A Little Victory over Death

Modern medical technology presents Christians with many questions. The fact that they are not only ethical, but profoundly personal and spiritual questions as well, came home to Robert Clouse three years ago when he elected to undergo a heart transplant. Clouse, professor of history at Indiana State University (Terre Haute, Ind.), is perhaps best known among evangelicals as editor of The Meaning of the Millennium (InterVarsity Press, 1977).

The following account was written with associate editor Rodney Clapp, who researched ethical concerns surrounding the transplant issue.

I wear a surgical mask in public. Some children, more candid than polite, stare at me. Once in a while one asks his embarrassed parent if I’m likely to hurt anybody. My wife, Bonnidell, joshes me: She says I must be careful not to wander into an unfamiliar bank with the mask on. But I feel a bit ornery now and then, so someday I may.

Other than the papery, yellow tissue across my mouth and nose, which I wear because of my increased susceptibility to infection, I don’t look so different. Due to the prescribed drugs I’m taking, my face is rounder than it once was. I’m a little hairier and no longer balding. But only my long-time friends would notice.

What is really different is underneath, unseen, quietly ticking. My heart is not the same one I was born with and that pumped blood through my body until I was a 53-year-old man. My new heart is two years old. Or should I say 32? The person who gave it to me was 30 when he died.

The History Of A Dream

Organ-transplant patients unsettle many people. A social-service worker at the hospital where I had my surgery tells me transplant patients have a hard time getting jobs, even job interviews. Potential employers fear these prospective employees may keel over upon hearing a difficult question. Or, as the social-service worker more colorfully puts it, “The interviewers can’t wait to get out of the room because they’re afraid the heart might fall out on their desk.”

I understand the uneasiness. I hardly thought twice about transplants until my life depended on one. Since then, of course, I’ve thought a good deal about them.

As a historian, I cannot avoid viewing the present from the perspective of the past. When I survey the parade of precedents to modern organ transplants, our contemporary uneasiness about transplants loses a little of its edge.

As early as 2000 B.C., surgeons attempted to graft skin from the neck or cheek to repair a mutilated nose, ear, or lip. In the third and fourth centuries A.D., there originated legends about the twin saints Cosmas and Damian. The pair was unusual in the annals of medical history, refusing to accept any fees (they were consequently beheaded). But even more unusual, and historically dubious, is the tradition that Cosmas and Damian amputated a cancerous leg and replaced it with the healthy limb of a person who had died earlier the same day.

The Middle Ages brought accounts, possibly with some basis in fact, of masters whose noses were replaced with those of their slaves. (Legend had it that the slave who sacrificed a nose must scrupulously be kept alive; if he was not, the transplanted nose would shrivel and drop off the master’s face.)

In the sixteenth century one Gasparo Tagliacozzi took nasal transplantation a step further. He reconstructed the nose with a flap of skin from the inner, upper arm of the patient. The arm was put in a cast and held to the face for two or three weeks, allowing the arm skin to affix itself to the face. Afterward Tagliacozzi would cut the skin away from the arm. Since all of this occurred without the benefit of anesthesia, it is little wonder that the procedure was basically unappreciated.

From the eighteenth century forward, medicine made rapid progress: methods of tying up weakened arteries were developed and perfected, along with aseptic (infection-free) surgery, anesthesia, blood and tissue-typing, and other medical advances essential to modern transplant technology.

And in the twentieth century, one step has rapidly followed another, like a toddler learning to walk who hurtles forward faster and faster to retain his balance:

• In 1913, Dr. Alexis Carrel transplanted a kidney from one cat to another; later he worked with Charles Lindbergh (following Lindbergh’s historic transatlantic flight) to develop a perfusion machine that drenched removed organs in blood and sustained their life.
• In 1954, Boston doctors successfully transplanted a kidney from one twin brother to another.
• In 1960, Sir Peter Brian Medawar won the Nobel Prize for his study of organ rejection, pinpointing parts of the immune system that attack transplanted tissue.
• In 1963, a Paris physician saved a man dying of leukemia with a total replacement of bone marrow; the year also marked the first successful liver transplant.
• In 1966, a Minnesota doctor successfully transplanted a kidney and pancreas into a 32-year-old woman.

