ASTS Chimera – Diane Mossholder Nothing to Confess by Donald Hricik, MD, Chief of the Division of Nephrology at Case Western Reserve University and Medical Director of Kidney and Pancreas Transplantation at Case Medical Center, tells a riveting story while touching on several issues relevant to the field of transplantation and modern medicine, most notably disease transmission through transplanted organs and tissue and the true cost of malpractice lawsuits to the institutions and individuals involved in them. The novel tells the story of an apparently healthy man who dies seemingly from a cocaine overdose and is evaluated as a donor by Lance Turner of the Ohio Organ Bank. After conversations with the patient’s girlfriend and mother, Turner approves the donor, whose heart, lungs, kidneys, pancreas, and liver are then transplanted into various patients. The joy of receiving this gift of life is poignantly conveyed through the story of a young man who receives a kidney. But when several of the recipients begin dying from a mysterious virus, the search for the cause begins. The identification of the virus and its likely origin then calls into question whether the donor evaluation was sound. The aftermath illustrates the extreme emotional toll that lawsuits can take on the defendants, including an interesting analysis of the total monetary cost of such suits and what that means for health-care costs in this country. ~ Diane Mossholder, ASTS Chimera -Spring 2013

A Review of Nothing to Confess (2013) Author: Donald Hricik Nothing to Confess is a work of fiction written by a practicing transplant doctor, Donald E. Hricik, MD, Professor of Medicine and Chief of the Division of Nephrology at Case Western Reserve University School of Medicine in Cleveland, Ohio, where he also serves as Medical Director of the Transplantation Service at the University Hospitals Case Medical Center. The result is that this book reads like a current real-life series of events, making for an exciting and sometimes scary read, a testimony to the story telling skills of the author. Given the author’s medical practice, and myself knowing much about the transplant community and workings, it was hard to separate fact from fiction in his writings, for as he cites in the back cover of the book, “His novels are fictional stories based on some harsh realities in the world of academic medicine.” What began as a “casual” reading quickly turned into a fast paced “page turner” resulting in missed daily to-do items replaced with a one day very enjoyable reading, so be forewarned. Come prepared for a back and forth in time story telling style that both makes for excitement and in my case, some frustration in keeping characters and time events in their proper place. Luckily, once begun, I couldn’t put the book down so they were fresh in my mind and easily recognized in their relationships. Let me put that compliment into better perspective. My original plan was to get around to reading this book in a few weeks, given I had several others ahead of it. Out of curiosity I opened and read the first few pages and that was like trying to eat just one cookie from the bag, and by day’s end I found myself not only finished the 228 page read, but picking up his earlier book, Racing to Pittsburgh, for another very enjoyable read while nothing else was getting done in my normally busy life. The scary part of the story is all about the very real possibility, but thankfully infrequent in life given all the safeguards and skills of the role players, of a disease being transmitted from an organ donor to the transplant recipients of those donated organs. The medical staff, especially the OPO (that’s “organ procurement Organization”) coordinator, each play critical roles in first recognizing the terrible events in play after multiple surgeries around the country turn bad over time and then dealing with the consequences once recognized. The detective work explains much of the organ donation/transplant process that is clearly based in fact, while adding the emotional dimensions in play with the characters affected by the tragic incidents that are so in contrast to the intentions of all involved of successful life saving procedures. Come prepared for an emotional roller coaster ride read, one that will entertain while also educating about the complex life and death process surrounding the modern miracle of organ donation and transplantation that is providing many years of life extension to patients who enter the system facing death and come out with hope and life with new and different challenges. Just remember, this is a novel, ever so well written by a gifted doctor/author. ~ Jim Gleason, UNOS Newsletter

Doctor Donald Hricik has written a novel that both entertains and educates. Nothing to Confess is a medicolegal thriller that takes the reader behind the scenes in the fascinating and complex world of organ transplantation. Hricik’s intimate knowledge of this world is palpable in his characters and their dramatic journey. ~ David Kerns MD, Author of , P:ersonal Communication

"Donald Hricik's second novel, Noving to Confess (like his first book, Racing to Pittsburgh) uses the setting of the transplant field to explore the human condition. In Nothing to Confess, seven patients with end stage organ disease: two with kidney failure, two with lung failure, one with heart failure, and one with liver failure, receive organs from a single donor in what they think will be the "Gift of Life", but then something goes wrong. In Nothing to Confess, Hricik, an academic transplant nephrologist and natural teacher, explores the complexities of organ donation and transplantation and uses his novel to educate his audience. He poignantly describes the emotional and financial toll on patients, their families, and caregivers when something unexpectedly goes wrong. Patients and family members are pressured to sue and caregivers are always vulnerable even when there is nothing to confess. I recommend this novel to all health care workers in the transplant field. This novel will be technically educational even for those within the field. More importantly, it will help them to understand their vulnerability and help them to cope when something unexpected does go wrong. I also recommend this for all medical students, residents, fellows and nursing students who have not yet completed their training. One is perhaps most idealistic at the end of training. In Nothing to Confess, Hricik paints a realistic picture that accurately captures the feelings and emotions caregivers feel the first time they have a claim or suit filed against them. The eduction is worth the read." ~ Daniel Brennan, MD, Medical Director Kidney Transplantation, Washington University, Personal communication

"The field of organ transplantation is a fast-moving and complex endeavor that involves hundreds of professionals. Organ donation significantly benefits the lives of thousands of patients each year. In his new novel, "Nothing to Confess", Dr. Donald Hricik, an internationally renowned transplant physician, successfully portrays the many facets of this field while telling an accurate and compelling story. This book will be a "page turner" for all who enjoy medical thrillers and is a must read for those who have any interest in organ transplantation." ~ James A. Schulak MD, Past President of the American Society of Transplant Surgeons, Personal communication