Nursing Book Club

When Death Becomes Life: Notes From a Transplant Surgeon by Joshua D. Mezrich, M.D.

A provocative look at organ donation

In the prologue of When Death Becomes Life, author Joshua D. Mezrich, M.D., states that this book “is neither a memoir nor a complete history of transplantation.”  It’s actually a little of both, as well as a well-thought-out examination of the dramatic impact organ transplants — or the lack of them — can have on lives of donors, recipients and the medical staff involved.

Mezrich is well-qualified to discuss this subject. A Cornell graduate, he has spent 11 years on the transplant team at UW Health in Madison, Wis., following a two-year transplant fellowship at the same institution. He explains how he selected this specialty as his life’s work and introduces us to the logistics of modern transplants:  how transplant organs are requested by a coordinator, obtained by a specialized team  and moved from one part of the country to another.

These procedural details bring us to what makes transplants unique among medical procedures. While the surgery can be lifesaving, it necessarily begins with tragedy: the death of a young, healthy donor.

The death of a potential organ donor is a delicate balancing act and a race against time. Families need adequate space to grieve and say goodbye, but the sooner the surgical team can begin extracting transplantable organs, the greater the opportunity for that one death to save many lives. It’s exhausting work, physically and emotionally. I’m familiar with this process both through my acquaintance with donor procurement coordinators and from a friend who donated her son’s organs after he died in a motorcycle accident.

Nursing Education

Thus, I knew even before I read this book that organ donation now includes much more than just major organs like the kidneys or heart. However, I learned some things I didn’t know, such as the fact that “allocation of livers is based entirely on risk of waitlist death.”

History Lessons

Despite the disclaimer in the prologue, the author does provide a historical overview of transplantation, including the strange and sometimes obsessive characters who have pursued and undertaken this practice. Mezrich takes us back to the early 1900s, when an ambitious French medical student named Alexis Carrel decided that there must be a better way to suture blood vessels and thereby set the stage for successful transplantation of human organs.

Today, superior equipment, much improved technique and speedier surgeries have vastly improved the success rate. However, what has most radically changed the face of transplant surgery was the development in the ‘70s of the immunosuppressant cyclosporine, which provided a means of staving off the body’s rejection of transplanted organs, greatly improving long-term survival rates.

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I enjoyed the opportunity to see these complicated surgeries in a different light. It’s quite interesting to think about the body’s organs as a team that sometimes has to learn to work with a new member, or how organs like the kidney can just continue doing their jobs as long as they have the blood flow to support their function.

Existential Questions

Death Becomes Life is also a provocative meditation on our own existence: how to save it, when it ends and the ethics involved in both. Brain death is a relatively recent concept in medical science and some would say it’s still not cut and dried — an important question in deciding when a patient should become a donor so that others may live.

Mezrich says, “Transplant is all about having someone else join you in your illness.” What this fascinating book shows us is that each donor and each transplant touches many people, including someone you may never know and never really be able to thank.

When Death Becomes Life: Notes from a Transplant Surgeon by Joshua D. Mezrich, M.D. (Harper Collins., 2019)


Christine Contillo, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.


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