• And in 1967, the South African surgeon Christian Barnard made history with the performance of the first human-to-human heart transplant (animal-to-human transplants were previously attempted).

Organ transplants are not yet commonplace. But in 1986 there were 8,800 kidney transplants (nearly twice the number in 1981), 1,300 heart transplants (three times the number in 1984), and 924 liver transplants (double the number in 1984). Survival rates have also briskly risen: 90 percent of kidney transplant patients now survive more than a year, as do 85 percent of heart-transplant patients and 65 percent of liver-transplant patients.

But these are just statistics. The fact is that each number represents a person: a man who has a family, a woman with friends and neighbors who call her by name, a child with a dog that greets her home from school. Each number represents a person who in an earlier time would certainly have died prematurely, but who today has a second chance. I am one of them. And I am grateful.

A Radical Step

In the 1983–84 school year I was visiting professor of evangelical Christianity at Juniata College, in Huntingdon, Pennsylvania. When I went to Juniata, I had been teaching at Indiana State for 21 years, and Bonnidell had been teaching educational psychology there for 17 years. We were excited about a change of place and pace.

The Pennsylvania fall was everything we could have expected. Juniata’s campus stands on steep, tree-blanketed hills. Walking to classrooms, glancing out the window while I lectured, hiking with Bonnidell in the evenings, I saw the foliage exploding in reds, oranges, and yellows. I felt alert and peppy, with nature rioting around me and the brisk air stirring my lungs.

Of course, fall has another side. Those beautiful leaves are not releasing their grip and drifting to the ground simply so poets can rhapsodize. Fall is a season of death. I never thought about that at the time.

But gradually Bonnidell and I realized something was wrong. First I couldn’t climb the hills without losing my breath. Soon I had to sit down to reserve enough energy to teach an entire period. Often I could not summon the strength to carry groceries inside the house. Trying to sleep, I would wake up short of breath. When Bonnidell hugged me, she heard rasping and gurgling noises inside my chest.

Finally, I visited a doctor. He told me I probably had a heart problem. But I knew most heart problems were caused by arterial constriction, which meant accompanying chest pains. And I had no pains; I just couldn’t breathe. I dismissed the small-town doctor’s diagnosis, but took his advice to have it checked out back in Indiana.

Over the Thanksgiving holidays, I consulted with our family physician in Terre Haute. He heard a description of my symptoms, took x-rays, and sent me immediately to a specialist in Indianapolis. On Thanksgiving Day, sitting in a hospital, I learned I had congestive cardiomyopathy.

Cardiomyopathy often is caused by an enigmatic virus that settles in the left heart muscle and deteriorates it. No one knows where the virus comes from or who is likely to catch it. But as a result of it, my heart was enlarged to two-and-one-half times its normal size. The amount of blood pumped into the aorta was diminished; that explained why I was so weak. And the right ventricle continued to pump blood into the pulmonary circulation; that explained why I had so much trouble catching my breath.

Neither Bonnidell nor I had spent much time in hospitals. I hadn’t even had a physical for 20 years. On top of that, I’m basically an optimist. We were told cardiomyopathy could not be conclusively treated: About one-third of its victims get better, one-third stay the same, and one-third get worse. So we took the huge doses of medicine the specialist prescribed and headed home, certain I would recover.

During the next year and a half, I spent most of my days on the couch. I could no longer climb stairs or lift anything weightier than a couple of books. I lectured sitting down. The doctors juggled drugs, trying to steady the condition. But it was out of control, headed downhill and gaining speed.

