SUMMARY - When Death Becomes Life - Joshua D. Mezrich

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Here is a summary of the key points:

  • Willem Kolff was a Dutch physician who invented the first successful dialysis machine while in hiding from the Nazis during World War II.

  • In 1941, he moved to a small hospital in Kampen, Netherlands to avoid scrutiny from Nazi supporters over his controversial views.

  • At the hospital, Kolff treated patients and also worked to save people from the Nazis by faking illnesses or using other tactics.

  • In 1942, inspired by a patient who died of kidney failure, Kolff invented the first dialysis machine using simple components like a rotating drum lined with cellophane sausage casing as a dialysis membrane.

  • His machine was able to filter waste from blood, proving dialysis was possible as a treatment. This was a breakthrough as it gave kidney patients a chance to temporarily manage their disease until transplantation became possible.

  • Kolff's innovative dialysis machine, created under difficult wartime conditions, laid the foundations for developing dialysis into a life-saving treatment that has enabled widespread kidney transplantation.

    Here is a summary of the key points:

  • In 1954, Joseph Murray performed the first successful kidney transplant between identical twins at Peter Bent Brigham Hospital in Boston. The transplant functioned well with no rejection.

  • However, early attempts transplanting kidneys between non-identical individuals failed due to immune rejection. Total body irradiation was used to suppress the immune system but carried high risks of infection.

  • Advances like Roy Calne's work transplanting dog kidneys using immunosuppressive drugs like 6-MP helped push the field forward. Calne demonstrated drugs could prevent rejection.

  • By the late 1960s, with the development of powerful new immunosuppressive drugs like cyclosporine, one-year survival rates for kidney transplants rose to over 50%. This established transplantation as a routine treatment for kidney failure.

  • Pioneers like Murray, Calne and others overcame significant challenges through persistence, clinical trials, and collaborations to eventually develop transplantation into a viable therapy through improved organ preservation, surgical techniques, and immunosuppression.

    Here is a summary of the key points:

  • Christiaan Barnard performed the world's first human-to-human heart transplant on December 3, 1967 in Cape Town, South Africa.

  • The recipient was 53-year-old Louis Washkansky, who was dying of heart disease. He received the heart of 24-year-old Denise Darvall, who was brain dead after a car accident.

  • Barnard waited 15 minutes after removing Darvall from life support to ensure her heart had stopped beating before extracting it for transplant.

  • The surgery was initially successful, with Washkansky's new heart functioning well. However, he died 18 days later from complications including infection.

  • Barnard went on to perform more heart transplants, helping to establish the procedure. His landmark first transplant demonstrated the feasibility of human-to-human organ transplantation on a large scale.

    Here is a summary of the key points:

  • The passage describes a difficult liver transplant surgery performed by Dr. Starzl that had major bleeding complications during the procedure.

  • Despite losing almost 100 liters of blood, the surgeons were able to stabilize the patient enough to be considered for another transplant as a last resort option.

  • The family was informed the prognosis was very poor but the surgeons wanted to exhaust all efforts.

  • After further intensive work in the operating room, the patient recovered sufficiently to receive a new liver, ultimately surviving against expectations.

  • The surgeon was surprised but pleased to later see the patient healthy in follow-up, reflecting on how close he came to giving up but was convinced to keep fighting for the patient.

So in summary, it describes a case where major bleeding complications during transplant almost cost the patient's life, but through perseverance of the surgical team, he was able to be re-transplanted and make a full recovery.

Here is a summary of the key points:

  • Nate developed ulcerative colitis in high school and was later diagnosed with primary sclerosing cholangitis (PSC), a progressive liver disease.

  • Despite his health challenges, Nate pursued his goal of becoming a physician and was in medical school. However, his PSC was severe and he needed a liver transplant to survive long-term.

  • As a PSC patient, Nate was lower on the transplant waiting list under the MELD allocation system, which prioritizes primary liver diseases over secondary diseases like Nate's.

  • Nate hoped his MELD score would rise or he could receive a living donor transplant to avoid waiting. His cousin volunteered to donate part of her liver.

  • The transplant surgery was successful but Nate developed several post-op complications requiring multiple return operations. It was a difficult outcome.

  • The story highlights challenges patients like Nate face under the current allocation system and calls for rethinking priorities to consider quality of life factors beyond just risk of death. A living donor helped Nate but came with its own risks.

    Here is a summary of the key points:

  • Living organ donation involves significant medical risks for the donor, as they are undergoing surgery and losing part of an organ for the benefit of another person.

  • However, for recipients it can mean avoiding long waits on transplant lists and potentially receiving a better matched organ from a living donor. This often leads to improved outcomes.

  • Kidneys and portions of livers are the organs most commonly donated from living donors. A single kidney or partial sections of the liver can typically be donated without compromising the donor's long-term health.

  • The process requires extensive medical evaluation and counselling to ensure risks are fully understood and deemed acceptable by both donor and recipient. Their well-being is the top priority.

  • While risks cannot be eliminated, living donation allows recipients to receive potentially life-saving transplants from loved ones rather than waiting for a deceased donor organ. This provides emotional support as well.

The summary covers the main concepts that living donation involves risks to donors but significant benefits for recipients in need of organ transplants. It focuses on kidneys and livers as the organs commonly donated this way between individuals.

Here are summaries of the key passages:

  • Francis D. Moore's 1995 book "A Miracle and a Privilege" describes his experiences as a pioneering kidney transplant surgeon at Peter Bent Brigham Hospital in the 1950s-1960s, performing some of the earliest kidney transplants.

  • Moore's 1964 book "Transplant: The Give and Take of Tissue Transplantation" provides an overview of tissue transplantation up to 1964, including early challenges and successes of kidney transplantation. He was a pioneer in the field.

  • Siddhartha Mukherjee's 2010 book "The Emperor of All Maladies" provides a history of cancer and scientific efforts to understand and treat the disease. It likely contains information on the development of cancer immunotherapy.

  • Joseph E. Murray's 2001 autobiography "Surgery of the Soul" describes his role in performing the first successful kidney transplant between identical twins in 1954, helping establish kidney transplantation.

  • John S. Najarian's 2009 book "The Miracle of Transplantation" discusses the history and progress of organ transplantation from a surgical perspective, including his work developing new immunosuppressive drug protocols.

  • Harris B. Schumacker Jr.'s 1999 book "A Dream of the Heart" details his contributions to developing the first successful heart-lung bypass machine.

    Here is a summary of innovations in kidney transplants and open-heart surgery in the 1950s:

  • In 1950, the first successful kidney transplant was performed by surgeons at the Peter Bent Brigham Hospital in Boston. The kidney was from a living donor and the recipient survived for over 8 years. This demonstrated that kidney transplantation was possible.

  • In 1954, surgeons at the University of Minnesota performed the first successful kidney transplant from a cadaveric (deceased) donor. This showed that kidneys could be transplanted from non-living sources.

  • In 1953, surgeons at the Massachusetts General Hospital performed the first totally open-heart operation using a heart-lung machine. This allowed surgeons to operate on a stationary, non-beating heart while the patient was on bypass.

  • In 1954, Dr. John Gibbon performed the first successful repair of a ventricular septal defect using a heart-lung machine. This demonstrated that complex open-heart surgery to correct congenital defects was possible.

  • These procedures established proof-of-concept that organ transplantation and open-heart surgery were feasible thanks to advances in surgical techniques, understanding of rejection, and the development of the heart-lung machine for bypass support. They laid the foundation for future improvements and widespread adoption of these practices.

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