowledge to later perform the first heart transplant, advancing open-heart surgery significantly.

Christiaan Barnard was from Cape Town, South Africa and had never spent a winter in Minnesota where he trained. He was fascinated by the earliest open-heart surgeries using cardiopulmonary bypass machines.
Barnard completed his training in just two years, as promised, working constantly in the wards, lab, and studying languages in his spare time. He trained under Wangensteen and Lillehei.
Despite a mistake that resulted in a patient’s death, Lillehei encouraged Barnard to continue operating to gain experience.
Barnard was driven and ambitious, wanting to do something exceptional, while Shumway was more relaxed and unsure of his next steps after training.
Shumway experimented with localized heart hypothermia and stopping the heart completely during surgery using cardiopulmonary bypass at Stanford, paving the way for more complex heart procedures. This included the earliest canine heart transplant experiments with Richard Lower.
Christiaan Barnard and Norman Shumway were pioneers in heart transplant surgery in the late 1960s. Barnard performed the first human-to-human heart transplant in 1967 in South Africa, while Shumway developed the first successful heart transplant program at Stanford.
Barnard lacked some of Shumway’s natural surgical skills and had a difficult personality, but he was determined and meticulous in patient care. He spent time in the US training with David Hume, where he observed Lower performing cardiac transplants in dogs.
In December 1967 in Cape Town, Barnard got a call about a potential heart donor, 24-year-old Denise Darvall, who was brain dead after a traffic accident. Her father consented to organ donation. Barnard used her heart for his first transplant patient, 53-year-old Louis Washkansky, who had severe heart failure. This landmark surgery made Barnard famous as the first to complete a human-to-human heart transplant.

Christiaan Barnard performed the first human-to-human heart transplant on December 3, 1967 in Cape Town, South Africa. The recipient was Louis Washkansky, who received the heart of Denise Darvall. Darvall had suffered severe brain damage in an accident and was being kept alive on a ventilator.

Barnard knew turning off the ventilator would result in Darvall’s legal death and make her heart available for transplant. However, he waited 15 minutes after turning off the ventilator to ensure her heart had stopped before removing it. This first transplant was successful, with Washkansky’s new heart beating strongly, but he later died of infection after 18 days.

Barnard went on to perform more transplants, including of Philip Blaiberg on January 2, 1968. Though pioneering, heart transplants were risky in those early days due to the crude nature of heart-lung machines and a lack of powerful anti-rejection drugs. But Barnard’s work established heart transplantation as a life-saving medical procedure.

In January 1968, Norman Shumway performed the first heart transplant in the US at Stanford. The recipient had severe heart disease but suffered many complications and died after 14 days.
In May 1968, Richard Lower performed the first successful heart transplant at the Medical College of Virginia. The donor was Bruce Tucker, a black man who had been brain dead from a head injury. Tucker’s family could not be located to provide consent.
A few days later, Tucker’s brothers discovered his heart and kidneys had been removed without their knowledge or consent. They sued Hume and Lower for removing the organs without permission.
At trial, the jury determined that removing Tucker’s organs did not cause or accelerate his death, since he was considered brain dead. This supported the emerging concept of brain death. However, Hume and Lower failed to properly consider Tucker and his family.
In 1968, over 100 transplants were performed worldwide as many surgeons rushed to perform the new procedure. However, outcomes were generally poor due to lack of experience and immunosuppression. Most programs shut down by 1969.
Norman Shumway is considered the “father” of cardiac transplantation as he persisted through the difficult 1970s and enabled eventual success when cyclosporine became available in the 1980s.
The first lung transplant in a human was performed in 1963 by James Hardy at the University of Mississippi Medical Center. He transplanted the lung of a brain-dead donor into John Richard Russell, a prisoner with lung disease who was dying. Russell survived for 19 days.
Lung transplants were very rare and unsuccessful for many years after Hardy’s pioneering surgery. Improvements in immunosuppression, especially the development of cyclosporine, led to better outcomes starting in the 1980s.
The first successful single lung transplant was performed in 1983 by Joel Cooper in Toronto. The recipient, Tom Hall, lived over 6 years. Cooper went on to perform the first successful double lung transplant in 1986.
Norman Shumway and Bruce Reitz performed the first combined heart-lung transplant in 1981 at Stanford using cyclosporine. The recipient, Mary Gohlke, survived over 5 years. This established heart-lung transplant as a viable option.
While lung transplants had high mortality for many years, outcomes steadily improved such that over 90% of recipients now leave the hospital alive thanks to advances made by pioneers like Hardy, Reitz, Cooper and others.

The passage discusses the history and treatment of type 1 diabetes. It describes how insulin was isolated in the 1920s, greatly improving life expectancy but not providing a cure. Managing blood sugar levels remained difficult.

