Cell-ebrate the Memories

Your cells, all of them, not just the ones in your brain, retain memories. I know, it sounds like fiction. I wouldn’t believe it either if I were you. I mean, how could they remember your favorite tastes, your nervous habits, and your most vivid memories? And yet, it might not all be science fiction. Cellular memory is a popular theory, not merely confined to the pages of Stephen King novels.

I’m with you on this one, I like to stay on the side of caution. And I don’t believe everything I hear. It’s just that some transplant patients have such weird experiences after transplant that they have no other explanation. Take the 29-year-old lesbian who was a fast food junkie and received a heart from a 19-year-old female vegetarian who was self-proclaimed “man crazy.” All of a sudden after transplant, the recipient started reporting that meat made her sick and she was no longer attracted to women. In fact, she became engaged to marry a man.

OK, that one makes sense. She got a new heart and we all know that’s the seat of love. Nothing could’ve changed that. But then look at the story of Claire Sylvia, probably the most famous of the cellular memory stories. Claire was a healthy, active dancer before she received her heart-lung transplant. Then all of a sudden Claire began having peculiar changes like cravings for beer and chicken nuggets. Later, Claire found out that these were favorites of her donor and that he even had chicken nuggets in his jacket pocket when he died in a motorcycle accident.

See, that one’s a little weird and it makes you start to think if this stuff is real or just the beginning of the plot to a really bad horror film. I mean maybe all that fried food started to get to her donor’s heart, clogging those arteries with memories of Denny’s. I’m really not sure. And we haven’t even gotten to the freakiest story yet, where an eight-year-old girl received the heart of a ten-year-old who had been murdered. After the transplant, the recipient started having horrible nightmares of a man murdering her donor. The dreams became so traumatic that she went to a psychiatrist and then to the police to seek help. According to the psychiatrist, “…using the description from the little girl, they found the murderer. He was easily convicted with the evidence the patient provided. The time, weapon, place, clothes he wore, what the little girl he killed had said to him…everything the little heart transplant recipient had reported was completely accurate.”

Besides having the world’s worse defense attorney, that story really makes you quiver. If I was a donor, what would my organs remember of me? Would it be my calm attitude, a love of pizza, or all the TV I watch? As far as I can tell my new liver didn’t bring any new memories with it. And so I’m not sold on cellular memory. They say the best way to live after death is to donate your organs. And perhaps that’s not as fictitious as we all once thought.

Give Me Liver, Or Give Me...

In a controversial decision, Israel is set to become the first country to give priority to patients for organ transplants for non-medical criteria. In response to the shortage of organ donations in the country, one of the lowest in the developed world, Israel’s parliament passed a law that gives priority to patients who signed an organ donor card and their immediate families. Donors would therefore move up in line for an organ if they or their family members had previously donated an organ.

There is a fine-line between moral grounds and the betterment of society. UNOS, for example, believes that there should be no “valuable consideration” concerning organ donation, usually interpreted as payment. But why shouldn’t there be? Currently donors receive no compensation for medical costs, loss of income, accommodation, or child care. Sort of a consolation prize, Pennsylvania is the only state that has approved a law to pay for funeral expenses of people when organ donation occurred after death. UNOS says that the important factor is “giving” but if we are so concerned with our generosity than why do thousands die yearly from organ failure?

Money does not need to be the way to fix organ donation however. In fact, I would venture to say we shouldn’t use payment as an incentive. I believe that monetary compensation could take advantage of the poor. There is no way to check someone’s motives and people will do almost anything for money. Even an opt-out clause, where people are automatically signed up as donors, can go against their wishes. Although I agree with the theory of an opt-out clause, people deserve the freedom of choice to make such a life-altering decision.

Alexander Tabarrok argues, in his new book Entrepreneurial Economics, that a “no-give, no take” policy (the Israeli policy is a lenient version of this) would dramatically increase organ donation. It would dually increase supply while still allowing those who donate solely out of goodwill to do so without being deterred by compensation. And those that refused to donate, due to fear or religious objections, would still be eligible for surplus organs. I am not convinced that this is the correct approach. But with only seventy percent of Americans signing a donor card and only 45 percent of Israelis, something needs to be done. If the Israeli system works then, and I’m hoping it does, perhaps the rest of the world might see that the best kind of gift is the one that keeps on giving.

