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Melodie Winawer M.D.
Melodie Winawer M.D.

A Piece of Someone Else

A neurologist’s view of organ transplant.

In 1954, Ronald Herrick gave one kidney to his twin brother Richard, marking the first successful living donor organ transplant. Since then, transplant—of pancreas, liver, heart, lung, small intestine, thymus, hand, eye, and even face--has transformed and saved thousands of lives.

The need remains high: 118,000 people currently await an organ, and every 10 minutes one more person joins the national waiting list. Transplant is the ultimate gift—the gift of life. But receiving that gift is complex: full of both joys and challenges. Putting one person’s organ into another person goes beyond basic physiology.

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I am a neurologist, and three years ago, I saw my first transplant patient for neurological evaluation. Since then I’ve seen many more individuals considering, scheduled for, recovering from, and living with transplant. That first visitor was a young man who, several years before, had become short of breath, suffering from a lung disease called sarcoidosis. He’d worsened steadily despite treatment until he was nearly suffocating, and on the verge of death. Then, after months of waiting on the transplant list, his turn came. He underwent single lung transplant and woke up the next day able to breathe. The story he told me was miraculous, magical, and breathtaking— he went to sleep drowning, and woke up alive, gulping in fresh, sweet air.

He’d come to me with worsening headache, and my job was to figure out why. Was it a side effect of the medications that prevented his body from rejecting the foreign lung? Was it a result of a brain infection from that immune suppression? Could the same disorder that had turned his lungs into scar tissue now be involving his brain?

Fortunately, tests didn’t find any dangerous cause. But in my first meeting with him, what preoccupied him most was not his headaches, but something deeper and more mysterious: what this lung, this gift from a person who had died to give him life, might bring with it--in addition to the gift of breath.

When I’d finished my examination, he said: “I know my donor was a gardener. I never cared about plants, never looked at flowers before. And now I do—all the time. I see how beautiful they are.” His smile held in it not just the miracle of his own survival, but something else too, the thought that with this lung came more than just breath. He’d been granted life, and a new way of looking at life—what he was certain was the donor’s way.

Recently, a patient who’d undergone kidney transplant twenty years before came to me with worsening memory. Although our visit focused on her neurological problem, she began to tell me the psychic experience of being rescued from certain death. She’d watched her father die in his 30s of the disease that she had inherited, a disease that filled her kidneys with cysts. She hadn't expected to survive, and she’d lived as though there was no tomorrow. And then suddenly-- there was. Survival was a tremendous but complex gift from her very much alive, much younger brother. She’d never considered a career, because she had no concept of a future. When suddenly a future was within her grasp, her life went from approaching its end to stretching out for decades, and she’d never prepared for that possibility.

Transplant, accepting a part of someone else’s body as your own, calls into question the nature of identity. This surgery transmits not only a piece of tissue, but a piece of someone else’s existence. If the first transplant patient I’d seen felt that the new lung had given him a love of flowers, then he must, in some way, have believed that the lung brought a fragment of the identity of its donor with it, and that that identity now added to his own. If my patient with a new kidney spent years expecting to die but then found herself looking at a long future, even if the kidney did not imbue her with her brother’s characteristics, she had incorporated the once foreign possibility of having a future at all. In this way, transplant changed her identity profoundly too.

Galen, a second century Greek philosopher, physician and surgeon, declared that the heart was the organ most closely related to the soul. Modern science has turned to the brain to explain emotion; science doesn’t pretend to explain the soul. But many transplant recipients I care for explain, articulately and with passion, that the organs they gratefully receive carry something intangible with them, some force for transformation that transcends the physical. This most cataclysmic of surgeries, which combines two lives in one body, may help us understand the perplexing, profound nature of the self.

At the end of my visit with that first lung transplant patient, he’d paused before leaving my office, reflecting once more on the unknown donor who’d changed his life. “I never used to do this before,” he said, taking a deep, easy breath and looking out the window over my desk, “but now…now I look at the sky.”

About the Author
Melodie Winawer M.D.

Melodie Winawer, M.D., is an Associate Professor of Neurology at the Columbia University Medical Center.

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