Pancreas transplantation was attempted as a potential cure. The key challenges included the organ being prone to leakage and infection. In the 1980s, Dr. Hans Sollinger at the University of Wisconsin pioneered connecting the transplanted pancreas to the bladder to drain pancreatic juices, dramatically improving outcomes. However, this led to urinary complications long-term. In the 1990s, he switched back to connecting it to the intestines.

The passage then describes evaluating a patient, Mary J., for pancreas transplantation. She suffers from brittle diabetes with unpredictable blood sugar swings and hypoglycemic unawareness, experiencing blackouts. A transplant could eliminate this risk and allow her to live freely without constant management of her condition. In summary, while insulin provides lifesaving treatment, pancreas transplantation offers the possibility of curing type 1 diabetes.

Early pancreas transplants in the 1960s-1970s led to many complications from leaking of pancreatic enzymes through the duct or at surgical sites. Various techniques were tried to prevent this with limited success.
The first successful human pancreas transplant was in 1966 at the University of Minnesota, but the patient only survived two months due to rejection and infection. Over the next 7 years they performed 13 more with mixed results.
Outcomes did not really start to improve until the 1980s with the advent of the drug cyclosporine which reduced rejection.
The author describes a complex case from 2008 of a man (JB) who had received a prior kidney-pancreas transplant. He required multiple return surgeries after developing a leak from his transplanted pancreas due to a fall. It was very difficult to fully remove the pancreas due to extensive scarring. This highlights the challenges of pancreas transplantation.
While pancreas transplants provide quality of life benefits over just insulin treatment, they can also lead to serious complications requiring multiple surgeries as this case demonstrates.
Dr. Sollinger and his colleague Bobby were performing a liver transplant on a cirrhotic liver with a pre-existing TIPS catheter.
They carefully dissected the liver from the major veins. When removing the last attachments (hepatic veins), Bobby pulled out the TIPS catheter. This caused a large blood clot to enter the heart, arresting the patient.
CPR was started immediately. After 10 minutes of effort, the patient’s heart restarted and blood pressure returned. However, it was unclear if the patient’s brain was still functioning or if continuing the transplant would be a waste of a donor liver. The surgeons were left unsure of how to proceed.
The passage describes the author visiting Dr. Thomas Starzl, a pioneer in liver transplantation, at his office in Pittsburgh in 2016.
Starzl was fearful before operations but felt compelled to pursue transplant surgery when others said it wasn’t possible. He remembered failures vividly.
Starzl grew up in Iowa and had an interest in medicine from his time in the navy. He trained at several top hospitals but struggled with the brutal competition.
Starzl set up his own lab at the University of Miami to study the liver’s regenerative properties. He discovered liver bypass could cure diabetes in an early patient, spurring his research in animals.
The passage provides background on cirrhosis and complications like esophageal bleeding that were challenges for patients before transplantation was possible. It sets the stage for Starzl’s pioneering work developing liver transplantation techniques.

So in summary, it introduces the author’s meeting with Starzl and provides biographical context for how Starzl became interested in transplantation as a way to help patients with end-stage liver disease.

