Learning to give life

Dr. Joshua Mezrich hadn’t intended to go into transplantation. However, chance put him in the operating room during a kidney transplant, and the sight of the organ coming to life filled him with awe — and a passion. He’s now a kidney and liver transplant surgeon at the University of Wisconsin, in Madison, where he also teaches as an associate professor.

Dr. Mezrich recounts that story and the nearly unbelievable history of transplantation in his book, When Death Becomes Life. Alongside the medical victories, he also tells the stories of recipients and donors, putting human faces to procedures that seemed like science fiction during most of the postwar era.

What first attracted you to transplant surgery? Your book makes it clear that this is an intense and often tragic job.

Dr. Joshua Mezrich: When I entered medical school, I didn’t know anything about surgery or transplants. My only exposure to surgery was Hawkeye Pierce from M*A*S*H. I thought I would do something like pediatric oncology because I like kids and I thought I could make them laugh.

But on my first day of surgery, we were rounding and running around all day. I was so busy I didn’t eat or drink anything. Around midnight, the resident said to me, “Why don’t you go next door and scrub on this case?” I really wanted to go home, I was so exhausted. But she said, “Just go scrub in.”

It was a kidney transplant. They had classical music playing. The kidney was this beautiful little thing that had been sustaining someone else’s life. When they released the clamps, it pinked up. I had this feeling like: “That is so incredible. I can’t believe this works.” Even to this day, the idea that it works blows my mind — that we can sew an organ in and it just springs to life right in front of our eyes. It’s a story that almost sounds too good to be true.

One of those stories was about Michaela, a 17-year-old who needed a liver. Could you tell her story?

Michaela got a liver from C.L., a donor who had a rough life, a very different life than Michaela. But his mom, Laurie, wanted to make something of his death. She felt like he spoke to her in a way, that he would always be there. She equated that with organ donation.

Michaela was this very healthy young woman who got sick rapidly; she was almost dead when she got the transplant. When she woke up, the first thing she remembers is that she wanted to eat a hamburger. She was dying for a hamburger, which was weird because she didn’t really eat a lot of meat; she didn’t really eat hamburgers. She just suddenly
loved them.

Michaela did amazingly well and wanted to find out who her donor was. She wrote to the family [through an anonymous contact program], but Laurie hesitated. When Laurie answered her letter, the first thing it said was that C.L. loved hamburgers. And who knows, right? The idea of cellular memory probably scientifically doesn’t make any sense. But the story’s so great. They stay in touch and meet a few times a year. Laurie really looks at Michaela as another daughter.

That impact on the families — a phrase that stuck with me was “we take from death.” Because donation isn’t just giving life, it’s giving comfort to the survivors.

When we go on procurement, we get the opportunity to meet with donor families. I still remember my first procurement. The donor was a young person who had died unexpectedly. The team said to me, “All right, let’s go talk to the family.” I was horrified. I was thinking, “They’re going to look at me like this vulture.” But that couldn’t have been further from the truth.

You go into this room with 15 people who are crying, different ages, different relationships to the donor. But they were so excited to hear about the transplant, to understand the process. Who was going to get those organs? Would they be transplanted that night? They wanted to tell us about the donor, about who they were, what they liked to do. It was very clear to me this gift was going to be a legacy they could all hold onto — something positive out of this tragic event.

I really look at the donors, obviously living but deceased, as our patients too. When I think about donors, I think of them as people who run into a burning building to save someone. It’s that level of heroism. Our deceased donors — it’s their last gift.

Something that’s so shocking about these techniques is how rapidly they were developed. There’s the gentleman who figured out that he could use sausage skin to make a kidney machine —

Yeah, for dialysis.

Yes, the first dialysis machine. That happened in the early ‘40s; in about 20 years, they were doing transplants. Within a dozen or so more, they were doing transplants fairly routinely.

It’s shocking. It’s like sending a man to the moon. I think in the ‘40s transplantation was science fiction. In the ‘50s, there were a few crazy people doing it, but it was between identical twins, which is not really an option for most people. In the ‘60s, they had a few successes but still people were dying frequently. And by 1983 it was a legitimate field with a predictable outcome. About 30 years to get over these incredible barriers — it’s an incredible story of innovation.

What do you think is the next step for transplants?

I love the research in xenotransplants — transplanting organs from a different species. Everyone now is thinking about pigs as the organ donors. And with genetic modifications and CRISPR technology to do gene editing, there are some strategies to reduce rejection. That won’t be a home run overnight, but I think it might be reality.

Organ pumping and repair is a really fascinating field. We take the organs out of the donor and put the organ on a pump. We do it for liver, for kidney. There’s the heart in the box, which Grey’s Anatomy did an episode on some years back, but now it’s becoming a reality. I think this really will be a way to figure out whether you can make marginal organs better. Maybe you can de-fat a liver by putting it on a pump. Maybe you could do gene therapy on it. I think it’s all very, very exciting.

                           The above article originally appeared in the Spring 2020 issue of Quarterly Insights magazine.

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