65 published these findings: Publication is R. E. Billingham, L. Brent, and P. B. Medawar, “Actively Acquired Tolerance of Foreign Cells,” Nature 172 (1953): 603–6.
65 “The real significance”: Medawar, Memoir of a Thinking Radish, 133–34.
CHAPTER 5: KIDNEY BEANS: MAKING KIDNEY TRANSPLANT A REALITY
70 Boston, Massachusetts: The primary sources for this section on the origins of kidney transplant are David Hamilton, A History of Organ Transplantation (Pittsburgh, PA: University of Pittsburgh Press, 2012); Nicholas L. Tilney, Transplant from Myth to Reality (New Haven, CT: Yale University Press, 2003); Paul Terasaki, ed., History of Transplantation: Thirty-Five Recollections (Los Angeles: UCLA Tissue Typing Laboratory, 1991); and three autobiographies: Joseph E. Murray, Surgery of the Soul (Boston: Boston Medical Library/Watson Publishing International, 2001); Roy Calne, The Ultimate Gift (London: Headline Book Publishing, 1998); and Francis D. Moore, A Miracle and a Privilege (Washington, DC: Joseph Henry Press, 1995).
72 “administrative objection”: Francis D. Moore, Transplant: The Give and Take of Tissue Transplantation (New York: Simon and Schuster, 1964), 40.
74 “buzz saw”: Thomas Starzl, “My Thirty-Five-Year View of Organ Transplantation,” in Terasaki, ed., History of Transplantation, 150.
75 “Despite the discomfort”: Terasaki, ed., History of Transplantation, 39.
76 “Our doubts and hesitation”: Ibid., 63.
76 David Hume’s series: Published in D. M. Hume, J. P. Merrill, B. F. Miller, and G. W. Thorn, “Experiences with Renal Homotransplantation in the Human: Report of Nine Cases,” Journal of Clinical Investigation 34 (February 1, 1955): 327–82.
79 “Five months later”: Moore, A Miracle and a Privilege, 162.
81 “I felt a first blast of heat”: Murray, Surgery of the Soul, 6.
81 “When I first saw the young aviator”: Ibid., 3.
82 “What we were doing”: Ibid., 9.
82 “Charles was my introduction”: Ibid., 15.
83 “Like many twins”: Ibid., 75.
84 crazy “bunch of fools”: Ibid., 63.
84 “I had heard of such things”: Ibid., 76.
84 “I think we have to be careful”: Ibid., 77–78.
85 “We approached insurance companies”: Ibid., 77.
85 “Get out of here”: Ibid., 78.
93 “Some have wondered”: Ibid., 98.
93 “The lecture theatre was crammed”: Calne, The Ultimate Gift, 21.
94 he found an article in Nature: R. Schwartz and W. Damashek, “Drug-induced Immunologic Tolerance,” Nature 183 (1959): 1682.
94 He published this major finding: R. Y. Calne, “The Rejection of Renal Homografts: Inhibition in Dogs by 6-Mercaptopurine,” Lancet 1 (1960): 417.
95 “The high point”: Calne, The Ultimate Gift, 49.
95 “The whole period”: Medawar, Memoir of a Thinking Radish, 135.
96 “In just eight years”: Murray, Surgery of the Soul, 117.
97 By 1963, he had presented and published: Publication is T. E. Starzl, T. L. Marchioro, and W. R. Waddell, “The Reversal of Rejection in Human Renal Homografts with Subsequent Development of Homograft Tolerance,” Surgery, Gynecology, and Obstetrics 117 (1963): 385.
97 Jean-François Borel and Hartmann Stähelin: J. F. Borel, C. Feurer, C. Magnee, and H. Stähelin, “Effects of the New Anti-lymphocytic Peptide Cyclosporin A in Animals,” Immunology 32 (June 1977): 1017–25.
98 “somewhat reluctantly agreed”: Calne, The Ultimate Gift, 116.