Thomas Starzl performed the first liver transplant in a human on March 1, 1963. The recipient was a three-year-old boy named Bennie Solis who was born with biliary atresia, a disease where the bile ducts never properly form.
Bennie’s condition was terminal, as biliary atresia was essentially a death sentence at the time with no treatment available. He had severe liver damage and cirrhosis.
Starzl had perfected liver transplant techniques through over 200 successful operations in dogs. However, performing the first human liver transplant presented enormous challenges, as Bennie’s condition and coagulopathy from liver failure made surgery extremely risky with the medical knowledge and technology of the time.
This first human liver transplant by Starzl marked a major milestone, though it did not initially succeed due to the difficulty of the case and limitations of the early 1960s medical environment for such complex organ transplantation surgery. It was a pioneering step towards establishing liver transplantation as a life-saving treatment.
Dr. Starzl performed the first liver transplant on a 3-year-old boy named Bennie who had a diseased liver. The surgery was enormously difficult due to extensive scar tissue and the liver’s connections to other organs. Bennie also had a bleeding disorder. Despite their best efforts, Bennie bled out during the surgery and they were unable to complete the transplant.
Fast forward to the story of a liver transplant recipient named Tito. The surgery began well but during reperfusion of the new liver, massive bleeding occurred from tears in the blood vessel connections. The surgeons tried several strategies to control the bleeding and restore blood flow to the liver but were unsuccessful. The liver appeared non-functional and Tito’s condition deteriorated severely.
The surgeon broke the news to Tito’s daughter that he did not expect Tito to survive but would keep trying everything possible. He returned to the OR determined to keep fighting for the patient. After several hours of intensive effort to control bleeding and repair blood vessels, the surgeons managed to stabilize Tito enough to consider next steps, though his prognosis remained grave.
The surgeon starts to think there is a small chance Tito could survive after losing almost 100 liters of blood, though he is still very sick.
They update Tito’s large family and the surgeon says Tito likely won’t make it but they are making some progress and it’s a long shot he could get listed for another liver transplant as the best case scenario.
The surgeon gets tired after leaving the OR covered in blood. He feels relief that Tito’s family at least got to say goodbye.
After more work in the OR, Tito recovers enough to get a new liver transplant and eventually does well, to the surgeon’s surprise when he sees Tito in his office healthy later on.
The surgeon reflects on how close he came to giving up but was convinced to keep trying by Orinda’s trust in him. This story shows the challenges but also rewards of being a surgeon and fighting for patients.
Calne received an unexpected call from his old mentor, Franny Moore, who was visiting his son in Cambridge. Moore agreed to come to a meeting where Calne was presenting his plan to perform the first liver transplant in England.
At the meeting, every person voted against Calne’s plan, deeming it too dangerous. Calne then introduced Moore, who simply said “Roy, you have to do it.” With Moore’s support, the opposition collapsed and plans were made for the surgery.
Moore assisted Calne on this first transplant. Due to the small size of the recipient’s blood vessels, Calne performed the world’s first “piggyback” transplant, leaving the recipient’s major vein intact.
Sadly, the recipient died of infection over two months later. Four of Calne’s first five patients never left the hospital. However, one patient named Winnie Smith survived for five years before dying of infection.
In the 1970s, transplantation faced many challenges. Starzl and Calne’s teams performed most liver transplants but faced high mortality rates due to rejection and infection. A new immunosuppressive drug was needed to improve outcomes.
In the early 1980s, Starzl incorporated cyclosporine into liver transplantation with great success. This helped establish liver transplantation as a standard treatment rather than experimental. Starzl went on to train many future transplant surgeons.
The patient, Jason, was a young history teacher who was first diagnosed with Crohn’s disease at age 15. During a trip to Scotland, he developed severe itching and fatigue which turned out to be caused by primary sclerosing cholangitis (PSC), a rare autoimmune disease that attacks the bile ducts and can cause liver disease.
Jason’s condition progressed to liver failure and he was placed on the transplant waiting list. The author, a transplant surgeon, evaluated Jason and discussed his case and risks of transplant.
When a deceased donor liver became available that was a match for Jason’s blood type, the author accepted it even though the donor was older, as Jason’s condition had deteriorated and a transplant was urgently needed to save his life.
The author then coordinated the process of transferring Jason to the hospital, notifying the transplant team, and preparing for the surgery once the donor organ was procured. Jason and his family were hopeful the transplant would allow him to recover.
There is an ongoing debate about whether alcoholics should receive liver transplants, as some see alcoholism as a self-inflicted disease caused by lack of willpower or self-control. Others view it as a mental illness.
The author poses a question to medical students about their views on transplant eligibility for alcoholics. About half think they should be considered, while most agree the patient should have 6 months of sobriety first.
However, the author then asks what if the patient won’t survive 6 months? What if denying the transplant means a young mother of 3 or 26-year-old will die, leaving children orphaned.
This challenges the students’ views by putting a human face and emotional context to the decision, considering the impact on dependent children if the parent is denied a lifesaving procedure. It raises difficult questions about balancing clinical criteria with compassion in these complex cases.
Overall the passage explores the nuanced debate around allocating limited liver resources, specifically regarding transplant eligibility for alcoholic patients. It questions clear-cut policies by highlighting the human cost of denying transplants in some scenarios.
Lisa received a liver transplant due to cirrhosis from alcoholism. Her surgeon (the author) observed that she seemed low risk for relapse based on her presentation.
The surgery went smoothly and her recovery was good initially. However, 10 months later she was readmitted with liver dysfunction, indicating she had resumed drinking.
She continued to deny drinking despite evidence to the contrary. Within 5 years her liver had failed and she passed away.
The author later contacted Lisa’s husband Jay to try to understand what happened. Jay was angry that the transplant center had not adequately treated Lisa’s alcoholism, seeing it as putting a bandaid on a gushing wound.
Jay provided context that Lisa had some mental health issues and drinking may have been related to trauma in her past. Her sudden death deeply impacted her family.
The story illustrates the complexity of providing transplants to alcoholics, as recidivism remains a major risk even for patients who appear low risk initially. It also highlights the need to adequately treat underlying alcoholism or mental health conditions.
Lisa had a difficult upbringing with an abusive and alcoholic father. Her relationship with her family was strained.
She experienced PTSD from a sexual assault in college that she never fully dealt with. This played a role in her alcoholism.
Lisa’s drinking gradually increased over time. At first it seemed under control but it progressed to the point of advanced cirrhosis from alcohol abuse.
She received a liver transplant but relapsed into drinking after the surgery. She went through many cycles of rehab attempts and hospitalizations as her liver failed again.
Her husband Jay and family suffered tremendously over many years trying to help her but she struggled with denial and embarrassment about her alcoholism.
Lisa ultimately died at age 45 from complications of her alcoholism, not directly from liver disease. She was unable to truly acknowledge and address her addiction.
Her case highlights how the medical system prioritizes procedures over long-term management of mental health and chronic diseases like addiction. More support after her transplant may have helped Lisa stay sober.

