Over the last few years it has been almost impossible to pick up a newspaper or magazine without finding some heartwarming story from the world of transplantation surgery. Kidney transplantation has been done successfully since 1954, and heart transplantation, to a much more limited degree, since 1967. With the discovery in the early 1980s of cyclosporine, an antirejection drug that is much safer and more effective than any previously available, the number of heart transplants has increased dramatically. Liver and pancreas transplants are also being done with increasing success.
With the five-year survival rate now more than 50 percent for heart transplant patients and close to 80 percent for kidney patients, there is no doubt that organ transplantation is here to stay.
These procedures are not, however, the unmitigated joy that brief news reports might lead one to believe. For every lucky recipient there has to be an unfortunate donor and a bereaved family (except for some kidney transplants where family or friends may be willing and suitable donors). And even in the successful cases life is not problem-free. Life with a transplanted organ usually involves daily doses of a number of potent medicines and constant vigilance so that any rejection can be recognized and treated as soon as it begins.
"Donor" is a behind-the-scenes look at how the process works. It begins with a death. A 17-year-old-girl is hit by a car while crossing the street. She sustains a severe head injury and, despite prompt medical attention at the University of Maryland Shock Trauma Center in Baltimore, she is soon brain dead. Jo Leslie, the head of the Maryland's Organ Procurement Center in Baltimore, is called to the hospital. It is her job not only to talk to the parents of the victim and try to persuade them to donate their daughter's organs but also, once this has been done, to find appropriate recipients.
It is an emotionally wearing job, but it must be done. There are hundreds of patients waiting desperately for organs that may save their lives. Suitable donors -- otherwise healthy people who die of head injuries -- are relatively rare.
Pekkanen began research on his book before cyclosporine became readily available, so in this case Jo Leslie asks only for the kidneys and the corneas. She arranges for their removal and for tissue typing. Using the computerized system that organ transplantation centers have established, she finds appropriate recipients for each organ: one kidney to the wife of an Army major at Walter Reed, the corneas to blind men in Massachusetts, the second kidney to a 4-year-old boy who has already undergone two kidney transplants that ended in acute rejection. The organs are procured, flown off to their various destinies and transplanted with varying degrees of success.
Pekkanen cuts from one story to another, letting us get to know not only the donor and her family but the recipients and their families as well. Through it all he weaves the story of Jo Leslie and her life and work at the Procurement Center. Each of these stories is poignant and dramatic; each contains moments of happiness and despair. For once (and it's about time) the emphasis in a "medical" book is not on the few dramatic moments but on the trials and tribulations that precede and follow the operations.
"Donor" is not (nor was it intended to be) a comprehensive overview of the subject -- for example, there is almost no discussion of the tremendous economic problems that widespread use of transplantation will create -- but it does give the reader, in a smoothly written, absorbing, almost novelistic style, an understanding of a medical advance with which an increasing number of us may have to deal. In this era of expanding patient participation in medical decision making, "Donor" is well worth reading.