Three Rivers

The news last week that CBS has canceled “Three Rivers” is, by all accounts, not surprising. After all, the show was never any good. The script was lousy, the acting uninspiring, and the time slot even worse (going against Sunday Night Football is never a good idea). And yet, I’m oddly disappointed that I won’t get to see another episode. As unrealistic as the characters were, I indelibly fell for them. And so I’m sad to see the show go.

For those of you who don’t know, Three Rivers is about a transplant center in Pittsburgh. This is the only reason I started watching it. The show focuses on all aspects of the center, the surgeons, the nurses, and the patients. The only problem is they get it all wrong. First, no one in the hospital is yellow, has blue lips, or is suffering to breathe. Instead, they’re all tall and good looking. No one waits for a transplant either. In a single hour (minus commercials), these patients get sick, get wait listed, transplanted, and ultimately better. Three Rivers, in essence, is ER for transplant patients – everything is rushed and chaotic. You never get to know the patients or feel their suffering. Hell, half of them don’t even look sick.

The doctors are no more realistic on the show. The 28 year-old chief of surgery (?) is a surgeon, hepatologist, cardiologist, and pulmonary specialist. There is no team-work in this transplant center. Unfortunately, in Three Rivers there is only a hierarchy, diminishing the role of doctors, nurses, social workers, and every one else who helps in the transplant center. I met my surgeon once before surgery. He explained to me what would happen and then the next time I saw him was at the operating table. Surgeons are great but they don’t replace the role of everyone else who made my upgrade possible.

Despite all this nonsense, the show is somewhat compelling. Less gossipy than Grey’s Anatomy and more heartfelt than House, the show swaddles the fine line between entertaining and sappy. All the episodes are feel-good tear-jerkers. Even better is the positive effect the show has had on organ donation. The drama shows the positive outcomes from transplant surgery, while the actors have all come out in support of organ donation. And so, I understand why Three Rivers was canceled. I'm just not so happy about it.

Look Who's Talking

A few weeks ago, I spoke publicly about my experiences at a local high school. I am not a confident speaker. Although I have no problems writing about my feelings, I have a very hard time sharing them out loud. I believe I am a good speech writer, but not a good speaker. I get very nervous as my heart pounds through my chest like a drum.

I spoke that day along with Robby Berman, head of the Halachic Organ Donor Society, to a class of 11^th and 12^th graders. Robby began the discussion by talking about organ donation in Jewish law. He then went on to discuss his viewpoint that donors should be monetarily compensated for their great sacrifice. Robby is a great speaker. He is funny and engaging as the students questioned and analyzed his talk. It was definitely a tough act to follow.

I spoke that day for the last ten minutes of class. I thanked the class for allowing me to join them and then spoke about my experiences, beginning with my diagnosis at 12 and ending with my transplant just a few weeks earlier. The class was amazing. They were extremely attentive and asked excellent questions. They made me, a shy and nervous speaker, feel comfortable and welcome.

This Saturday I spoke briefly at my synagogue. The people in my community have been amazing these past few months. Usually, one’s support group consists of their family and friends but I have been fortunate enough to have the entire community rally around me. And so, I felt that it was appropriate to thank them publicly. After services concluded, the Rabbi introduced me and I got up to speak. After thanking the Rabbi and his wife, I gave a short sermon:

The Talmud in Succah, when describing the proper height of a succah, says “MeOlam Lo Yardah Hashchinah LeMateh MeAsarah (G-d’s presence does not lie below ten lengths of a fist)” It is if that part of the physical world is devoid of G-d’s presence. And yet, it is specifically in this place that the Talmud tells us to place our Menorah on Hanukkah. Now, during the dark winter months, we light a candle and bring G-d’s presence down to a place that is normally devoid of Him.

At times, this past year has been extremely dark for me and my family, I have often felt devoid of G-d’s presence during these difficult times. But my family, friends, and the community at large have been the candle to lift me through this. They have helped me get to this point and I want to thank all of you for that. Have a Happy Hanukkah.

I hope to speak publicly again. I know I’ll be panicking beforehand but I’ll feel even better afterwards. It’s important for people to see that even a young person can get a liver transplant. And more importantly, that he can recover so soon afterwards.