So in summary, Lisa’s difficult past, untreated PTSD, and genetic factors predisposed her to alcoholism, but lack of acceptance and long-term management of her addiction ultimately led to her premature death despite interventions like transplantation.

Herb was an alcoholic whose drinking slowly permeated every aspect of his life. He started hiding his drinking and drinking alone.
He found himself getting sick more often with “flu-like” episodes that would leave him bedridden for days. His doctor said his health problems were caused by drinking, but Herb didn’t believe it.
On Labor Day 1990 at a family party, Herb was visibly drunk and taken to the hospital. His blood alcohol level was extremely high at 0.375.
He went to rehab but relapsed shortly after. Another stint in treatment and he agreed to long-term inpatient treatment at a facility specializing in addiction for professionals like himself.
There, he finally acknowledged he had a problem with alcoholism during a church service. He was also diagnosed with cirrhosis of the liver from drinking.
After 3 months of treatment, Herb was sober for a year as required to receive a liver transplant. The surgeon warned Herb not to drink after or he would “take back” the new liver.
Over 25 years later, Herb has remained sober and sees his transplant as giving him a new appreciation for life and chance to help others struggling with addiction.

Nate developed ulcerative colitis in high school and was diagnosed with primary sclerosing cholangitis (PSC) in college. PSC causes scarring of the bile ducts in the liver and can lead to liver failure.

Nate’s symptoms from PSC became severe, including extreme itching and pain. He saw many doctors and had multiple procedures to try to manage the disease. Despite his struggles, he continued pursuing his goal of becoming a physician.

Nate is now in medical school but still has active PSC. He needs a liver transplant to survive long-term but is lower on the transplant list due to the nature of his disease. He faces uncertainty about his health and ability to complete medical training.

Nate’s perseverance in the face of a chronic illness that requires lifelong management illustrates both the challenges patients face and the importance of finding a fair system for allocating scarce transplant resources. Alternate approaches to prioritizing patients with diseases like PSC are discussed.

Liver transplantation can help reset a patient’s health, but the current organ allocation system (MELD) prioritizes patients with primary liver disease over those with secondary liver disease from other illnesses. This limits access for patients like Nate who have secondary liver disease.
Rather than judging how patients acquired their illness, the allocation system could consider quality of life factors, number of hospitalizations, ability to return to productivity in addition to risk of death. But the system is unlikely to change in the near future.
Nate was able to get a MELD exception and complete medical school while waiting for a transplant. He hoped his MELD score would continue rising or he could get a living donor transplant.
Nate’s cousin volunteered to donate part of her liver. The surgeon, who knew Nate well, was hesitant but performed the transplant successfully.
However, Nate developed post-op complications including an arterial clot, bleeding, infection and rejection that required multiple return trips to the operating room. It was an immensely difficult time for both patient and surgeon.
In summary, while transplantation can help diseases like Nate’s, the current allocation priorities and risk of complications made the outcome uncertain even with a living donor. A rethinking of the system was suggested to consider more than just risk of death.
Nate was an intern who had many serious medical issues and procedures during his time in medical school, including multiple liver transplants. Despite his poor health, he persevered and graduated.
At graduation, Nate gave an inspiring speech about the importance of hope. He talked about how hope got him through his illness and wait for a transplant.
Nate emphasized that as doctors, giving patients hope is so important, both for realistic short term goals when treatment is going well, and to combat despair when options run out.
His story emphasized overcoming adversity through perseverance and hope. However, his medical issues were not entirely over, as he had further complications after graduation requiring another transplant.
The speech highlighted Nate’s uniquely challenging medical school experience due to his health problems, but how he was still able to draw lessons to share with his fellow graduates. It celebrated the human ability to find hope even in very difficult health situations.

Wilson’s disease causes copper to accumulate in the liver due to an inability to bind copper to a carrier protein and transport it out. This leads to liver inflammation and damage over time. About 5% of Wilson’s disease patients present with sudden and severe liver failure in their teen years, which can be fatal without a transplant.

Michaela was one such patient who presented with fulminant liver failure from Wilson’s disease. She was given top priority status (1A) on the transplant list due to the severity of her condition. By Sunday she was declining rapidly and in need of a liver transplant urgently.

