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Unveiling the Bigger Picture

Updated: Sep 16, 2021

Scrubbing into the operating room, every member of the surgical team is focused on the task at hand: to successfully procure the lifesaving organs that will be transplanted into recipients who are waiting for these precious gifts. Before anything can begin, the team takes a moment to share information, provided by the donor family, about the donor’s life, personality, and passions. “Everyone in the operating room takes a moment of silence to reflect on the donor and donor family.” Then, like a switch, they must turn off their emotions attached to the donor and start the operation.

In preparation, Dr. Joshua D. Mezrich, MD finds it helpful to look at the surgery as a puzzle. He thinks through every step of the surgery and visualizes each task he must complete for a successful outcome, before stepping into the operating room. As he moves through the operation Dr. Mezrich uses mental images to anticipate the next steps while reassessing the patient and seeking help from his team. Each task is one step closer to finishing the “puzzle of the surgery.”


This strategy helps Dr. Mezrich focus on the logistical aspect of the operation and alleviates the emotional pressures that may creep in throughout the course of a surgery. This type of focus began early for Dr. Mezrich. He grew up in a family of readers. His parents made he and his two brothers read two books a week and they would discuss their books at family dinners. This attention to detail fueled his passion for reading and writing later in life.


When Dr. Mezrich was in third grade, his father went to medical school. Although as a young boy, he never imagined he would become a doctor, he does believe seeing his father in this setting set a tone for his future. Dr. Mezrich studied Russian at Princeton University where he expanded his intrigue in language, culture, and literature, but eventually he did decide to go to Medical school.

After completing two years of classes at Cornell University Medical School, he began his rotations. The first day of his surgery rotation was a day he will never forget. “It was a crazy day. I was too scared to eat or drink anything and I felt sick all day,” said Mezrich. Around 12 am, he was asked to go to a kidney transplant surgery. After a long and chaotic first day, this was the last thing Mezrich wanted to do.


It was the middle of the night in New York City, and out of nowhere a kidney was brought into the operating room in a cooler. At first look, “it was a lifeless piece of meat,” recalled Mezrich. He watched as the surgeon transplanted the donor kidney into the recipient and then the “lifeless piece of meat” turned pink and started producing urine.


In that moment, Dr. Mezrich was astonished at what he had just witnessed. Fascinated by the innovation of the transplant, Dr. Mezrich wondered, “Could I do this? Is this something I could do one day?” From that point on, Mezrich knew transplant surgery was where he wanted to end up.


As Dr. Mezrich became more involved with the world of transplantation, he faced the mental and emotional obstacles that naturally come along with working in this specialty field.

“I was so nervous the first time I spoke with a donor family.”

Much to his surprise, his conversations with donor families were emotional, but overall happy and insightful. As someone who loves reading, the stories he heard about donors had a grip on him. Not only did these stories enthuse Mezrich to continue pursuing transplantation, but they also planted a seed for a bigger concept.


After becoming a transplant surgeon specializing in solid organ transplantation including liver, kidney, and pancreas at the University of Wisconsin Hospital in Madison, Wisconsin, Dr. Mezrich was motivated to write a book. Mezrich read the book, “The Emperor of All Maladies,” by Siddhartha Mukherjee, which utilizes patients’ stories to explain the history of cancer. Inspired by this formula of combining clinical information with personal stories, Mezrich wanted to do the same with his book.


This was the start of a three year interviewing and writing process that culminated in Dr. Mezrich’s book, When Death Becomes Life: Notes from a Transplant Surgeon. Mezrich created a three-part template for his book. The first part focused on the innovation of transplant. Mezrich spoke with the pioneers of transplantation and gave them the platform to share their story. He shed light on the history of transplantation and how far the field has come in the past few decades. The second part of the book is centered around his personal perspective on what is it like to be a transplant surgeon. He shares the reality behind what is like to be in an operating room; the timing, the precision, the back-up plans, all the factors that influence a transplant surgeon’s success. The third part of his book, Dr. Mezrich shares patient stories. With 16 years of experience in the field of transplantation, he saw the emotional, physical, and financial challenges his patients endured, first-hand. In this final section,


Mezrich has a chapter on each organ with both inspiring and heartbreaking stories about transplant recipients, living donors, and donor families. A few of the stories involved previous patients of his. A young girl who grew up in a town that was 99% white and received an organ from an African American. A boy who choked on a tack and forever changed the lives of his family members. Mezrich did not just write about their stories, he explains how “I used these stories to talk about bigger concepts.”


In his book, When Death Becomes Life: Notes from a Transplant Surgeon, Dr. Mezrich delves deep into controversial topics including the transplant waiting list; deciding who gets a transplant and who dies waiting, race, money, defining death, and living donation. He addresses questions like; Does an alcoholic get a transplant before someone else lower on the waiting list? Does it mean if a Caucasian woman receives a kidney from an African American man? When someone finds out the race or background of the person who donated an organ to them, what is their reaction? He also discusses how these scenarios play into the problems within our society overall. The connection between a donor and recipient is seemingly sacred, yet underlaying beliefs and societal issues are brought out through the process of transplantation.


Dr. Mezrich’s book conveys many messages, but the main theme is highlighted in the book’s title, “When Death Becomes Life.” Transplantation starts with death and ends with life. In other fields, this is not the case. Many surgeons spend their entire career fighting death. But with transplant, “it is a tragedy that leads to beauty.” Although individuals tragically pass away, there is beauty in the fact that they were able to give the gift of life as their final act.

As someone with many different creative pursuits, Dr. Mezrich’s passion for connecting with individuals within the transplant community does not stop with his work as a transplant surgeon or author. Earlier this year, in January of 2021, Dr. Mezrich was asked to be the host of “The Sett,” the official podcast for the University of Wisconsin Department of Surgery. He graciously accepted the offer, eager to have a new medium to unleash his creativity outside of the operating room.


Since starting the podcast, Dr. Mezrich has interviewed a variety of doctors. He says, “It’s not just about transplantation, it is about what kind of person they are. What choices did they make in their life that led them to this point? How did they succeed?” This outlet has allowed Dr. Mezrich to meet many new people, learn how they arrived at where they are today, and start conversations about some of the problems our world is facing. All this, while sharing these discussions with his podcast listeners.


Dr. Mezrich’s view on transplantation is utterly uniqueand stimulating. His passion for storytelling stimulates discussion surrounding many of the topics he believes characterize transplantation; family, love, loss, sacrifice, challenges, heartbreak, success, and ultimately life itself. The donation and transplant community are extremely fortunate to have Dr. Mezrich as a transplant surgeon and innovative leader in the field. While his surgical work is exemplary, it is his unique gift of sharing the beauty of transplantation – ‘when death becomes life’, that is truly magnificent.


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