On the weekend of Memorial Day, 1985, I gained 30 pounds with water retention. My ankles and legs were swollen, my abdomen bulged tight as a drumskin. By this time I was tired of the entire, drawn-out struggle. I felt near death. Bonnidell later told me the life had left my eyes.

Then my cardiologist, who had earlier suggested a heart transplant, began to urge it in earnest. It seemed such a radical step that Bonnidell and I had not pursued it before. Now I found myself alone during long nights in a hospital room, praying and thinking.

Lonely Nights, Anxious Thoughts

Before and since those lonely nights in the hospital, I have given much thought to the ethics of organ transplantation. Most of my friends have supported my decision to have the transplant, but some have challenged it. One acquaintance told me he could not believe that I, a devout Christian, did not choose simply to die.

The issue revolves around our understanding of the whole person. For Christians, a person is not merely a disembodied soul or a soulless body: a person is a unity of both—an ensouled body or an embodied soul, as it has often been put. Moreover, our bodies (through skin, eyes, ears, noses) allow us to perceive God’s creation, to express ourselves to God and to other persons. And our bodies will themselves be resurrected.

But what does it do to the person—an embodied soul—if some body parts are replaced with those of another person?

In one sense, we have long been interchanging bodily parts and using artificial parts—to the point that we now do so without a second thought. Many of us wear glasses or dentures, for example, and do not consider it a moral issue when an amputee straps on a prosthetic leg. We donate blood and, when necessary, gratefully receive transfusions.

In fact, this unity of body and soul—the person—constantly shifts and changes. I change internally by reading different books, making new friends, or visiting a strange culture. Yet I continue to think of myself as the same person I was before I read those books, made those friends, or visited that country.

Similarly, my body is forever changing. Every seven years its entire cellular structure is revolutionized. My fingernails and toenails replace themselves. I lose hairs and grow new ones. My blood sugar content fluctuates. My stomach and intestinal contents are different after each meal or even each aspirin.

With soul and body, there is both change and consistency. We are persons who develop, but we each develop along lines consistent with our former personhood. The outlines of the body and soul demonstrate a basic continuity between what they were yesterday and what they will be tomorrow. Even at a twenty-fifth high school reunion we see similarities in the inner lives of our former classmates and the persons they are today. “Ah,” we say, “the same old Jack: still a card.” And we recognize (at least after introductions) the bodies of these old friends.

So it is, I think, that if a child’s tonsils or appendix were removed, no one would regard her as a lesser person than she was before the surgery. Nor do we look on a pregnant woman as a new and odd creature, although she carries within her a second heart, a second pair of kidneys, and other organs—all with a genetic makeup dissimilar to her own. Even the transplant of a mundane organ such as the kidney does not give most people second thoughts. But somehow the heart is different.

I suspect this is the case because the heart is noticeable. The kidney, the liver, and other unsung organs are the coal miners of the body, working unseen and unheard, little respected, and likely to be neglected. Not so the heart. With attention, we can sense its presence. It pounds against our rib cage to protest overexertion or fright. If the liver begins to fail, we won’t know until related problems are apparent. But if the heart drops its tempo, we head for the clinic straightaway.

The heart is also one of the body’s most glamorous organs. It, not the bladder, is what we write songs about and draw on valentines. And in the Bible, the heart is the symbolic center of body and soul. When persons harden their hearts, they have rejected God. They accept God with pure hearts, and are called to love God with all their hearts.

The heart’s conspicuousness and symbolic significance make it the organ that has most profoundly caused people to stop and think about the rightness or wrongness of organ transplants. As Christian ethicist Paul Ramsey puts it, we find ourselves musing, “What is man now that his heart has been reduced to a replaceable muscle?”

Yet we have known for a long time that feelings and the will do not literally reside there. The heart symbolically stands for the whole person, and the whole person remains even if he or she has altered some convictions or even the physical organ we call “heart.”

