24 THENEWYORKER,FEBRUARY28, 2022
hyperacutely rejected. The kidneys were
monitored for more than fifty hours,
after which the experiment ended.
“To do a trial in a living human, you
need to know that it’s reasonable to be-
lieve the trial will give the patient over
all a better outcome than not being in
the trial,” Montgomery said. People in
need of a kidney who are otherwise rel-
atively healthy have a decent chance of
receiving a human kidney; people less
likely to do well with a transplant are
lower on the list, but that also means
they are less likely to do well with an
experimental procedure, such as a pig-
kidney transplant. In the case of the
pig-heart transplant, the patient, David
Bennett, Sr., had been rejected by sev-
eral centers for a heart transplant, owing
in large part to a history of not being
good about taking medications—a ne-
cessity for transplant success. In the case
of a kidney transplant, many patients
can be sustained by dialysis, a misera-
ble but often effective treatment. Of the
pig-heart transplant, Montgomery said,
“It was stunning. It was incredibly in-
spiring and exciting, and my nieces and
kids called me. It was very personal in
that way.”
The fourth of four boys, Montgom-
ery was seen by his elementary-school
teachers as undisciplined and a slow
learner: “The nun called in my mom to
say she shouldn’t expect the same from
me as from my brothers.” He was also,
in his words, a magnet for wounded an-
imals. Robins, squirrels, beavers: he was
obsessed with trying to nurse creatures
back to health. One year, for Christmas,
an older brother gave him a box of min-
iature tombstones, “with the names of
all the creatures that had died under my
care.” His mother put him in a differ-
ent school, but still had him work with
some nuns, who offered therapy of a
sort. It was decided that the problem
was that he had been “a butt-scooter,”
he said. “I had never crawled. So these
nuns would get on the floor with me
and we would all crawl around.”
When he was fourteen, his father fell
very ill with heart troubles. The family
was told that the only thing that could
save him was a heart transplant—a new
procedure at the time—but that he was
too old (fifty!) to qualify. Montgomery
recalls doing his homework in his fa-
ther’s hospital room.
Montgomery eventually became a
better student (though, as far as I know,
no randomized-controlled trial exists
that can fairly assess the impact of the
crawling therapy). He attended medical
school at the University of Rochester,
and then started a surgical residency at
Johns Hopkins. In his first year there,
after his brother Richard died, Mont-
gomery arranged to have a colleague in
the pathology department of Hopkins
examine his brother’s heart. The col-
league detected familial dilated cardio-
myopathy, or FDC. One aspect of FDC
is sudden death; another is episodes of
ventricular tachycardia. Montgomery
began to wonder how he could continue
in the surgical field.
He wasn’t sick enough to qualify for
a heart transplant, but he had a de-
fibrillator put in. “It was just a dumb
box,” he said. If something sets the de-
fibrillator off, it administers a shock di-
rectly to the heart; the shock is so pow-
erful that the fear of it going off is too
much to bear, some patients have told
him, and they wanted theirs taken out.
Montgomery took a break after his
second year of residency to get a Ph.D.
in immunology at Oxford. He learned
to live with the Sword of Damocles,
and returned to his surgical training. “I
taught myself to stay calm,” he said.
“Let’s say I was going to give a talk in
front of people, I would think to my-
self, O.K., what’s the worst thing that
could happen? That would be dying—
that would be pretty bad. But every-
thing below dying began to seem not
so important. That produced a benev-
olent cycle, where I would perform bet-
ter because I was relaxed.”
Montgomery became a celebrated
transplant surgeon. At Johns Hopkins,
he was named the chief of transplant
surgery and directed the team that de-
veloped so-called domino kidney trans-
plants. A fellow-surgeon, Dorry Segev,
had studied computer science. One day,
Montgomery was looking at their white-
board of data on kidney patients and
donors, as a way of seeking out matches:
“I said, ‘There must be a better way to
do this.’ And Dorry said to me, ‘Of course
there is.’” That weekend, Segev and his
wife, Sommer Gentry, who was an M.I.T.
mathematician, wrote a computer pro-
gram, and, not long afterward, Hopkins
began lining up multiple surgeries in-stead of a single swap. Imagine you want
to donate a kidney to your partner, but
you’re not a match. In a domino trans-
plant, several partner donors donate, and
all the patients receive a kidney, but, for
purposes of matching, a donor’s kidney
goes to someone she doesn’t know, just
as her partner receives a kidney from
someone he doesn’t know. In 2009, the
Hopkins team did a twelve-person, mul-
tistate procedure, working in conjunc-
tion with hospitals in Oklahoma City
and St. Louis.
The team also helped expand the
pool of kidneys that would be consid-
ered viable for transplantation. “I had
this colleague, Niraj Desai, and he was
very early thinking about, What if we
used hep-C-positive kidneys?” Mont-
gomery recalled. Every year, hundreds
of organs were deemed unusable because
their donors had hepatitis C. “This was
when there was early treatment for hep C,
but it wasn’t very effective,” Montgom-
ery said. But, a couple of years later, an-
tiviral drugs were developed that could
cure hepatitis C. Desai’s idea had come
of age. A trial was conducted of patients
who would otherwise not have received
kidneys but who consented to receive
hep-C-positive organs, and were subse-
quently treated for hep C. Later, the trial
was expanded to hep-C-positive hearts.
Four years ago, Montgomery received a
hep-C-positive heart. “I think I was the
seventeenth patient in the trial,” he said.
“If I’m going to ask others to do it, I
have to be willing to do it myself.”
An unexpected reprieve from mor-
tality—the most poignant example of
this that comes to mind is the one in
which it is a pig whose life is indefinitely
spared. In “Charlotte’s Web,” by E. B.
White, Charlotte, a spider, makes Wil-
bur, the pig, more valuable to the farmer
as a beloved individual than as pork.
Charlotte, though, having completed
her egg sac, will die very soon, in the
natural cycle to which her species is con-
demned. She says to her friend:
Christmas will come, then the snows of
winter. You will live to enjoy the beauty of the
frozen world, for you mean a great deal to
Zuckerman and he will not harm you, ever.
Winter will pass, the days will lengthen, the
ice will melt in the pasture pond. The song
sparrow will return and sing, the frogs will
awake, the warm wind will blow again. All
these sights and sounds and smells will be yours
to enjoy, Wilbur.