Joshua Mezrich’s When Death Becomes Life is an engaging collection of a surgeon’s memoirs that interweave various definitions of death, from its legal, medical, and philosophical boundaries to the power it grants to organ donation and transplantation. The text chronicles Mezrich’s training and career as a transplant surgeon, while successfully incorporating developments in the field at the hands of 19th- and 20th-century pioneers and their implications to heart, kidney, liver, and pancreas transplantation.
The text is organized into six parts, with the first three expanding on Mezrich’s medical school and residency training, and his inspiration to pursue transplant surgery as a career. The historical backdrop describes the start of chest and abdominal transplantation, jumping from relatable recounts of Mezrich’s surgery rotation as a medical student to the beginnings of vascular anastomoses in 1890s, the mid-World War II dialysis experiments, the discovery of extracorporeal membrane oxygenation, and the first uses of immunosuppression for graft tolerance.
The second half of the text transitions from the historical approach; Mezrich instead dedicates each chapter to one of his past patients—an organ donor or recipient. Each story gives a human voice to a unique, highly debated topic in transplant ethics. The first of these cases discusses the role of transplant surgeons in organ allocation decisions and poses: how sick is too sick for a patient awaiting transplant to no longer qualify as a surgical candidate? Mezrich then asks, “who are the right people to receive this gift of life?” (p. 225), as he explores the debate among transplant centers on whether to allow patients with acute alcoholic hepatitis to join the liver transplant waitlist without meeting the current criteria of six months of sobriety. Another captivating chapter, “As They Lay Dying”, introduces two families of donors: one after brain death and another after cardiac death. More powerful, however, is Mezrich’s deep dive into the changing definitions and “types” of death since 1960s, emphasizing the crucial role transplantation played in defining death both medically and legally.
Mezrich’s personable writing renders his reflections and the history of transplantation accessible to a wide range of audiences. The cases and landmark experiments may suit various backgrounds, including scientists, ethicists, historians, medical professionals, trainees, and even families of donors or recipients. Readers may also notice Mezrich’s precise explanations of the experiments and the procurement process. His writing not only provides enough detail to engage lay audiences but may also serve as an example to medical trainees of how to effectively communicate complex medical procedures to patients.
Overall, When Death Becomes Life bridges death with life through the scientific, ethical, and clinical responsibilities of a transplant surgeon. As Mezrich notes “in every other area of medicine, we spend our lives trying to fight off death … transplant is different. In this field, … death is our starting point.” (p. 276), the text continuously reframes death with perspectives of the past, present, and future of transplantation, and is especially suited to readers interested in the intersection of death and clinical practice.