The Heart: A Novel

Nursing Book Club

The Heart: A Novel

The philosophical and clinical aspects of organ donation

By Maylis de Kerangal, trans. Sam Taylor (Farrar, Straus and Giroux, 2015)
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Reviewed By Christine Contillo, RN, BSN, PHN

If we think about organ donation at all, we generally think about how lucky the recipients are to escape from the grasp of death or be freed from degenerative chronic disease. It’s human nature not to want to dwell on the donors, who are often young and healthy victims of traumatic, violent deaths who leave behind stunned and grieving families.

French author Maylis de Kerangal’s 2014 novel Réparer les vivants (translated in the U.K. and Canada as Mend the Living and in the U.S. as The Heart) helps us to refocus our thinking as we follow one day in the course of a heart transplant, presenting a gripping portrait of a complicated surgery that comes at a great cost.

It Begins With Death

The day begins with daring, 19-year-old surfer Simon Limbre as he leaves his mother’s house early to find the perfect wave. We are included in the carefree world of Simon and his best friends until 9 a.m., when their van has an accident on the way home.

The cause is left ambiguous. Was the driver speeding? Too tired after their early morning of surfing? Were they swerving around an animal in the road? Kerangal doesn’t say, so all we know is that motor vehicle accidents are one of the leading causes of death in this age group and only two of the van’s three occupants were wearing seat belts.

A Fragile Process

The story then follows all the characters and decisions involved in the donation of Simon’s heart and the transplant for which it is bound. We meet the social workers who speak with the young man’s separated parents, the emergency department team, the surgical team, the ICU staff and the national organ and tissue bank coordinators. We learn about their personal problems over the course of the day.

We also learn a little about how brain death is declared and about the actual transplant surgery, which involves transportation by both trucks and airplanes, inter-hospital transfers, the harrowing severing and clamping of the recipient’s heart and an extracorporeal circulation regimen that lasts over two hours.

The reader soon realizes just how fragile and tentative this entire process is and how an unexpected problem can make it all go south at any moment.

What makes The Heart interesting is its presentation of the very human and frequently flawed characters who make all of this possible. We feel the grief of Simon’s family and friends; the pride of the staff at their miraculous accomplishments; and the recipient’s hope and trepidation as she sets out from the apartment where she and her children have been waiting for months.

No one knows if the surgery will be a success, so as the anesthesia is administered, the patient is still unsure of her future — or if she even has one. However, by 6 a.m. the next day, all is resolved.

The Beat Goes On

As we know, this process takes place almost every day, with more than just hearts. Patients may receive donor kidneys, corneas, ligaments, skin and much more. Amazingly, skilled morticians can still facilitate an open casket funeral even after multiple donations.

In many states, including California, organ donation is made easier with checkboxes and signatures on a driver’s license. However, organ donations are just one of the reasons that families need to discuss advance directives, even with teenagers.

The Heart is fascinating, grim, realistic and optimistic, all at the same time. While it covers only 24 hours, it’s an emotional roller coaster for both donor and recipient families. This novel, translated from the French by Sam Taylor, is a compelling look at a difficult topic.   

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