A new “replaceable muscle” beats in my chest. But I believe I love God with the same heart—that is, my consistent but developing core self—I did when I confessed Jesus as Lord 39 years ago.

Three Theological Considerations

So, alone in my hospital room and since, I have not found good reason to oppose organ transplants in general, and a heart transplant in particular. But I not only thought in my hospital room; I prayed. I won’t pretend to have come up with a neat, systematic answer during those anxious nights in Indianapolis. But meditating on it since, I can see that I was moved in favor of organ donation and transplantation by three strong theological rationale.

First, the “cultural mandate” of Genesis 1:28: “God blessed them and said to them, ‘Be fruitful and increase in number; fill the earth and subdue it” (NIV). Many theologians have understood this command to mean that humanity should explore, cultivate, and develop the resources of the Earth. They extend the mandate to include human existence, one aspect of God’s creation. As Anthony Hoekema writes, “Man is called by God to develop all the potentialities found in nature and in humankind as a whole. He must seek to develop not only agriculture, horticulture, and animal husbandry, but also science, technology, and art.” If Hoekema interprets fairly, organ transplantation is a legitimate extension of humanity’s mandate, the exercise of God-given creativity in the cultivation of natural potentials. We should oppose it no more than some of our ancestors should have opposed anesthesiology, saying God flatly willed men and women to suffer in surgery.

Second, organ donation and transplantation is highly Christian because Christians regard death as an enemy. In Paul’s words, it is the “last enemy” (1 Cor. 15:26). Although life is not the ultimate good—not in itself “sacred”—the biblical bias is emphatically on the side of life. The Bible tells us to “choose life” (Deut. 30:19), and that Jesus came so we might have eternal life (John 3:16). It is a deeply Christian deed, then, to stand against death wherever and whenever we can. Of course, Jesus alone gained the final, conclusive victory over death. But our little victories imitate his great victory in a significant provisional sense.

And third, organ transplantation echoes the example of Jesus Christ and his victory on the cross in another sense. He saved us from sin and death, after all, by offering up his body. Celebrating the Last Supper, we remember that we live because he gave his body and his blood. The Cross is the symbol of his self-giving, and when we choose to follow him we are called to make his Cross our own. There are few more dramatic ways we can give to someone else, in the spirit of that Cross, than to share our body and our blood.

Waiting For The Real Thing

However ethical I may have thought organ transplants to be, it was not an easy decision to go ahead with the operation. I knew I might well not survive the surgery. The medication required to avoid organ rejection after the surgery would have dangerous side effects, such as an increased likelihood of cancer. And the entire procedure in 1985 was costly—around $100,000. We certainly did not have the funds for it. (Today, heart-transplant costs average about $50,000. Uncomplicated cases average $30,000, comparable to the cost of heart-bypass surgery.) I learned that insurance companies had been sporadic in helping to pay for transplants, and I did not want Bonnidell saddled with an impossible debt.

Which was exactly what I told Dr. Harold Halbrook, the chief transplant surgeon at Indianapolis’s Methodist Hospital. Looking back, I think it a wonder that Halbrook did not leave me to die. But Methodist Hospital is unusual in the amount of funds it expends on patients who cannot pay, and Halbrook said he would only expect me to make an earnest effort to get my insurance company to handle the bill. On that basis, I agreed to be a candidate for a transplant.

I say “candidate” because the simple need for an organ does not guarantee your name will go on the waiting lists. There are psychological tests to be considered, as well as the condition of the rest of your body. It must be determined that you have no additional organ-system failure, infection, or malignancy—any of these factors might prevent long-term survival. And psychological stability is essential for enduring the stress of waiting for a donor, as well as complying with the post-transplant routine of medicine, diet, and exercise.

Maybe since my wife is an educational psychologist, I take the psychological concerns seriously. There have been cases of men getting worried and depressed after they learned they were carrying a heart transplanted from a woman. Bigoted people have worried they might be receiving a heart from a person of another race. And doctors have reported some patients wondering if the donor “had Jesus in his heart.” Emotional problems, of course, hardly increase the chances of survival for the transplant patient.

