Someone Else's Lungs

The school bus radio broke the news to me: The Jarvik-7 artificial heart had replaced a human heart and the patient had lived. My sciencehungry young mind whirled: How did it work? What had the surgeon done with the sad, defective human heart that had failed its owner, a dentist named Barney Clark? The choice had been transplant or death, and this gadget-heart had thrown open a new door in medicine. Even if the new heart had only extended a man’s life for fewer than four painful months, having one’s own vital organ fail no longer meant immediate death. A heart could be removed and replaced with something other. And if a heart could be transplanted, I reasoned, what other organs might soon be swapped out on the operating table?

Transplants were possible.

The first time I saw Jonathan, with his shiny blond hair, there was something about his face that became synonymous with my brain’s lifelong image of him. It was a smile that seemed to be from somewhere other than this world, surrounded by deep wrinkles that belonged on someone much older. He’s been gone for several years now—and I hadn’t seen him for a long time before that—but I can vividly recall that face, and the musical laugh that always came out of it.

The laugh originated in lungs that had betrayed him since birth: mucous-filled, fibrous, cystic lungs. Or maybe the laugh originated from his heart, one fully devoted to Jesus, the name he reverently spoke often in his quiet, sweet South African accent. He coughed and laughed, took digestive enzymes, and traveled the country and the world, sharing the good news about Jesus that he had learned from his missionary parents.

Several years later, after too much time in the hospital with pneumonia, he was given someone else’s lungs, and more time. When the surgeon trimmed away his ruined lungs, his world-travel wings were clipped as well. But his laugh remained; the transplanted lungs hadn’t changed that at all.

New lungs would give him time to meet and marry the love of his life. He would have more years—working from a U.S. home office—to support others who now traveled doing the global missionary work to which he had devoted his life. There would be more laughter in the world from that wrinkled smile with the matching crinkly eyes.

Transplants were good.

Later, Jonathan’s laugh was quieted for many weeks while he slept in a coma. The immunosuppressive drugs that prevent transplantorgan rejection had held open the door for colon cancer to grow unchecked. His only hope for treatment required an abdominal surgical site kept open to a doctor’s view day after day, as the calendar pages turned. He lived. He went home.

But there was more pneumonia, more cancer, more coma. It ran together, and then it came to an end.

As I learned more about the immune system, I came to understand that accepting someone else’s organs in a transplant meant more than just receiving interchangeable spare parts. A transplant meant likely trading one cause of death for another, because turning off the immune system to prevent organ rejection was akin to unlocking the front door to the castle and leaving the drawbridge down over the moat. Nothing would be kept out. It was first-come, first-served to any pathogen that wandered in or disease state that developed.

Transplants were still good, right?

I began to take a deeper look. I had known several other people involved with transplants, and I was surprised to learn about some of the other issues they had encountered, such as the deep sorrow that can arise as a family waits for a donor. Anguished family members can find themselves hoping and praying for a donor to die. When they learn that organs are on the way, their relief can also be hung with the heavy chains of grief for having hoped for the death of a stranger. The weight falls hard on some and is not easily shrugged off.

Learning that new lungs might arrive with a spiritual heaviness embedded in their delivery informed my previous, glass-half-full, scientific viewpoint. It came as a surprise to hear how a soul can be deeply scarred in the search for its loved one’s next breath. An unconsidered reality was now before me: If I ever needed and chose to be the recipient of a vital organ, my loved ones might struggle with the moral net I had cast over them. Was it still a better choice than the alternative?

Were transplants good for some families and not others? Were they good only if we didn’t think too deeply about these questions? Or were they good only if we could peacefully answer them all?

And what if I were to be an organ donor? The weight of that decision would certainly fall more heavily on my family than it would on me. After all, it is not the donor, but the family who lives with that decision when it is carried out.

I had declared my own organ-donor intentions at the Bureau of Motor Vehicles back when transplants had simply been good. Transplants had extended the lives of people I cared about. My decision had included consideration of myself, some nameless stranger whose organs had failed, and the cut-and-paste surgical science that could save a life using what I no longer needed. I had not considered that this transaction would have implications for others. I now needed to understand what those were.

I spoke with someone whose dearest love, a registered organ donor, had died unexpectedly, leaving him in a room with medical professionals who had to get on with the business of harvesting the organs to be donated.

After his wife died, her body had to be kept on life support for a full day to give the transplant surgeons time to arrive. And while the new widower was still in shock, the questions came about what he would permit them to take. He was fine with the liver, heart, kidneys, and even bone. After all, those were interior structures he had never seen. But he soon felt the list growing morbid.

“Retinas?”

He paused. “Okay.”

“Eyeballs?”

His loved one’s body was being dismantled, and although donating her organs was what she had wanted, the timing of these decisions was hurting him, piercing him even through shock. He told the surgeons, “We quit here.”

He later received grateful letters from several of his wife’s organ recipients and their families. He was glad they had been helped; he was a goodhearted man and he knew this is what his wife had wanted.

Could everyone’s family bear with such strength the added burden of organ harvesting in the hours after a loved one’s accidental death? I wondered. What would it be like for my family if I were the donor in such a scenario? Who would be in the room answering those questions and waiting for the transplant team to arrive if it were my body on the table? I needed to consider those individuals in my own decision about being a donor. I now realized that my choice to donate organs would barely affect me at all. It would greatly affect other people, some of whom I know and dearly love, and others I’ll never know but also need to love.

There were more issues surrounding transplants than I had ever realized. How could I weigh them all?

Several years before the first Jarvik-7 heart transplant, I had learned a song at school about how to treat others. “Do as you wish to be done by,” we sang, our high, childish voices fueled by our gusty lungs, “for that is the Golden Rule. Do as you wish to be done by—at play, at home, at school.” It had been good advice for life, and it had stuck with me through the years. Could that old, simple principle possibly apply to such new, complex issues as the ones now being posed by the science of transplants?

The song hadn’t addressed a scenario in which I needed someone else’s lungs and so hoped for an unknown person to take his last breath. It hadn’t told me whether I should register to give a desperate stranger my heart at a time when the hearts of my loved ones would be freshly broken from an unexpected goodbye. The principle of “do unto others” hadn’t equipped me to weigh all of the ethical, spiritual and emotional aspects of transplants of which I was now aware.

Or maybe it was the only thing that had.