Giving the greatest gift of all

It Could be you. It could have been you. Except that, if it had been you, you wouldn't have known about it.

I don't know about it either. All I know is that an old friend has just been miraculously, and, God willing, lastingly restored to life from near- death by a clever surgeon called Heaton - a man my own age, but with something in his eyes which you cannot see in mine - at an over-stretched NHS hospital in slightly run-down part of south London, which nevertheless manages to be one of the world's great centres of excellence.

Somebody died. I don't know who they were or how they died, but I do know that in one of the few entirely selfless acts of generosity available to us (since none of us will be around to see the relief and gratitude of our beneficiaries) this person donated his body into the control of Mr Heaton and his colleagues. They removed his (or maybe her; I don't know) liver and, with eight hours of meticulous, painstaking and physically gruelling work, gave it to my old friend. He can breathe properly now.

His belly is no longer swollen. His skin is pink, not gamboge yellow. He can eat. He can live.

Another friend worked there once, in the Liver Failure Unit. Exhilarating work, he said, because the science of it all was coming on in great leaps. People who would have died, now lived. But there were awful things, too. The worst, he said, were the young women. Trouble with the boyfriend, usually. They reached for the paracetamol, took an over- dose: not much, 10 grammes or so, enough to show they were serious but not enough to die. They didn't want to die, he said. They wanted to be loved. Parasuicide.

So they would be brought in, unconscious, yellow, dying. David and his colleagues would bring them round. The parents would be there; the boyfriend too, usually. The girl would be sitting up in bed, tearful, so sorry, she didn't mean, never really wanted to, thank God she had survived and she would never ever do it again. Ever.

That was the bad part. Because someone had to explain that she had perhaps 24 hours to live. They had brought her round but the damage done to her liver by the paracetamol was catastrophic and irreversible. It was all over. Dead Man Walking; Dead Girl Weeping.

"You'd get hardened to it, though," I said.

"Not to them," he said. "They're so ... "

We looked at each other, ashamed of ourselves for feeling that the death of a young, pretty, sad, hopeful girl should be somehow so much worse than that of an old man, somebody ugly, a dullard. But it wasn't a thought. It was an instinct, something ageless and reptilian and we knew in our bones it was true.

But there's nothing in our bones to tell us how to feel about donors. I have seen them. They lie there, warm, in the institutionalised compassion of the intensive care unit, washed up there like wrack on a catastrophic tide: a subarachnoid haemorrhage, perhaps, or the screech of brakes too late on a wet road, and now there's only the soft grief of the family, the brisk kindnesses of the ITU nurse, the hussssh-click of the respirator, water running and the faint bitter smell of hibitane hand-wash as someone enters the ward. Murmuring voices at the nurses' station, a grumbling registrar, eyes like bruises in his fatigue-grey face. Occasionally an alarm goes off but it's not like the films; it's silenced immediately, and the cause attended to. The family waits. Soon Mr Heaton will come in with the team and take him (or her) away, but if they come now it will be too late, and if they never come it will still be too soon. The person they loved is still here but has already gone; the end has already come, and now they wait for it to come again.

And the other family, the other friends, waiting with the dying one who will receive the donor's last gift. They don't want to know, don't want to think about it, have fallen into the old theological conundrum of warfare: can I pray for the bomb not to fall on me, knowing that means it will fall on someone else? The only comfort is that the sacrifice wasn't voluntary; he made his (or her) testament in the hope that it would never be executed, never believing that it would happen, not to him, not to her. We have no ability to imagine things turning out so desperately badly, for the good reason that our very existence proves that, up to now, things have always turned out okay.

I remember sitting in the Groucho Club talking to Jeffrey Bernard one evening. He said he had just been in hospital next to a man who had had a heart transplant. Fretting about the philosophical implications, unable to sleep, Mr Bernard wandered down to the porters' cubby-hole for a fag and a cup of tea. "I wonder what it must be like," he mused, "waking up with someone else's organ throbbing away inside your body." "Easy, Jeff," said the porter; "just ask any woman."

That way, sanity lies: just be philosophical and don't think about it. My friend has already banished it from his mind. He just says to himself: I feel much better; I hope it lasts. But for the rest of us, it's more difficult. What sort of life had to end before my friend could start to live again? Was the donor a man? A woman? How old? What did they do? Did they like croissants for breakfast, enjoy making love, see their life as a failure, hope for the future, wish for an end? Did they polish the car on the day it killed them? Did it hurt, at the end? Had they ever written a book, planted a tree, wept over a Brahms symphony, had a religious vision, eaten snails, held a newborn baby, licked their lover all over, stolen money, owned a kangaroo-hide stock-whip, had their pocket picked, sung in public, declared all the love they had to declare? And what duty do we owe them, to carry on the imagined life they may have lived?

All we know is that, whatever else they did, they saved a life. So perhaps all my friend's duty is therefore to live that life. Perhaps that's true for all of us. You don't have to have a transplant for that to make sense. !

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