98 Nevertheless, five of seven: R. Y. Calne, D. J. G. White, S. Thiru, D. B. Evans, P. McMaster, D. C. Dunn, G. N. Craddock, B. D. Pentlow, and K. Rolles, “Cyclosporin A in Patients Receiving Renal Allografts from Cadaver Donors,” Lancet 2 (December 23–30, 1978): 1323–27.
98 Calne then performed: R. Y. Calne, K. Rolles, D. J. White, S. Thiru, D. B. Evans, P. McMaster, D. C. Dunn, G. N. Craddock, R. G. Henderson, S. Aziz, and P. Lewis, “Cyclosporin A Initially as the Only Immunosuppressant in 34 Recipients of Cadaveric Organs: 32 Kidneys, 2 Pancreases, and 2 Livers,” Lancet 2 (November 17, 1979): 1033–36.
CHAPTER 6: OPEN HEART: THE INVENTION OF CARDIOPULMONARY BYPASS
103 Open Heart: The primary sources for this section on the origins of open-heart surgery and the development of cardiac bypass are Harris B. Schumacker Jr., A Dream of the Heart (Santa Barbara, CA: Fithian Press, 1999); G. Wayne Miller, King of Hearts (New York: Crown Publishers, 2000); and David K. C. Cooper, Open Heart (New York: Kaplan Publishing, 2010).
113 “Within 6 minutes”: Schumacker Jr., A Dream of the Heart, 73.
114 “During that long night”: Ibid., 74.
115 “I can recall prowling”: Ibid., 124.
115 “I will never forget”: Ibid., 126.
120 “I shall never forget the first time”: Ibid., 154.
125 blood type AB, which no one in his family shared: Blood type AB is the universal recipient, so if it were just a matter of blood donation, a donor with any blood type would be a match. But in this case, where the blood flows through both people once they are hooked up to the catheters, if the person serving as the “pump” were not blood type AB, his own antibodies would have destroyed the blood cells of the baby as they flowed through the circuit.
125 “I just wanted to do”: Miller, King of Hearts, 155.
126 “I believe we are approaching”: Shumacker Jr., A Dream of the Heart, 158.
CHAPTER 7: HEARTS ON FIRE: MAKING HEART TRANSPLANT A REALITY
130 Hearts on Fire: The primary sources for this section on heart transplantation are Donald McRae, Every Second Counts (New York: G. P. Putnam’s Sons, 2006); Christiaan Barnard and Curtis Bill Pepper, One Life (Toronto: The Macmillan Company, 1969); and Cooper, Open Heart.
136 “[E]ven now I can recall”: Barnard and Pepper, One Life, 183–84.
137 “When will you sleep?”: Ibid., 186.
138 “Look, Chris,” Lillehei told him: Ibid., 202–3.
140 “We would stand there”: Ibid., 319.
142 “I couldn’t leave the patient”: Ibid., 329–30.
144 Barnard himself had spent much less time: There is controversy surrounding this. Shumway and Lower were convinced that it was here that Barnard first became acquainted with the idea and techniques of heart transplantation, and then ran back to South Africa to scoop the Americans. Barnard maintains that he was planning heart transplantation for years before this. While it is true that the Americans had spent years doing extensive research in transplantation, on both the operative technique and postoperative care, Barnard himself did do upward of fifty transplants in dogs prior to the first in humans. It is likely that Barnard did pick up some details of the technique from Lower, but unlikely that this short episode played a major role in the success Barnard enjoyed with transplantation.
145 “There is nothing to think”: Barnard and Pepper, One Life, 259.
146 “If you can’t save my daughter”: Ibid., 280.
146 “Denise Darvall had entered”: Ibid., 286.
147 “So we waited”: Ibid., 303.
148 Roughly forty years later: McRae, Every Second Counts, 192 and 335. This story remains controversial, and the exact details of what happened that day are open to interpretation. While Marius related these details to McRae, he has reportedly told others that this wasn’t the case and that they did wait for the heart to stop before placing Denise Darvall on bypass (personal communication, David Cooper). No one else on the operating team ever confirmed that they actively stopped the heart. Either way, Darvall did meet the criteria for brain death, and starting with Barnard’s second transplant, it became routine to stop the heart with potassium.