Eight Crazy Nights

Celebrating the Jewish holidays in the hospital is a very surreal experience. On the one hand, you lose the chance to really immerse yourself in the holiday because of tests, doctor visits, and how you feel. But, on the other hand, you are undoubtedly more connected to G-d just because of your surroundings. I’ve now spent three major holidays cooped up in the hospital and each time has been a unique experience.

This week begins the holiday of Hanukkah. Last year, I was unfortunately in the hospital for most of the holiday. Only a few weeks earlier I was told my liver was failing and would need to go on the liver transplant list. And so to be in the hospital so soon after that was a painful wake-up call as to where my health was heading. It was not the atmosphere for a holiday, nor was I in the mood for one.

Although Hanukkah takes place during the dark hours of the cold winter, it is one of our brightest holidays. The candles we light each night bring some light into this dark time. We sing, play dreidel, and dance with our families around the warmth of the lights. It has always been one of my favorite holidays. But in the sterile environment of the hospital, the candle lighting ceremony is not the same. For one, you aren’t even allowed to use candles for fear of burning down the hospital. Instead, I used an electrical menorah which serves the purpose but doesn’t feel the same. And dreidel playing is a lot more difficult when you are attached to an IV pole.

Hanukkah celebrates the miraculous military victory during the Diaspora. It is remembered more, though, for the miracle of the Temple candles lighting for eight straight nights. With the holiday revolving around the candle lighting, sometimes the first aspect of the holiday can be lost. But that year, in the hospital, it was specifically the fight that I celebrated: the fight against greater odds, against something stronger than you, a fight not possible without a miracle. And so I fought, with the miracle of Hanukkah as inspiration, to leave the hospital and beat this disease. And miraculously, I went home that winter with a few nights of the holiday left to celebrate.

All the News That's Fit to Print

Several weeks ago, I attended a panel discussion on organ donation in Jewish law. Although many prominent rabbis believe that organ donation is fine, the topic is still ripe with controversy. Many people in the ultra-orthodox world will not donate their organs even though they will accept them. In the past several years many rabbis have become proponents of organ donation and the rate of Jewish donors is rising.

The discussion took place in Highland Park, NJ, where Aviva and I used to live. The first panel speaker was Dr. Michael Eleff who is medical director of the Cancer Institute of New Jersey in Hamilton. Dr. Eleff presented the audience with the history of organ donation as well as the medical procedures for all transplants. Although extremely interesting, I found Dr. Eleff’s tone to be somewhat depressing. He brought up the negative aspects of donation like the liver donor who died in Mount Sinai Hospital many years ago and the immense pain associated with bone marrow transplants. Still, it was very insightful and a good way to begin the discussion of organ donation.

Robby Berman, the founder and director of the Halachic Organ Donation Society (HODS), spoke next. Robby began by describing the controversy in Judaism, which derives from the question of when does death occur. Rabbis disagree as to whether death occurs when breathing stops (brain-stem death) or when the heart stops beating. Clearly, those who believe in the latter view do not allow for organ donation. After going over the various views and the opinion of HODS, Robby spoke about the problems of organ donation in Israel. Because of the controversy surrounding donation in Jewish law, Israel has a very low rate of donation, roughly 10 percent. America, for example, has around 40 percent of its population donate life-saving organs. Robby spoke about the problems of donation and how the HODS foundation is trying to combat that.

Finally, Rabbi Dovid Goldwasser, an author and leader of a congregation in Brooklyn, addressed the audience. The Rabbi began with a parable in the Talmud.

An angel once visited a great Torah scholar. When he came to the door, the scholar gave him bread but the angel asked for the scholar’s soul. Immediately, the scholar gave it to him.

Rabbi Goldwasser explained that the ideal in Judaism is to give of yourself completely. Although I was expecting him to speak about the aspect of organ donation and Jewish law, the Rabbi instead spoke about the more general topic of giving of yourself, whether it be your time, your money, or your organs.

In attendance at the discussion was a writer for the New Jersey Jewish News. She approached me after the talk and asked about my story. Although I didn’t address the audience that night, I was introduced as someone who had a life-saving transplant. The reporter asked to write an article about my upgrade and I agreed. Click here to read the article.

Animal Planet

I love animals. I mean, who doesn’t love going to the zoo and watching Animal Planet? And so you can imagine my disappointment when I found out I could have had a liver from a cute, cuddly animal. Xenotransplantation is the transfer of organs from one species to another. Of course, no successful xenotransplant has ever been performed, but that doesn’t mean I shouldn’t dream.