A 17-year-old boy named C.L. sustained brain death in a car accident. His mother Lori consented to organ donation. Testing confirmed C.L.’s organs were healthy and a match for recipients, including Michaela who received his liver. The surgery commenced in the early hours, replacing Michaela’s severely damaged liver with C.L.’s healthy donor liver in the hopes of saving her life. Timely organ donation and transplantation was Michaela’s only chance for survival.

Here is a summary of the key points about organ donors from the passage:

There are two types of deceased organ donors - brain-dead donors and donors who are determined to have met all brain death criteria after cardiac death.
Brain-dead donors have suffered events like strokes, accidents, or trauma leading to loss of oxygen to the brain, causing it to swell inside the skull. This can lead to herniation or blockage of blood flow, killing brain cells and allowing a diagnosis of brain death. Even though these patients are legally dead, their organs can still function if on a ventilator.
Donors determined brain dead after cardiac death are patients for whom withdrawal of life support is planned. After the heart stops beating, tests can confirm full brain death so organ recovery can proceed.
Donating organs in death is seen as an altruistic, meaningful act that extends the gift of life to others and affirms the value of human life, even in the face of mortality. It gives nobility to the final moments.
The strength, courage and generosity of organ donors and their families is highly praised and considered amazing by the doctor who wrote this passage.
There are two types of deceased organ donors: brain dead donors and donation after circulatory death (DCD) donors.
With brain dead donors, organs can be removed while the heart is still beating, as brain death constitutes legal death.
DCD donors will die from withdrawal of life support. Organs must be retrieved rapidly after circulatory death to be viable for transplant.
If organs were removed from DCD donors before circulatory death, it could be considered the cause of death rather than the underlying condition.
Procurement involves respectfully recovering organs to honor the donor and benefit recipients in need.
Families often find meaning in donating a loved one’s organs to save others, though it is an emotionally difficult process for all involved.
Many donors die from unexpected medical events rather than just accidents or violence. Their untimely deaths motivate the donation of organs to help prevent others from similar fates.

The summary focuses on the key ethical and logistical issues around organ donation from deceased individuals, especially the differences between brain death and circulatory death donors. It aims to captures the essence without excessive detail.

Caleb, the young son of Dan and LeAnn, began choking on a small green tack and stopped breathing. He was rushed to the hospital but his condition deteriorated.
Doctors placed Caleb in a medically induced coma to recover from lack of oxygen, but his vital signs crashed and he was declared brain dead.
Dan and LeAnn immediately agreed to donate Caleb’s organs. Ultimately eight organs were transplanted, including his heart, lungs, liver, kidneys, and more, saving multiple lives.
Kylie was the oldest daughter of Shirley and Bruce. One Sunday, Kylie was in a fatal car accident on her way home.
Kylie was declared brain dead at the hospital. Due to her unstable condition, her kidneys were quickly removed to potentially save lives while tests were pending.
Shirley and Bruce said goodbye to Kylie before organ procurement began. Kylie’s wish to donate her organs helped Shirley cope with the loss of her daughter.
Transplantation success relied on defining death and refining transplant procedures and immunosuppression over decades. It also required grappling with philosophical issues around life, death, and defining what constitutes death.
Alexandre described transplanting a kidney from a patient in a deep coma who was not expected to survive. This may have been the first transplant from a heart-beating donor.
In 1966, a conference was held in London to discuss ethical issues in transplantation, including obtaining donors. Calne described difficulties procuring organs from deceased donors in UK hospitals.
Alexandre disclosed at the conference that his team in Belgium had transplanted kidneys from 9 patients meeting criteria of brain death, though their hearts were still beating. This was controversial, as others said organs could not be removed from living patients.
Efforts to define brain death continued over the following years. In 1967, Beecher initiated a discussion at Harvard Medical School on ethics around hopelessly unconscious patients. Beecher and Murray agreed Harvard should develop a definition of death to help address issues around transplantation and dying patients.

Here is a summary of the provided text:

The passage discusses the challenges faced by transplant pioneers in the early days of organ transplantation. It describes the formation of a committee at Harvard Medical School in 1968 to define brain death, which was an important step to overcome obstacles to organ donation. However, public acceptance of brain death and organ transplantation was not immediate.

It then shares the story of a patient named Wayne who had ALS and wanted to donate his organs after his death. The doctor planned to remove Wayne’s kidneys while he was under anesthesia and then let him die naturally of his disease. However, the hospital’s lawyers warned the doctor there was significant risk of criminal charges for accelerating Wayne’s death, so the plan could not proceed.

