Thomas E. Starzl. 440 pages. Pittsburgh, Pennsylvania: University of Pittsburgh Press; 1992. $24.95.

Organ transplantation is one of the great medical advances of our era. The simplistic notion of treating organ failure by introducing new body parts was made possible only by communities of immunologists, surgeons, and medical subspecialists working together to solve the formidable problems of organ procurement and rejection and to address related issues of ethics, societal costs, and funding priorities. Few aspects of modern medicine touch so many areas. Few have been so visible to the public, and few have aroused so much emotion among both professional and lay sectors—the heartfelt television pleas for organ donors for dying children, alleged black markets for organs abroad, competition among scientists and institutions for scarce federal grant funds, arguments about costs and benefits of transplantation in times of limited resources, ethics of couples having children as potential donors for ill siblings, definitions of death, and transplanting animal organs in humans.

No physician in recent memory has been more closely identified with the evolution of transplantation than Dr. Thomas E. Starzl, the author of this interesting memoir. Starzl's autobiography reflects the man, the events, and the era. Many of his recollections are fascinating—his not being offered the Hopkins chief surgical residency position, his brilliant performance on the oral surgical board examination, his fear of surgery, and his meeting Winston Churchill when the "Iron Curtain" speech was delivered in 1948. Other comments provided insights into his role in the development of clinical renal, liver, and other organ transplantation and of the necessary immunosuppressive therapy. By reading of his interactions with other leading physicians, surgeons, and government figures during these times, we learn his perspectives on the controversies and jealousies surrounding clinical transplantation and his own career activities.

What comes across is a portrait of a man capable of prodigious and often brilliant work. His seminal contributions to the understanding of the physiology of the transplanted liver and his major role in the development of renal and hepatic transplantation as clinical entities are vividly portrayed. He provides excellent discourses on his views of the ethics of clinical trials in transplant patients (which have engendered considerable controversy), and he generously shares credit for his accomplishments with his many students, fellows, and colleagues and with others in the field.

Starzl is least effective in communicating his feelings. He provides several mawkish vignettes about patients, and his few references to his family are awkwardly presented. His portrayals of other people who have affected his life are uneven, ranging from almost fawning admiration to deep insightfulness.

All this makes for a book that is of interest to certain audiences. The press liked this book, calling it "well-crafted" (Kirkus Reviews), noting the author's "flair for clean, vivid writing" (New York Times), and terming it "frank and fascinating" (Booklist) and "powerful, poignant, deft" (Publishers Weekly). Although we both enjoyed the book, our impressions are somewhat different—one of us quite enthusiastic, the other more restrained. The style is occasionally uneven, more suitable in some places for the lay public and in others for scientists. The views are strong, biased, and sometimes arrogant; but, after all, that is the man and this is his story.