149 “For a moment”: Barnard and Pepper, One Life, 314–5.
150 “Eighty-five . . . Eighty”: Cooper, Open Heart, 335.
151 “Professor, I want”: Barnard and Pepper, One Life, 392–93.
152 “[T]he prognosis for recovery”: McRae, Every Second Counts, 277.
154 “The transplant team engaged in”: “Virginia Jury Rules That Death Occurs When Brain Dies,” New York Times, May 27, 1972.
154 “When cerebral function is lost”: McRae, Every Second Counts, 280.
154 “This simply brings the law”: “Virginia Jury Rules That Death Occurs When Brain Dies.”
155 “Congratulations on your first”: Denton A. Cooley, 100,000 Hearts (Austin, TX: Dolph Briscoe Center for American History, 2012), 125.
156 “In the eyes of the media”: Calne, The Ultimate Gift, 128–29.
158 “Although the patient”: Wickii T. Vigneswaran, Edward R. Garrity Jr., and John A. Odell, eds., Lung Transplantation: Principles and Practice (Boca Raton, FL: CRC Press, 2015), 23.
161 “The appearance of Mary”: Sara Wykes, “5 Questions: Bruce Reitz Recalls First Successful Heart-Lung Transplant,” Stanford School of Medicine News Center, March 9, 2016.
162 “I said, ‘Tom’”: Kas Roussy, “Lung Transplant ‘Patient 45’ Remembered 30 Years Later,” CBC News, November 6, 2013.
CHAPTER 8: SYMPATHY FOR THE PANCREAS: CURING DIABETES
163 Sympathy for the Pancreas: The primary sources for this section on type 1 diabetes, including the discovery of insulin and pancreas transplant, are Thea Cooper and Arthur Ainsberg, Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle (New York: St. Martin’s Press, 2010); Michael Bliss, Banting: A Biography (Toronto: University of Toronto Press, 1992); Hamilton, A History of Organ Transplantation; and Nicholas L. Tilney, Transplant: From Myth to Reality (New Haven, CT: Yale University Press, 2003).
CHAPTER 9: PROMETHEUS REVISITED: LIVER TRANSPLANTS AND THOMAS STARZL
178 Prometheus Revisited: The primary sources for this section on liver transplantation are Thomas E. Starzl, The Puzzle People (Pittsburgh, PA: University of Pittsburgh Press, 1992); Calne, The Ultimate Gift; Terasaki, ed., History of Transplantation; Hamilton, A History of Organ Transplantation; and Tilney, Transplant: From Myth to Reality.
182 “The truth was worse”: Starzl, The Puzzle People, 59–60.
186 “The most important consequence”: Ibid., 57.
188 “My approach had been”: Ibid., 73.
192 “[W]e viewed the principal hurdle”: Ibid., 99–100.
201 On April 17, 1968: T. E. Starzl, C. G. Groth, L. Brettschneider, I. Penn, V. A. Fulginiti, J. B. Moon, H. Blanchard, A. J. Martin Jr., and K. A. Porter, “Orthotopic Homotransplantation of the Human Liver,” Annals of Surgery 168 (1968): 392–415.
201 “A grim conclusion”: Starzl, The Puzzle People, 170.
201 “The mortality from”: Ibid., 165.
203 “After listening”: Calne, The Ultimate Gift, 96.
204 In 1981, Starzl published: T. E. Starzl, G. B. G. Klintmalm, K. A. Porter, S. Iwatsuki, and G. P. Schroter, “Liver Transplantation with the Use of Cyclosporine A and Prednisone,” New England Journal of Medicine 305 (July 30, 1981): 266–69.
205 “I was wiped out”: Chuck Staresinic, “Only Starzl Dared To,” Pitt Med, Spring 2006.
206 “maestro” . . . “Watching Dr. Starzl”: Quoted in Stephen J. Busalacchi, White Coat Wisdom (Madison, WI: Apollo’s Voice, 2008), 476.