When the doctor told transplantation pioneer Thomas Starzl this story, Starzl responded that the early pioneers were able to succeed by performing transplants “before the naysayers had a chance to say nay.” The passage credits pioneers like Starzl for their courage in establishing organ transplantation despitefacing legal risks and opposition from others at the time.

It highlights the challenges surgeons currently face when operating on living kidney donors, as these healthy individuals undergo risks from donation despite no medical benefit for themselves. However, it also describes the gratitude many donors feel for being able to donate. It shares stories that illustrate the impact living donors can have through donation chains coordinated by the National Kidney Registry.

The surgeon describes the surgical procedure for removing a donor’s kidney laparoscopically. Small incisions are made and ports are inserted for instruments and a camera.
The colon is mobilized to access the kidney. Then the spleen and its attachments are carefully mobilized away from the kidney.
The blood vessels (vein, artery, and sometimes multiple vessels) supplying the kidney are dissected out. This is a delicate process to avoid injury.
The adrenal gland is peeled off and the adrenal vein divided. The posterior attachments of the kidney are then freed up.
The kidney is flipped over and confirmed to only be attached by its vessels and ureter. A small incision is made below the pant line.
A metal tube with expandable bag is inserted. The vessels are stapled and cut using a linear stapler. The kidney is placed in the bag and removed from the body.
The donor area is inspected for bleeding before closing the ports and completing the procedure. Complications can arise but the vast majority go well. Expertise is key to handling difficult cases.
Living organ donation allows a loved one suffering from organ failure to not have to go through it alone. A donor takes a physical risk in donating part of their organ to help the recipient.
Kidneys and portions of livers can be donated from living donors for transplantation.
For kidney donations, living donor transplants have better outcomes than deceased donor transplants - the recipients don’t have to wait on the transplant list and living donor kidneys last longer on average.
For liver failure, there is no dialysis option so transplantation is critical. Living donor liver transplants perform similarly to deceased donor livers.
Donating a portion of the liver carries a higher risk of death (1 in 200 to 1 in 600) and complications than donating a kidney. Donors need to fully understand these risks.
Proper screening and evaluation of potential living donors is important to avoid coercion and ensure donors understand the risks and are doing so voluntarily. Despite risks, living donation can save lives and bring families together during difficult times.
Torril donated her kidney to save her mother’s life. This also revealed that Torril’s father had undiagnosed cancer, which was then treated.
About a year after the transplant, Torril’s mother developed blood cancer due to the immunosuppressive medicines and ultimately passed away, which was tragic.
During that extra year with her mother, Torril’s parents lived and helped run Torril’s organic farm. This additional healthy time with her mother was meaningful for Torril.
In a speech in memory of her mother, Torril talked about how her mother’s ashes now contained a piece of Torril as well, mixed in for eternity.

So while the story doesn’t have a fully happy ending due to Torril’s mother later developing cancer and passing away, donating her kidney allowed both an extra healthy year with her mother and the discovery of cancer in her father, which was treated. Torril found meaning in that additional time with her mother despite the later tragedy.