The first documented case of xenotransplantation was performed in 1682, when a bone from a dog was used to repair the skull of an injured Russian aristocrat. Supposedly, the surgery was a success but that doesn’t mean its not wrong. After all, dogs are man’s best friends. Clearly dog lovers, the church was angered by the transplant and asked for similar procedures to be prevented in the future. And so, it wasn’t until 1963 that the next documented case of xeontransplantation was performed.

Thomas Starzl, known as the “father of modern transplantation”, performed the first ever liver transplant in 1963. That same year, Starzl also grafted six Baboon kidneys into patients in Denver, Colorado. Due to the lack of human donor organs, Starzl attempted to use our closest relatives. Initially, Starzl thought of using chimpanzees since their organs are of similar size and they have compatible blood types with humans. But chimpanzees are listed as an endangered species and so, Starzl went with the next best thing, baboons. Baboons have a similar body size to humans, but due to their infrequency of blood group O (the universal donor), their long gestational period, and few offspring, they are not ideal candidates. In addition, since primates are so closely related to us, there is an increased risk of disease transmission. For the six patients in 1963, none of this mattered anyway. Due to the lack of successful anti-rejection drugs at the time, the patients only survived between 19 and 98 days after surgery.

Despite the lack of success in transplanting baboon kidneys, doctors did not stop trying. A year later, chimpanzee kidneys were transplanted into 12 patients in New Orleans. Most patients died soon after but one survived nine months with no signs of rejection. This small “success” allowed surgeons to go further, this time transplanting a chimpanzee heart into a 68-year-old male, who only survived for a mere two hours. Five years later, in 1969, while Buzz Aldrin was walking on the moon and Jimi Hendrix was rocking Woodstock, a little child received a liver transplant from a chimpanzee. The child only survived one day.

The most famous xenotransplantation occurred in 1984. The Baby Fae case sparked an international debate on the ethical use of xenotransplantation. Stephanie Fae Beauclair, better known as Baby Fae, was an American infant born in 1984 with hypoplastic left heart syndrome. She became the first infant subject of a xenotransplant procedure, receiving the heart of a baboon. The procedure, performed by Leonard L. Bailey at Loma Linda University Medical Center, initially appeared to be successful, but Fae died 21 days later of a kidney infection. Despite the constant failure of using primates in surgery, doctors continued to research the subject. In 1992, the most successful case of xenotransplantation occurred, when a four-drug cocktail assisted a baboon liver transplant. The patient died 71 days later of a brain hemorrhage, which was unrelated to the typical rejection seen in cross-species transplantation.

Recently, scientists have switched gears and decided that pigs would be the best candidates for organ donation. Pigs are dirty animals, wallowing in filth, and so I can’t say I agree with them. They also aren’t kosher but Jewish law does allow them to be used for organ donation*. Scientists believe that due to their genetic distance from humans, pigs are less likely to pass on their diseases to immuno-compromised individuals. They are also readily available and their organs are comparable in size to humans. Therefore in 1992, a pig liver was implanted next to a patient’s liver in order to buy time for a human organ to be found. The patient died 32 hours later. I can’t imagine what your MELD score must be in order to warrant getting a pig’s liver, especially with the fear of swine flu. In fact, the only successful xenotransplantation to ever occur was in 1993 to a man named Adam…The movie was Untamed Heart and Adam was played by Christian Slater.

Aviva and I once had a turtle. We had to feed it live fish, change the water in its tank weekly, and watch while it did absolutely nothing to entertain us. Eventually, the responsibility and burden became so big that we set it free in the Raritan River. That responsibility becomes exponentially greater when the animal you need to take care of is actually inside of you. One day my kids will ask me for a pet. A dog or a cat, hopefully fish. I’m hoping that on that day I’ll be able to tell them that the only way they’ll be getting an animal is if the doctors put one inside their daddy.

*I am not kidding. Organ donation from a pig is a contemporary halachic issue. Rabbi Mordechai Halperin, M.D., the Chief Officer of Medical Ethics for the Israeli Ministry of Health, answers the question: “As long as transgenic pigs are created for medical purposes only, there is no prohibition against performing organ transplants from them.”