After interviews and extensive physical evaluations, I was accepted into the program. Then I rented a beeper, to wear day and night. Because an extracted heart will remain viable for only four hours, I had to be at Methodist Hospital, 70 miles from Terre Haute, within 90 minutes of my summons. If I could not make it, I was to stop and telephone the hospital, at which point a helicopter would be sent to pick me up.

The whole affair, then, had an air of extreme drama about it. For six tense weeks in the spring and summer of 1985, Bonnidell and I waited. My friends were alarmed at how weak I was becoming. Medicines turned my skin gray. Doctors told me my heart was circulating only eight cubic centimeters of blood with each beat; 50 is normal. One physician said he had never seen a man on his feet with so little blood flowing.

I was cold—most of the blood in my body, circulating so feebly, left the extremities to gather around and sustain the vital organs. In addition, my digestive system and bowels stopped functioning almost entirely. Whether or not I would survive until a new heart was available was very much an open question.

The beeper sounded false alarms twice. Once it was merely signalling a dead battery. It went off a second time when I was getting ready for bed. Sitting on the edge of my bed, I nervously dialed the hospital, only to learn that someone had called a wrong number. Bonnidell and I tried to fall asleep peacefully, knowing we were facing at least another day of waiting.

At last, on July 8, the beep was the real thing. When I called the Methodist Hospital hotline, an encouraging voice asked, “Dr. Clouse, how would you like a new heart?”

A Bramble Patch Of Questions

I know little about the young man who gave me a new heart. I only know that, on a summer day in 1985, something happened in Buffalo, New York, and a man was killed. He had a strong heart. Its tissue type was close to mine. He had formerly agreed to donate his organs, or his family agreed on his behalf after his death. Telephone calls were made; computer banks were searched. My name came up. And while I was driving from Terre Haute to Indianapolis, my new heart was airborne, winging halfway across the country.

I can’t say that they were prominently on my mind at the time, but the entire process raises a bramble patch of very pointed questions.

The first is the question of the death of the donor. The determination of death is no longer so simple a matter as placing a mirror under a person’s nostrils. Machines can now keep a body breathing and blood circulating for days (though not indefinitely), even when the brain is irreparably damaged and the body will never again breathe and circulate blood on its own. Hence the introduction of the notion of “brain death.”

The fear, of course, is that an organ donor will be pronounced brain dead prematurely, for the sake of an organ recipient. Many people who consider signing an organ-donor card admit to wondering, “What if I have an accident and it gets touchy? Will the doctors give up earlier when they know I’m an organ donor? Will they declare me brain dead when I’m not really dead, and remove a vital organ for a transplant?”

That fear is allayed when we understand exactly what brain death is. It is not a “persistent vegetative state” where only part of the brain is destroyed, but the incapacitation of the entire brain. Catholic ethicist John Dedek puts it well: “A flat EEG is not in itself the decisive element. No one is to be declared dead who still has the potency of spontaneous respiration. But one who has no hope of ever recovering the power of spontaneous respiration because of irreversible destruction of the brain is no longer a living being, even though his heart and lung functions are being mechanically maintained.”

Brain death, then, is not a word play enabling venal physicians to remove organs prematurely. It is the result of the necessary recognition that medical machinery can now preserve, as Paul Ramsey remarks, “the vitality of specific organs of an unburied corpse.”

The physicians struggle as valiantly as ever against death, whether or not the patient is a prospective organ donor. I have seen and heard my doctors, who have performed dozens of transplants, curse motorcycles as “murder cycles” and stalk away from the emergency room in depressed resignation. (Significantly, hospitals guard against even a hint of deaths prematurely declared; for example, doctors attending a potential organ recipient are never the same ones attending a possible organ donor.)

