I read this book with some interest—firstly to learn more about the history of a field in which I have been practising for the past 15 years but also because I was fascinated by a seemingly simple question: why has the author chosen to write this book?
Figure 1.
Yale University Press, £19.95, pp 320 ISBN 0 300 09963 0
Rating: ★★
What did I learn? That it is very difficult to summarise a complex, evolving field in a short book, especially when attempting to satisfy a number of target audiences. Transplantation is sexy. It is also multifaceted, and areas such as the ethics of transplantation and the commercialisation of immunosuppression deserve greater coverage than a book such as this can give their due. Perhaps it would have been better to select a single target audience, a single theme, or a single organ.
Where literature succeeds—and medical history is no exception—is in bringing experience to life. Even in these days of evidence based medicine the case report has its place in the medical literature, because it is enjoyable and people remember it. This book, though well researched and written, cries out for a personal narrative. What did the author do? What does he believe? Who are the heroes and villains? The Puzzle People, Thomas Starzl's highly personal account of liver and other solid organ transplantation, published in 1992, succeeded by creating a sense of involvement, by making the reader care. In Tilney's rather dry text, however, history runs the risk of becoming simply a list of dates.
There is much to write about and to celebrate. In the United Kingdom 2400 people receive solid organ transplants each year (although it is shameful that a further 7000 are on an ever lengthening waiting list). Transplantation improves quality of life and is highly cost effective. After the first year kidney transplantation costs £4000 ($7500;€5900) to £6000, compared with £25 000 to £30 000 a year for dialysis.
Less commonly recognised is that transplantation also improves life expectancy, especially kidney transplantation. The expected survival of a dialysis dependent diabetic patient who receives a kidney transplant increases by 82%, even after adjustment for the higher comorbidity of patients who are not listed for a transplant. Similar stories of economic, personal, and (dare I say it) institutional benefit may be evinced in the cases of heart, lung, liver, multiple organ, and other transplantation.
To return to my original question, why write a book? Certainly not for money: hour for hour a dustman earns more than a medical author. For prestige? To set the record straight? For education? For personal satisfaction? For fun?
I confess that I have no idea why books are written, any more than doctoral theses (average readership less than 10, including the parents) or book reviews. Is it simply that we enjoy writing? For most authors that will need to be reward enough.
Nicholas L Tilney