How Death Becomes Life

Joshua Mezrich

Allen & Unwin

In 2015, the Internet was buzzing with reports that the world’s first head transplant would take place in the next couple of years. The projected timeline may have proven overly optimistic, but before you write the idea off as fantastical, it is worth remembering that less than 60 years ago, the same might have been said of replacing a person’s heart or lungs: such surgery has only been routine medical practice since the 1980s. In How Death Becomes Life, Joshua Mezrich traces the century of developments in medicine, engineering, immunology and bio-ethics that have led to this point and calls on all of us to help overcome the main limitation facing those who need this life-transforming surgery today: the lack of donor organs.

The first half of the book covers the history of transplantation and the numerous challenges that faced the men – and they were invariably were men – who pioneered the field. These ranged from learning how to suture blood vessels (a much more delicate and painstaking task than closing a flesh wound or surgical incision) to finding ways to keep patients alive long enough to reach the operating theatre in the first place; people are only able to receive kidney and pancreatic transplants because they have access to dialysis and insulin treatment in the interim. This was heroic medicine that would be almost impossible today, with surgeons spending years refining and perfecting their techniques on other animals – most commonly dogs – before translating them to humans. Many operations were carried out with the clear understanding that they were likely to be futile, and a patient’s death from post-operative infection rather than failure of the transplanted organ was considered a success.

The technical nature of this section is a little challenging (although most of the medical terms used are defined at some stage, the book would have benefited from a glossary and some basic anatomical maps), but it is full of fascinating details. I had no idea, for example, that a key discovery about immunocompatibility involved a New Zealand cattle farmer, nor that before the development of the heart-lung bypass machine, the blood of patients undergoing open-heart surgery used to be re-oxygenated by circulating it through a healthy volunteer.

In the remaining chapters, Mezrich draws on his own experience to explore a variety of topics, from the ethics of organ allocation and the use of living donors (who undergo operations that are of no physical benefit to them) to the physical and emotional costs and benefits of these surgeries for all concerned. And although he pays tribute to the altruism of donors and their families, he is matter-of-fact to the point of bluntness about the bloody reality of the operating room.

Such honesty is important and necessary, but it may cause some people to reconsider their position; one of the most striking images from the book is that of transplant surgeons from around the country converging outside an OR, waiting for a donor’s life support to be turned off before they swoop in to harvest every salvageable organ. Although the deceased has no need for them, and the surgeons have the moral and practical imperative to make the best possible use of their final gift, such utilitarian calculations feel out of place at a moment of such profound significance for the bereaved and for some the surgery itself may constitute an act of violence. I am not about to rescind my status as an organ donor, but reading this book has reinforced the emotional and psychological consequences this choice may have for friends and family and the importance of discussing this with them while I still can.

As for the matter of head transplantation, I am going to go out on a limb and predict that it is only a matter of time before we will have to deal with the physical – and philosophical – implications of transferring a mind to a new body.