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UW surgeon’s book reveals history, missteps, successes of organ transplants

January 7, 2019
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Dr. Josh Mezrich, a transplant surgeon at UW Hospital, has written a book, "When Death Becomes Life: Notes from a Transplant Surgeon." Mezrich, 47, writes that he's "not old enough to write a memoir." The book is a way "to use my experiences and those of my patients to give context for the story of the modern pioneers who made transplantation a reality."

Organ transplants can seem routine today, especially at UW Hospital, one of the nation’s largest transplant centers. But only a few decades ago, the field’s pioneers took significant risks, overcame repeated failures and sometimes crossed ethical lines.

It can be easy to forget that transplant surgeons, type A personalities with extensive training who save many people clinging to life, are humans who can have self-doubts, especially when their patients die.

Dr. Josh Mezrich’s book, “When Death Becomes Life: Notes from a Transplant Surgeon,” gives an overview of transplant history and lays bare Mezrich’s trepidations and triumphs as a kidney and liver transplant surgeon at UW Hospital, where he has been on staff since 2007.

The book, to be released by HarperCollins Jan. 15, includes suspenseful narratives that take readers behind the surgical curtain. Through stories of his patients, Mezrich marvels at transplant accomplishments, brings attention to continuing challenges in transplant delivery and occasionally questions the values of the U.S. health care system.

“I want people to really understand what it’s like to do this job,” Mezrich said in an interview. “It’s a hard job. There’s a lot of anxiety. You’ve got to work really hard to be perfect, but you can never be perfect.”

Beginnings

The assassination of French President Marie Francois Sadi Carnot in 1894 is a surprising starting point for transplant’s origins. But Carnot’s stabbing inspired Dr. Alexis Carrel, of France, to develop a method of tying two blood vessels together, essential for attaching organs, Mezrich explains in the book.

Dr. Willem Kolff, of the Netherlands, adapted the use of cellophane in encasing sausages to create a barrier for filtering blood, inventing dialysis during World War II while aiding Dutch resistance against the Germans.

Kolff’s first successful patient was an imprisoned Nazi sympathizer. Dialysis allowed people with kidney disease to stay alive long enough to receive a transplant.

Dr. Christiaan Barnard, a South African who trained at the University of Minnesota, is well-known for performing the world’s first human-to-human heart transplant in 1967. One reason he got a jump on the competition, Mezrich notes, is that South Africa defined death as the moment when two doctors declared a patient dead.

A few months later, in the United States, where brain death had not yet been defined, Dr. David Hume and Dr. Dick Lower removed the heart of Bruce Tucker, a black man who showed no brain function after a head injury, for a transplant.

Tucker’s family, upset that his heart and kidneys had been taken without their consent, sued. They were represented by attorney Douglas Wilder, who became America’s first black governor, in Virginia. A jury found the doctors not liable, but Mezrich believes they made a mistake.

“Regardless of the outcome of this trial, a great disservice was done to Bruce Tucker and his family,” he writes.

Dr. Thomas Starzl, perhaps the best known American transplant pioneer, was called a murderer by colleagues in the 1960s for attempting liver transplants on high-risk patients, including children, who died on the operating table.

“You couldn’t do what they did now,” Mezrich said of Hume, Lower, Starzl and others. “You’d get fired or arrested.”

Losses

In the book, Mezrich is forthright about his own flaws, such as becoming “desensitized” to patients as an overworked resident, when he regarded patients as “standing in the way of my accomplishing these tasks.”

He rues killing an elderly woman as a resident, apparently by puncturing her lung while trying to place a central line near her heart. “We call this a clean kill,” he writes. “No doubt about who was responsible.”

In what he calls another medical error later in his career, Mezrich forgot an important step during an operation on a man who had received a liver transplant. The next day, Mezrich “was going over the case in my brain the way a professional golfer goes through each shot in a round of golf, when suddenly I said out loud, ‘I never tied the other end of the duct shut!’”

He took the man back to the OR and closed the duct, and the man is doing well today, Mezrich writes. Though the vast majority of his surgeries are successes, he agonizes over the failures.

“We have many victories, but the losses are the ones we never forget,” Mezrich writes.

Case studies

Using only first names, Mezrich writes about Michaela Layton, a white woman from Spring Green who received a liver from C.L. Phillips, a black man from Rockford, Illinois. Phillips had spent time in jail and died in a car crash while fleeing from a shooting at a nightclub. Layton has become a transplant advocate, spreading “teachable moments: we are all the same on the inside,” Mezrich writes.

When Jason Letizia, a 30-year-old high school history teacher, needed a liver transplant, a liver became available from a brain-dead donor in his 60s. Mezrich had to decide whether to accept the less-than-ideal older liver or wait for a younger one and risk Letizia dying during the delay.

Mezrich took the older liver. It lasted about four years, and Letizia died after a second liver transplant. Mezrich still isn’t sure he made the right decision. “You’re never wrong if you follow the system, but it doesn’t always feel right,” he said.

Lisa, 41, whose last name was not available, had alcoholic cirrhosis. She reported being sober for more than six months, which is required to get a liver transplant. After receiving a new liver, she said she didn’t use alcohol again, but later acknowledged some drinking. Less than five years later, she died, apparently from damage to her liver from alcohol.

The transplant team wasn’t fully equipped to address her alcoholism, Mezrich said.

“Lisa didn’t die of liver disease; she died of mental illness,” he writes. “We celebrate, and pay for, the big, sexy interventions … But what really matters, and yet what our health care system doesn’t prioritize, is the day-to-day caring for chronic disease.”

For people wondering what it’s like to work in an operating room, Mezrich provides illuminating details. His hands cramp from ice used to preserve organs. It takes him two years of stitching vessels together before he develops the muscle memory needed to sew without thinking. His OR music preference: Tupac on Pandora. At the end of a kidney transplant, urine squirts onto his hands, a sign the organ is working as it should. “What a beautiful sight!” he writes.

The operating room is a high-stakes environment, but it can be the most relaxing part of his job, said Mezrich, whose wife, Dr. Gretchen Schwarze, is also a surgeon at UW Hospital. Their daughters Sam, 13, and Kate, 11, attend Hamilton Middle School.

“In the OR, you’re in control,” Mezrich said. “All the unknown happens once you’re out of the OR.”

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