Exchanging Hearts: A Medievalist Looks at Transplant Surgery

A new heart I will give you, and a new spirit I will put within you; and I will take out of your flesh the heart of stone and give you a heart of flesh.

–Ezekiel 36:26

We are members one of another.

–Ephesians 4:25

The exchange of hearts, a familiar motif in hagiography and romance, may seem one of the stranger marks of medieval alterity. Lyric poets routinely send their hearts questing after resistant ladies, who take the organ hostage with a kiss. When forced to separate, couples pledge their loyalty by exchanging hearts, which may come back to them with alarming literalism. Mystics—always female—offer their hearts to Jesus and receive his in return, sometimes entering his body through the bloody wound in his side. Jealous husbands kill and excoriate their wives’ paramours, feeding their hearts to the ladies in a secret cannibal feast. On autopsy, a lover’s heart reveals the name or image of the beloved or, mutatis mutandis, the tokens of Christ’s Passion.

Lovers no longer use these metaphors, nor do the devout. Yet, from one perspective, such narratives should be more intelligible today than ever before. Imagine what a medieval reader would have made of this tale. In 2004 a man named Sonny Graham, 65, of Hilton Head, South Carolina, married Cheryl Cottle, a widow thirty years his junior. Such unions, though rare, seldom make national headlines. This one did because in 1995, Sonny Graham had received the transplanted heart of Cheryl’s late husband, Terry Cottle. After four years of wedded bliss, Graham shot himself in the head and died—just as Terry Cottle had done thirteen years before.¹

In the three decades since modern transplants literalized the poetic metaphor of exchanging hearts, more and more such tales have emerged, to the consternation of surgeons. A 1999 study by Paul Pearsall and colleagues, published in the journal Integrative Medicine, describes ten cases of remarkable personality change among heart transplant recipients, as ascertained from interviews with patients, their families and friends, and donors’ families.² A middle-aged white factory worker, described by his wife as an Archie Bunker type, makes friends with his black colleagues and develops a passion for classical music. His donor, it turns out, was a young black man killed in a drive-by shooting en route to a violin lesson. A five-year-old boy, given a new heart in infancy, picks out his donor’s father in a crowd and runs up to him, calling “Daddy!” Another young boy with the heart of a drowned girl develops a sudden fear of water, which he always used to enjoy. A man with a woman’s heart becomes a better lover and experiences a newfound joy in shopping, while another develops a taste for perfumes and the color pink. A lesbian activist goes straight and gives up her favorite restaurant, McDonald’s, because the smell of meat now disgusts her. Her donor, a vegetarian and heterosexual, had run a health food restaurant. One of the case studies might have come straight from a medieval romance. An eighteen-year-old girl receives the heart of a boy her own age, a songwriter, killed in an auto accident. More than a year later, the boy’s parents discover that he had predicted his own death in a song titled “Danny, My Heart is Yours.” When the girl sees the boy’s picture, she recognizes in him the long-time lover who died to save her life: “I know he is in me and he is in love with me. He was always my lover, maybe in another time somewhere. How could he know years before he died that he would die and give his heart to me? How would he know my name is Danielle?”³

Personhood, Personality, and Transplants

Scientific responses to such anecdotes differ, to say the least. In the study just cited, the authors remark that all seventy-four patients in their sample “showed various degrees of changes that paralleled the personalities of their donors,” though not always as dramatically...