Professor Stephen Munn speaks...

As a transplant surgeon, it is my patients that make my life interesting. I want to tell you a story about such patients - a true story.

The first time I met this particular patient he was not a happy camper. He was in pain, some of which we had caused, he was recovering from a bout of infection, he was jaundiced and to add insult to injury he was in a six-bedded unit. I remember going to his bed and making a futile attempt to give us a little privacy by pulling around us the far from sound-proof curtains. Although he was distracted by pain, I could readily discern that it was not the pain that concerned him most. 

He had learned that the reason for his pain, infection and jaundice was a liver tumour - a cancer that was blocking the bile ducts in a portion of the liver. Furthermore, he had learned that this tumour could not be removed by surgical means.

This patient was a quiet, mild-mannered man. He was softly spoken, well informed and outwardly calm. I couldn't help thinking that on the inside he would be unlikely to feel so at ease. We talked for a long time about liver transplantation as a means of dealing with this tumour. We talked about the evaluation process, the waiting time, the surgery and its complications, the anti-rejection drugs and their side effects and we talked about the need for life-long surveillance. No matter how many potential problems I raised, each time I saw the same look in his eyes. In transplantation lay hope. The alternative was unpalatable, unmentionable. When I left his bedside I knew that he was a great transplant candidate. We put him through the evaluation process and then he was listed and had to wait for an organ to become available.

The wait must seem interminable especially to patients who have tumours. Subsequently this patient described looking at a tube of toothpaste and wondering if this was the very last tube of toothpaste that he would ever need. Mundane objects filled with horrific metaphysical implications. After three months of waiting he was finally transplanted. Some wonderful donor family somewhere agreed to allow their loved one's organs to be used to give a number of patients a second chance. My patient was one of those fortunate enough to receive such a gift. After first removing his entire liver, along with the tumour, we were able to sew in the new liver and watch it pink up immediately. It was a great liver. It quickly began to function and to our delight it began to make bile while we were still working on him. As predicted he was a model patient, recovering quickly with few complications. I recently saw him at nine months post-transplant and he continues to do very well. Like many patients given a second chance, he is making use of every opportunity. On the anniversary of his transplant he plans to be on vacation with his wife in a part of New Zealand he has always wanted to visit but never before taken the opportunity. He is tremendously grateful to that donor family. For the purposes of this story, I will call my patient John.

Now I need to tell you another story, a parallel one. To begin it properly I need to take you back more than 30 years to the 60's when the Beatles were singing about yellow submarines and strawberry fields and when Tim Shadbolt was not yet part of the establishment. In the late 60's two young people from rather different backgrounds went off to Teachers Training College. They were both fresh out of high school with high hopes and neither of them were blind to the attractions and opportunities that were on offer in the co-educational environment of that institution. These two young people, he a little shy, she more confident and outgoing, met, "went out" as they say and unequivocally fell in love. By the time they both graduated they planned to marry and when they went up into the remote north for their country service it was as husband and wife.

That was a busy but halcyon time in their lives. They were young, healthy, very much in love and their lives stretched ahead of them in seemingly endless fashion. Not surprisingly, she fell pregnant and both of them looked forward eagerly to this child conceived as it was at such a happy time. They saved every penny they could and came back to their hometown with enough for the deposit on a section. Eventually, in fulfillment of the Kiwi dream, they designed and had built a home to suit their needs. They continue to live in that home 26 years later. Their little son was born without mishap. For the sake of this story I'll call him Brad. Brad cried a lot as a baby, which his doting mother traced to a milk allergy. He grew up very quickly it seemed to his parents, attending in rapid succession the local primary school, intermediate and high school. He enjoyed motorsports and, incongruously, cooking. I understand that he was also quite artistic.

Brad trained as a patisserie chef and although he worked long hours at this job he enjoyed tinkering with his motorbike when he was finally home. By this time he was in his early twenties.  He was tall, dark, good-looking and often dressed in black. At work he met a lovely young woman who quickly indicated that his interest was reciprocated. She came, however, from a very different background. Her parents were not too keen on this dark, handsome, motorcycle-riding patisserie chef who had stolen away their daughter's heart. This did not stop Brad from seeing her, nor did it stop their relationship from escalating. Shortly thereafter Brad found himself to be an expectant father. Although he was frustrated by the disapproval of his potential in-laws, he was pleased about the prospect of being a father. He decided he ought to get a better paying job and to make some plans for his baby. Brad already knew he liked children. He had volunteered at the local school and had helped out at scout camps. He was the kind that kids liked to follow around the schoolyard. He had enjoyed that.

Ten weeks before the baby was due, Brad was home working on his beloved motorbike. There was an annoying squeak coming from somewhere under the seat. He and his Dad had discussed how to fix it. He worked on it for a while and then went out for a test ride. It was a lovely afternoon in late February. The road was windy but dry. He had ridden that way many times before. He was behind a woman driving a car when he pulled out at a leisurely pace on a long sweeping curve to get by her. For reasons that will never be fully understood Brad never made it around that bend. He and his bike left the road and he was found down a bank lying on his back with his arms outstretched as if he was resting. He had been killed instantly. At four o'clock he was alive. Now, at ten past five, he was dead. His mother had heard the ambulance and like all mothers everywhere had wondered. That night she had to go down and identify him. It was difficult to believe. For some reason she noticed his teeth now beautiful and straight. She remembered all the orthodontic work that had been done on them. And for that and a thousand other reasons, she remembered thinking "What a waste!"

Early the next morning, Brad's mother answered the phone. On it there was a polite woman asking if she would agree to donate Brad's tissues (his corneas and heart valves) for transplant purposes. Brad's mother had thought about this before and wanted to say yes. She calmly continued the conversation and said that yes, she thought that was a good idea and they could go ahead and take those items. When she finally hung up she felt completely shattered. She had to sit down. She turned to her husband for support, this man who had loved her for 32 years, who knew only too well what it was for her to allow them to take the eyes and heart from their only son. The man she looked at, this husband, lover and father that she knew was John, who unbeknownst to him, would himself need the altruism of another donor family within 18 months.

I tell you this story so that whether you are a transplant recipient, or a friend of that recipient, or a donor family member, you will be better able to appreciate the other side of the equation. Hope emerging from hopelessness, joy coming from pain, someone's dreadful and tragic loss being the means of someone else's gain. Such a remarkable juxtaposition of emotions and yet somehow a microcosm of all human existence. It is unusual for a transplant recipient to be a member of a donor family. John was one of those few.

His words rather than mine best encapsulate his experiences as a transplant recipient.

 "It's hard to put into words just how grateful and fortunate I feel. A few short months ago I believed that I probably wouldn't see my next birthday, the America's cup, or the new millennium. It was horrifying and shocking. To look at family pets with the belief that they would probably outlive me was painful. Trying to come to terms with leaving my wife of 32 years was appalling, so soon after the shattering tragedy of losing our only child. Almost as cruel was believing that our beloved grandchild, born months after his father died would be too young to even remember me. But now, thanks to you all, every day is an unexpected miracle. I have a lot of living to do. I owe you all everything."