The doctor performed a kidney transplant on a young woman that went well. However, when he got home later that night, he had a feeling to check his phone and found missed calls from the resident, Jake.
When the doctor called Jake back, Jake said the patient was bleeding internally. They returned to the OR to find the patient in serious condition, with low blood pressure and a distended stomach from internal bleeding.
They opened her up and found her abdomen filled with blood. It was a serious complication even though the original transplant surgery had gone smoothly. They had to act quickly to try and control the bleeding and stabilize the patient due to the risk of shock from blood loss.
It was a stressful case where everything had seemed fine originally, but a complication emerged afterwards, showing that things can take a turn even when the surgery itself goes as planned. The doctor had to rush back and deal with the emergency bleeding issue.
In 1964, Dr. Keith Reemtsma performed the world’s first organ transplant from a non-human primate (chimpanzee) into a human. The recipients were Edith Parker and Jefferson Davis, who both had end-stage kidney failure.
Davis received chimpanzee kidneys and survived 63 days post-transplant before passing away from pneumonia. Parker received chimpanzee kidneys and lived over 9 months before suddenly dying, possibly from an electrolyte imbalance.
Over the next two years, Reemtsma performed a total of 13 chimpanzee kidney transplants, with patient survival generally between 9-60 days.
Other early pioneers like Dr. Thomas Starzl also attempted non-human primate transplants, but recipients often died from infection due to the heavy immunosuppression required.
While the early experiments showed primate organs could function in humans temporarily, chronic rejection and other issues prevented long-term success. This led researchers to call for a moratorium on clinical xenotransplantation in the 1990s.
The passage discusses the author’s initial interest in pursuing a career in surgery as a medical student due to enjoying the intensity, problem-solving nature, and “ballsy” elements of the specialty.
It references a famous book for medical students considering surgery titled “So You Want to Be a Surgeon” which outlines helpful application tips and desirable surgeon traits like teamwork and responsibility.
However, the author notes they did not fully grasp the immense responsibility of making critical decisions that impact patients’ lives on a daily basis as a surgeon.
Nor did they anticipate how much time would be spent worrying over decisions, feeling guilty about mistakes, and stressing over struggling patients even when operations went well.
As a senior resident and now attending surgeon over a decade later, the author realizes they never gain a perfect bank of knowledge and still rely heavily on gut feelings for most decisions based on limited information.
This results in thousands of decisions over their career, some right and many wrong, with vivid memories of patients who did poorly despite their best efforts.
The passage concludes that surgeons develop coping mechanisms to deal with negative outcomes.
Dealing with bad outcomes in transplant surgery can be challenging both emotionally and mentally. Surgeons may cope in different ways, like blaming others, drinking, or trying not to dwell on outcomes.
The early pioneers of transplantation faced extremely high rates of failure but persisted due to their courage and belief in the potential of the field. They had diverse personalities and coping mechanisms.
Examples of pioneering transplant surgeons discussed include Joe Murray, David Hume, Roy Calne, Norman Shumway, Christiaan Barnard, and Thomas Starzl. They demonstrated courage in continuing their work despite failures and criticism.
Modern surgeons like Nancy Ascher and Allan Kirk continue the pioneering spirit through their dedication to surgery and transplant innovation. Ascher enjoys operating while Kirk enjoys the scientific and academic aspects.
Facing responsibility for patient outcomes takes an emotional toll over time. While surgeons must find ways to cope and move forward, the pioneers demonstrated courage not just in facing failure, but in succeeding through perseverance against doubts. Their drive and passion for surgery helped sustain them.
The author discusses their role as a transplant surgeon and how they are not addicted to operating but actually enjoy when cases are canceled so they can have more free time.
They admire the early pioneers of transplantation who made huge sacrifices and advances in the field but acknowledge the experimentation they did may not be tolerated today for ethical reasons.
The author agrees with some pioneers like Starzl that continued progress will require courageous experimentation but with careful research first.
They discuss the responsibilities and stresses of being a surgeon, always having patients on their mind even at home. While they don’t regret their career, they feel relief that their kids don’t want to follow in their footsteps.
The passage concludes with the author on a flight to procure organs for transplant. They reflect on taking organs from a deceased donor to save multiple lives and how the recipients will have a lifelong connection through transplantation. They are kept awake thinking about their role in continuing the work of the pioneering surgeons.
The author uses their own experience and patients’ stories to share the history of transplantation and illustrate the commitment of its pioneers. Their goal is to make this story accessible to non-medical audiences, as was done by Mukherjee and Stossel with their topics.
They thank their supportive brother Ben, who helped with the writing process, and their agent Eric Lupfer, who guided the project from the initial outline.
Their editor Gail Winston is thanked for teaching them how to write for readers and refine the manuscript over many drafts.
Fellow surgeons, interview subjects, family and dog Phoebe are also thanked for their support during the project.
The author jokes that a back transplant may be needed after long hours of working on the computer.
Most importantly, they express gratitude to donors and patients for inspiring their work and making transplantation possible. Patients are cited as the greatest teachers.

Here are summaries of the passages:

A Miracle and a Privilege. Washington, DC: Joseph Henry Press, 1995.

This book describes Francis D. Moore’s experiences as a pioneering surgeon in kidney transplantation at Peter Bent Brigham Hospital in Boston in the 1950s-1960s. Moore helped perform some of the earliest kidney transplants.

Transplant: The Give and Take of Tissue Transplantation. New York: Simon and Schuster, 1964.

This book provides an overview of tissue transplantation up to 1964, including the early challenges and successes of kidney transplantation. It was written by Francis D. Moore, one of the pioneers of kidney transplantation.

The Emperor of All Maladies. New York: Scribner, 2010.

This book by Siddhartha Mukherjee provides a history of cancer and scientific efforts to understand and treat the disease. It likely contains information relevant to the development of cancer immunotherapy.

Surgery of the Soul. Boston: Boston Medical Library/Watson Publishing International, 2001.

This autobiography by Joseph E. Murray describes his role as a surgeon in performing the first successful kidney transplant between identical twins in 1954. He helped establish kidney transplantation as a treatment.

The Miracle of Transplantation. Beverly Hills, CA: Phoenix Books Inc., 2009.

In this book, John S. Najarian discusses the history and progress of organ transplantation from a surgical perspective. He helped develop new immunosuppressive drug protocols.

A Dream of the Heart. Santa Barbara, CA: Fithian Press, 1999.

This book details the work of cardiac surgeon Harris B. Schumacker Jr., who made contributions to the development of the first successful heart-lung bypass machine and open-heart surgery in the 1950s.

