McCann’s essay is an account of his experience of liver transplantation. It describes his physical and psychic experience of liver failure while waiting on the list for an available organ, his experience in the hospital when the procedure was done, and the aftermath, in which he makes conceptual and emotional adjustments.


Richard McCann's beautifully written essay does many things within a few pages. It questions the degree to which the self is composed of the body, particularly the body one was born with, and how receiving a transplant changes the sense of oneself. It explores the role of memory in our conceptual compositions of our selves by describing the intense nostalgia for the bodily experience of childhood that he feels after the transplantation. It illustrates the relational nature of the illness experience in giving an account not only of McCann's liver failure and transplant but also his aging mother's dementia and by relating his experience as a transplant recipient to the losses of friends he endured through the U.S. AIDS crises.

McCann's essay offers an understanding of the way that medical treatment, as well as illness, can alienate a person from what is presumed to be health and normalcy. The author describes a conversation with a fellow passenger on an airplane, which began with that social act that defines the experience of so many who are visibly ill or disabled--staring. When the passenger sitting next to McCann stares at him while he takes the handful of immunosuppressants necessary to keep his body from rejecting his new liver, McCann feels disassociated by the experience: "I felt my own sudden strangeness, even to myself, as if I were a distinct biological phenomenon." As so many who are visibly atypical must do, McCann eases the starer's discomfort by explaining his situation, to which his seatmate responds by asking inappropriate questions about the donor's ethnicity and about the use of animal organs in transplantation, further illustrating how, as with ethnicity and disability, illness is often categorized as deviant rather than simply different in our society.

Unlike the multitude of first-person narratives that one finds on transplantation websites, all of which seem to participate in a single overarching narrative of recovery through transplantation, McCann's narrative examines and critiques those very conventions of storytelling. While he wanted the transplantation to be a happy ending, it was not. He became ill again: "The story wasn't over." His body and his story resist the convention of recovery and resolution that narrative often confers on the experience of illness, increasing the suffering of those who are unable to recover. McCann continues to struggle with the disease that led to his liver's failure. For many who receive transplants, illness recurs or the body rejects the new organ. These common developments clash with the story of a happy ending thanks to the miracle of medicine, and organ recipients often suffer not only the recurrence of illness but also a heavy burden of guilt for having rejected what had been given to them by a grieving family, the opportunity to keep alive some part of someone who had died.

McCann's essay describes emotional responses particular to those involved with organ donation, such as the disturbing metaphorical force of having part of that person's body implanted within one's own. He explains the transplant recipient's desire to make sense of this procedure through communication with the donor's family, as well as the donor family reaching out to the recipient as a way of dealing with their loss. He also describes the guilt many transplant recipients experience, knowing that one's own survival comes at the expense of another's death. While he fully comprehends that he is in no way responsible for that death, the troubling awareness of the loss that is necessary for him to live suggests his relation to the nineteenth-century grave robber who sold corpses to physicians for dissection: the resurrectionist.

McCann's narrative interrogates the logic--driven by the need for organs and by biomedical discourse's tendency to reduce people to physiology and disease states--that separates organs from bodies, presenting them as parts necessary for repairs "that one could airlift a great distance in an Igloo cooler marked HUMAN HEART or HUMAN EYES" (104). He protests this commodification of the body by conjuring up the distinct identity of the donor and her or his place within a social network. He connects the guilt he feels about taking something so precious from this fully imagined donor to the seriousness of his own bodily need, describing in detail what he suffered as he edged toward death from liver failure.

McCann's essay crystallizes the awful paradox of medicine, its ability to heal and the threat that it will harm in the name of healing. McCann does not directly address questions about the real and potential harms of transplantation, such as vulnerable populations selling organs and tissues on black or in legal markets or the degree to which the dignity of death and grieving is disrupted by the transplant team's objective of procurement. However, his essay makes it possible, and in fact necessary, to comprehend both the need of the donor and the potential harms of donation simultaneously.


Robert Atwan was the Best American Essays series editor.

Primary Source

Best American Essays 2000


Houghton Mifflin

Place Published





Alan Lightman

Page Count