CHAPTER 10: JASON: THE SECRET IS TO LIVE IN THE PRESENT
215 high MELD score: You might recall from chapter 2 that the “Model for End-Stage Liver Disease” score predicts how sick a patient’s liver is, and how likely he or she is to die without a transplant.
219 one of his favorite books: Arthur Herman, How the Scots Invented the Modern World (New York: MJF Books, 2001).
CHAPTER 11: LISA AND HERB: SHOULD WE DO LIVER TRANSPLANTS FOR ALCOHOLICS?
224 The six-month rule: R. Osorio, N. Ascher, M. Avery, P. Bacchetti, J. Roberts, and J. Lake, “Predicting Recidivism After Orthotopic Liver Transplantation for Alcoholic Liver Disease,” Hepatology 20, no. 1 (July 1994): 105–10.
224 To add to the confusion: P. Mathurin, C. Moreno, D. Samuel, J. Dumortier, J. Salleron, F. Durand, H. Castel, A. Duhamel, G. P. Pageaux, V. Leroy, S. Dharancy, A. Louvet, E. Boleslawski, V. Lucidi, T. Gustot, C. Francoz, C. Letoublon, D. Castaing, J. Belghiti, V. Donckier, F. R. Pruvot, and J. C. Duclos-Vallée, “Early Liver Transplantation for Severe Alcoholic Hepatitis,” New England Journal of Medicine 365 (November 10, 2011): 1790–800.
PART V: THE DONORS
269 “Show me a hero”: F. Scott Fitzgerald, The Notebooks of F. Scott Fitzgerald (New York: Harcourt Brace Jovanovich, 1978).
CHAPTER 14: AS THEY LAY DYING
271 “Donation gives”: Paul I. Terasaki and Jane Schoenberg, eds., Transplant Success Stories 1993 (Los Angeles, CA: UCLA Tissue Typing Laboratory, 1993), 36–37.
283 “All that remained”: Terasaki, ed., History of Transplantation, 340.
283 “On June 3, 1963”: Terasaki, ed., History of Transplantation, 340.
283 “coma depasse”: P. Mollaret and M. Goulon, “Le coma dépassé” (preliminary memoir), Revue Neurologique 101 (Paris, 1959): 3–15.
284 “We knew that kidneys”: Calne, The Ultimate Gift, 56.
285 “To throw some fuel”: Calixto Machado, “The First Organ Transplant from a Brain-Dead Donor,” Neurology 64 (2005): 1938–42; taken from J. E. Murray, “Organ Transplantation: The Practical Possibilities,” in G. E. W. Wolstenholme and M. O’Connor, eds., Ethics in Medical Progress: With Special Reference to Transplantation (Boston: Little, Brown, 1966).
285 “I doubt if”: Ibid.
286 “Although Dr. Alexandre’s”: Ibid.
286 “at the end”: Ibid.
286 “Across the country”: Murray, Surgery of the Soul, 120.
287 He was one of the first: L. Lasagna, F. Mosteller, J. M. Von Felsinger, and H. K. Beecher, “A Study of the Placebo Response,” American Journal of Medicine 16 (June 1954): 770–79.
287 Beecher became both famous and infamous: H. K. Beecher, “Ethics and Clinical Research,” New England Journal of Medicine 274 (June 16, 1966): 1354–60.
287 In September 1967: Beecher would later publish the results of this discussion in H. K. Beecher, “Ethical Problems Created by the Hopelessly Unconscious Patient,” New England Journal of Medicine 278 (June 27, 1968): 1425–30.
288 “As I am sure you are aware”: E. F. M. Wijdicks, “The Neurologist and Harvard Criteria for Brain Death,” Neurology 61 (2003): 970–76.
288 “The subject has been thoroughly”: Ibid.
289 The final document: “A Definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.” JAMA 205 (August 5, 1968): 337–40.
289 “In normal circumstances”: Hamilton, A History of Organ Transplantation, 347.
290 my patient Wayne: Joshua Mezrich and Joseph Scalea, “As They Lay Dying,” The Atlantic, April 2015.
