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The Puzzle People

Given the tensions and demands of medicine, highly successful physicians and surgeons rarely achieve equal success as prose writers. It is truly extraordinary that a major, international pioneer in the controversial field of transplant surgery should have written a spellbinding, and heart-wrenching, autobiography.Thomas Starzl grew up in LeMars, Iowa, the son of a newspaper publisher and a nurse. His father also wrote science fiction and was acquainted with the writer Ray Bradbury. Starzl left the family business to enter Northwestern University Medical School where he earned both and M.D. and a PhD. While he was a student, and later during his surgical internship at the Johns Hopkins Hospital, he began the series of animal experiments that led eventually to the world's first transplantation of the human liver in 1963.Throughout his career, first at the University of Colorado and then at the University of Pittsburgh, he has aroused both worldwide admiration and controversy. His technical innovations and medical genius have revolutionized the field, but Starzl has not hesitated to address the moral and ethical issues raised by transplantation. In this book he clearly states his position on many hotly debated issues including brain death, randomized trials for experimental drugs, the costs of transplant operations, and the system for selecting organ recipients from among scores of desperately ill patients.There are many heroes in the story of transplantation, and many "puzzle people," the patients who, as one journalist suggested, might one day be made entirely of various transplanted parts. They are old and young, obscure and world famous. Some have been taken into the hearts of America, like Stormie Jones, the brave and beautiful child from Texas. Every patient who receives someone else's organ - and Starzl remembers each one - is a puzzle. "It was not just the acquisition of a new part," he writes. "The rest of the body had to change in many ways before the gift could be accepted. It was necessary for the mind to see the world in a different way." The surgeons and physicians who pioneered transplantation were also changed: they too became puzzle people. "Some were corroded or destroyed by the experience, some were sublimated, and none remained the same."
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About the Author

Thomas E. Starzl, a pioneer in human organ transplantation, eloquently recounts the history of this miraculous field, its major players, and the legal and ethical issues that surround it. His medical genius and contributions to the sometimes-controversial procedures have been acknowledged and acclaimed worldwide. This paperback edition features a new epilogue that brings readers up to date on developments in transplant surgery. Now retired from active surgery, Starzl is director of the Transplantation Institute at the University of Pittsburgh Medical Center.


Powerful, poignant, deft, this memoir in itself serves as a masterful argument for organ transplantation as Starzl, a retired pioneer in the field, re-creates the intricate history, the stunning breakthroughs and the tragic failures of the controversial surgery. Born in Iowa in 1926 to a nurse mother and a journalist-science fiction novelist father, Starzl as a young doctor showed himself to be tenacious in perfecting kidney and liver transplants, while overcoming medical infighting and resistant medical and government bureaucracies. Moving from the University of Colorado to the University of Pittsburgh--he established renal transplantation centers at both--he takes us through the advances, from the technique requiring related kidney donors to cadaveric kidney and liver implants to the development of drugs to aid in managing rejection and infection, to programs for finding donors and transporting their organs. Starzl pays tribute to colleagues who either paved the way or helped set the course, while firmly judging those he views as impeders. If he does not lay to rest the philosophical and financial issues surrounding organ transplantation, he succeeds in making us reconsider reservations, reminding us that ``All triumphs in medicine are the forgotten sorrows of past days.'' Photos not seen by PW . (Sept.)

"One is reminded of the Elizabethan adventurers Drake and Raleigh, who through force of will, exuberance, and unbridled elan opened new lands, new visions, and new ideas.... A fascinating story." -Starzl tells a fascinating story, not only in giving his distinctly personal view of the evolution of organ transplantation, but also about himself. His book is recommended for anyone with curiosity about transplantation, or with broad interests in current medical events and the remarkable successes in clinical and biological sciences during the latter half of the 20th century.- --New England Journal of Medicine "Starzl tells a fascinating story, not only in giving his distinctly personal view of the evolution of organ transplantation, but also about himself. His book is recommended for anyone with curiosity about transplantation, or with broad interests in current medical events and the remarkable successes in clinical and biological sciences during the latter half of the 20th century." --New England Journal of Medicine

Distinguished surgeon Starzl here spends relatively little time on his patients or even in the operating theater. Instead, he focuses on research funding, the politics of hospitals and medical schools, and the great number of people and scientific advances necessary for achieving successful organ transplants. He also discusses the ethics (and dilemmas) of defining brain death, of human experimentation and randomized clinical trials, and of obtaining donor organs. Though he uses his autobiography to settle a few old scores, Starzl is a good writer, skilled at explaining medical complexities in lay language without oversimplifying. He also gives credit to his nonphysician technicians and other medical colleagues. With the current debates on healthcare costs, ``rationing,'' and perceived scientific irregularities likely to continue, this topical book is recommended for collections with strong medical or scientific/technological interests.-- Mary Chitty, Biotrends Research, Natick, Mass.

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