There is a second, and related, question: the question of organ procurement. The current U.S. policy for procuring organs is “express consent”: No organs are taken for transplantation unless the donor (or the donor’s family) has expressly donated them. Some ethicists and physicians, bemoaning the severe shortage of organs available for transplant, have argued for a policy of “presumed consent.” Under such a policy, organs could be taken for transplantation automatically, unless the deceased or the deceased’s family expressly forbid it. (This policy is already in effect in Denmark, France, Israel, Italy, Spain, and other countries.)

I personally favor express consent. Presumed consent smacks of statist coercion. It makes organ donation a matter of “societal taking” rather than “personal giving.” And in a way it weakens the case for organ transplants. It creates the impression that we cannot offer people persuasive reasons to donate their organs voluntarily.

The third question arising from the process that granted me a new heart is the question of allocation—how to determine who gets the scarce organs that are available. A fairly complicated set of criteria has developed. It includes the potential recipient’s age, emotional stability, physical condition, nearness to death, and tissue type. Most ethicists have argued, and rightly so, against making one’s estimated social worth a determining factor. We should also strictly prohibit any commercialization of the transplant process (though some have actually suggested organ donations might be used as partial payment of hospital bills or estate taxes).

As the system now stands, relatively wealthy people are more likely to receive transplants, since only they can afford them. (Although we can make allocation more just by altering insurance, Medicare, and other policies in a direction that would make transplants widely affordable.) However, laying aside the criteria determining the likelihood of survival, allocation should basically be a matter of first come, first served. In dealing with scarce resources, that is the way of a democracy. And as for the kingdom of God—there a poor man is no less valuable than a rich one.

Organ transplantation will increasingly confront us with these and other tough questions. For example, there is some pressure to introduce a new definition of death—“cognitive death”—for those in a persistent vegetative state. And some doctors favor exploiting the organs of anencephalic infants.

I cannot rest comfortably with such proposals. But as they are more intensely debated, it will be important to keep them separate from the legitimacy of organ transplants in general—just as we regard driving automobiles to be perfectly moral, even though they can be used to run down pedestrians or rob banks.

A Surgery Observed

Heart transplants, as I’ve said, are getting more and more common. But not too many people in Terre Haute, Indiana, have had them. So a local television station wanted to tape the surgery and televise parts of it. Since Bonnidell and I are educators, we agreed.

Only within the last year did I find it in myself to watch the videotape. On the tape I see myself reclining, in a blue gown, on a hospital bed. My thinning hair has fallen back off my forehead. Some of it rests across the white pillow. The camera does not capture my anxiety, really, or my weakness. But I do look tired. The reporter asks how I am feeling, then the top of a microphone appears in front of my face. With a wan, slightly raspy voice, I say that I am ready, that I am a little worried, but that “I have a lot of confidence in the surgeon.” I am a little self-conscious about this being on television, but I add, “And in God.”

Then follows several feet of tape depicting the preparation of the medical team. Eventually the camera catches me on a gurney, being wheeled through the halls. The gurney breaches and is engulfed by swinging doors. Bonnidell lingers behind, watching me disappear. She is not bent, but stands tall and confident. The reporter stops to offer a few encouraging words. Bonnidell smiles, but keeps glancing at the doors.

The scene changes, and we are in the middle of the operation. The camera gazes in wonder at all the equipment: tubes, pumps, panoplies of surgical instruments, monitors. My face, of course, is not visible. All that can be seen of me is a cavity in my chest, with several hands rummaging in it.

Soon the new heart is carried in, borne past the high-tech pumps and monitors in an ordinary picnic cooler. Watching now, I almost expect a surgeon to drop his instruments and exclaim, “Here’re the hot dogs!” Instead, someone removes the top and draws out the new organ, the one that today pounds inside my chest. It is in a plastic bag, dripping the cool solution that surrounded it. A nurse extracts the heart from the bag. It has a yellow cast in the lights.