CHAPTER 15: HEALTHY DONORS: DO NO HARM
302 Numerous errors: Lydia Polgreen, “Transplant Chief at Mr. Sinai Quits Post in Wake of Inquiry,” New York Times, Sept 7, 2002.
304 “Italy was a lifeline”: Denise Grady, “After Unusual Fatality, Transplant Expert Revives Career,” New York Times, March 18, 2004.
CHAPTER 16: COMPLICATIONS
314 “Charlie Wilson talks”: Malcolm Gladwell, “The Physical Genius,” The New Yorker, July 25, 1999.
CHAPTER 17: XENOTRANSPLANTATION: FROM ONE SPECIES TO ANOTHER
322 “Xenotransplantation is just”: There is some controversy over who should be credited for this very famous quote in my discipline, but I will stick with Roy Calne.
323 He showed up in Korea: Nick Taylor, “Heart to Heart: Can a Chimp Transplant Save Human Life?” New York Magazine, July 13, 1987.
324 “and shaved a chimpanzee”: Terasaki, ed., History of Transplantation, 555. 327 In 2002, researchers cloned: L. Lai, D. Kolber-Simonds, K. W. Park, H. T. Cheong, J. L. Greenstein, G. S. Im, M. Samuel, A. Bonk, A. Rieke, B. N. Day, C. N. Murphy, D. B. Carter, R. J. Hawley, and R. S. Prather, “Production of Alpha-1,3-galactosy
ltransferase Knockout Pigs by Nuclear Transfer Cloning,” Science 295 (February 8, 2002): 1089–92.
327 George Church’s group: D. Niu, H. J. Wei, L. Lin, H. George, T. Wang, I. H. Lee, H. Y. Zhao, Y. Wang, Y. Kan, E. Shrock, E. Lesha, G. Wang, Y. Luo, Y. Qing, D. Jiao, H. Zhao, X. Zhou, S. Wang, H. Wei, M. Guell, G. M. Church, and L. Yang, “Inactivation of Porcine Endogenous Retrovirus in Pigs Using CRISPR-Cas9,” Science 357 (September 22, 2017): 1303–7.
CHAPTER 18: SO, YOU WANT TO BE A TRANSPLANT SURGEON?
330 There is a book: Kaj Johansen and David M. Heimbach, “So You Want to Be a Surgeon,” 1986, on American College of Surgeons, https://www.facs.org/education/resources/residency-search.
333 “Isn’t this fun”: McRae, Every Second Counts, 67.
334 Once, on an airplane: This story was told to me by Münci Kalayoğlu, who was on the plane with Starzl.
334 In their book: Renee C. Fox and Judith P. Swazey, The Courage to Fail (New Brunswick, NJ: Transaction Publishers, 1978).
335 “Surgery, not just”: Cooper, Open Heart, 348–49.
338 “Desperate measures like”: Moore, Transplant, 275.
339 As Starzl said: From chapter 10, “The Transplant Surgeon, the Sociologist, and the Historian: A Conversation with Thomas Starzl,” in Carla M. Messikomer, Judith P. Swazey, and Allen Glicksman, eds., Society and Medicine: Essays in Honor of Renee C. Fox (New Brunswick, NJ: Transaction Publishers, 2003), p. 149.
Selected Bibliography
Barnard, Christiaan, and Curtis Bill Pepper. One Life. Toronto: The Macmillan Company, 1969.
Bliss, Michael. Banting: A Biography. Toronto: University of Toronto Press, 1992.
Brent, Leslie Baruch. Sunday’s Child? A Memoir. New Romney, UK: Bank House Books, 2009.
Busalacchi, Stephen J. White Coat Wisdom. Madison, WI: Apollo’s Voice, 2008.
Calne, Roy. A Gift of Life. Lancaster, UK: Medical and Technical Publishing Co. Ltd., 1970.
____. The Ultimate Gift. London: Headline Book Publishing, 1998.
Carrel, Alexis. Man, the Unknown. New York: Harper and Brothers, 1939.
Cooley, Denton A. 100,000 Hearts. Austin, TX: Dolph Briscoe Center for American History, 2012.
How Death Becomes Life Page 32