The Puzzle People. Pittsburgh, PA: University of Pittsburgh Press, 1992.

This book provides insights into the career of surgeon Thomas Starzl, who performed the first successful liver transplants and helped establish immunosuppressive drug protocols.

History of Transplantation: Thirty-Five Recollections. Los Angeles, CA: UCLA Tissue Typing Laboratory, 1991.

This book collects interviews and essays from pioneers in transplantation surgery and immunology, chronicling the history and scientific advances in the field.

Transplant: From Myth to Reality. New Haven, CT: Yale University Press, 2003.

This book by Nicholas L. Tilney provides a comprehensive history of organ transplantation from its beginnings to the modern era, including scientific, social and ethical aspects.

Lung Transplantation: Principles and Practice. Boca Raton, FL: CRC Press, 2015.

This book editors Wickii T. Vigneswaran, Edward R. Garrity, and John A. Odell Jr. details the principles and practice of lung transplantation as a treatment for end-stage lung disease.

Here is a summary of point 9 from the passage:

This point summarizes a quote from the book “A Dream of the Heart” by Shumacker Jr. The quote is “I believe we are approaching” and is cited on page 158. It doesn’t provide any additional context about what is being approached.

Here is a summary of the key events on July 13, 1987:

The Uniform Determination of Death Act was passed in 1991. This established brain death as a legal definition of death. Prior to this, criteria for determining death varied between jurisdictions.
In the Tucker case in 1990, brain death was recognized as a legal criteria for determining death. Tucker was declared brain dead but maintained on life support machines. The court ruled that she was legally dead even though her heart was still beating. This established an important legal precedent around brain death.
Determining the precise moment of death was a complex issue in early transplantation cases. In Barnard’s first heart transplant in 1967, the moment the donor’s heart was removed was controversial in terms of declaring the time of death. Precise criteria for declaring death had not yet been legally established.
Withdrawal of life support became an accepted way to allow organs to be donated after death. However, this was controversial in early transplantation as some viewed it as hastening or causing the death of donors. Legal and ethical standards evolved over time.
Debates around death, organ donation, consent and ethics were ongoing in transplantation in the late 1980s. The Uniform Determination of Death Act aimed to provide consistency in these criteria, which were still developing legally and medically.

Here is a summary of the given information:

Coma and heartbeat were considered in determining death for organ donation purposes. The Tucker case and Uniform Determination of Death Act are related to defining death.
Organ allocation relates to ensuring fairness in distributing organs to transplant candidates.
“Ethics and Clinical Research” by Beecher addressed ethical issues in medical research.
Eugenics, the science of improving populations through controlled breeding, was discussed in relation to Fallot.
The eyes and gall bladder were mentioned.
Details were provided about cardiac surgery residents and fellowships.
Topics included immunology, transplantation, heart and heart-lung transplants, kidney transplants including living donation, liver transplants including for alcoholics, lung transplants, and transplant complications.
Key figures mentioned were Barnard, Calne, Carrel, Cooley, Gibbon, Hardy, Herrick, Hume, Kolff, Lillehei, Lower, Matson, Medawar, Moore, Murray, Shumway, Starzl, and Watson.
The author was a medical student and intern/resident at the University of Chicago from the late 1960s to early 1970s, where he witnessed the first kidney transplant and participated in research using mice.
He completed his internship and residency in internal medicine at the University of Chicago from 1987-1988 and 1994-1995.
As an attending surgeon, he performed his first kidney transplant in the late 1960s/early 1970s.
He has had many patients over the years, some of whom are mentioned by name and their clinical cases described.
He was also a physician at Massachusetts General Hospital from 1973-1987 where he did clinical work and research using mice.
His career highlights include being involved in early kidney transplant work and research as well as serving as a transplant surgeon for many years with a variety of patients.
The University of Iowa, University of Miami, University of Minnesota, University of Mississippi Medical Center, University of Pittsburgh, University of Toronto, University of Utah, and University of Wisconsin were all involved in early transplant research and performed some of the first transplant procedures. The University of Wisconsin specifically developed an important organ preservation solution.
Vanderbilt Medical School and the Valley Forge General Hospital were also locations where early transplant work took place.
Figures like Owen Wangensteen and Abraham Verghese made important contributions to the field from various academic institutions.
Early transplantation procedures included kidney transplants as well as more complex operations like liver transplants and correcting congenital heart defects through procedures like repairing a ventricular septal defect.
Issues researched included histocompatibility, organ rejection, immunosuppression, and vascular techniques for reconnecting blood vessels during transplantation.

So in summary, the passage lists many of the key academic medical centers and individuals that advanced the field of organ transplantation through early clinical work and research in the mid-20th century.

#book-summary

When Death Becomes Life - Joshua D. Mezrich