The nurse holds the old heart, so large she must cradle it with both hands. The pitiful, faithful thing still quivers a little, reminding me of a marathon runner who has run past exhaustion and, lifted off the ground by those who assist him, uselessly churns his legs in the air.

Someone cups the new heart in the palm of one hand. It is membranous, slick, and, I imagine now with the pride of ownership, sleek. It is only 30 years old, and ready to take on a new challenge. It takes a stab at a few beats even as they sew it into my body.

Life After Transplant

It comes as a surprise to many people that, with most transplants, the surgery is far from the most tricky part. A heart transplant, for example, is technically a simpler operation than a heart bypass. In a transplant, the surgeon need only reconnect the large and manageable aortae; in a bypass the surgeon works with much smaller veins.

What has stymied and frustrated successful transplants is the body’s immune system, which attacks the alien tissue of the new organ. Dr. Frances Moore, a Harvard surgeon, compared the process to trying to make a ship without a bottom float with a cargo of cork. The ship will float if you can get the cargo in. The sensitive part is keeping it afloat until the cork is loaded.

Similarly, physicians caring for transplant patients must suppress the immune system enough that the new organ won’t be rejected, but not so much that the patient succumbs to a stray infection. The greatest advance in immunosuppression, so far, is the 1980 development of Cyclosporine.

Cyclosporine takes less of a scattergun approach than other immunosuppressive drugs, which basically depress the entire immune system. It targets T cells, the particular components of the immune system that attack alien tissue.

But Cyclosporine is only a piece of my daily regimen as an organ transplant recipient. Each day I take Tenormin and Apresoline to stabilize my blood pressure; Lasix, a diuretic; Persantine and Ascriptin, blood thinners thought to prevent or reduce chronic rejection as a result of coronary artery disease; Prednisone and Imuran (like Cyclosporine, immunosuppressants); and various ordinary medicines to settle a stomach that balks at being made into a portable pharmacy. My lifestyle must also include strict attention to health indicators. So every morning I weigh myself, take my pulse, temperature, and blood pressure. And three times a week I exercise by walking or bicycling.

My depressed immune system is why I wear a mask and frighten little kids. It is also why I got a terrible case of shingles, an ordeal more painful than the heart surgery and subsequent recovery; and why I have caught serious flu viruses—once a fever made my teeth chatter so severely that a filling cracked.

There are other prices an organ transplant recipient must pay. I have a strict diet to follow, and my life depends on it literally and immediately. Some of the drugs I take increase my chances of cancer or other health problems. And I may die at any time. My transplanted heart is not as predictable as a healthy, original organ.

But ask me if it was worth it and I don’t have to think about the answer. I preach every Sunday at the First (Grace) Brethren Church in nearby Clay City, Indiana. I’m finishing books and articles that otherwise would have remained unwritten. I’m still in the classroom—in fact, I was able not to miss a single semester—serving my life’s calling, with students I enjoy tremendously. (Shortly after the transplant, women students were showering me with sympathy kisses. “That’s all right,” Bonnidell said. “You look so beat up they know you’re harmless.”)

Another chance at work, though, isn’t the half of it. Getting out of bed in the morning is special. Every once in a while I pull off the shelf a book that’s been waiting a long time, crack it open, and realize: I almost didn’t get to read this one. I’m praying more intensely and learning about the spiritual qualities that truly matter—love, joy, patience, peace, and compassion. I’m more concerned with helping people out now, buying a gift for a friend or slipping money to someone in need. Out driving, I stop for a family on bicycles, mother and dad and little boys filing ragtag through the crosswalk. I revel in it.

The biomedical advances of the past two or three decades have given us all plenty of ethical headaches. But I’m here to tell you headaches are not the only things they bring.

Robert G. Clouse is editor, with his wife, Bonnidell, of the forthcoming Women in Christian Ministry: Four Views (InterVarsity).

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