Soon after arriving at his parents' home in Ruifang, his cell phone rang. The caller informed him, "Dr. Li, the family of a patient who is brain-dead from an automobile accident has agreed to donate his organs. We need you back here to prepare for surgery as soon as possible." As soon as he ended the call, Dr. Li knew that his family reunion would have to wait. Saying quick goodbyes to everyone, he left the house without delay and caught the next train for Hualien.

Once in Hualien, he harvested the donated kidneys and transplanted them into two separate recipients. The three operations took him well into New Year's Day. Only after making sure that the recipients were recovering normally did he take the train back to Ruifang. "We can't predict when we will have an organ donor. As the sole organ transplant surgeon in eastern Taiwan, I always have to be on-call. This is the duty that heaven gave me."

The transplant team

Dr. Li graduated from Taipei Medical University in 1991 and went on to complete his residency at Hualien Tzu Chi Medical Center. During this time, he became very interested in vascular surgery. He felt particularly sorry for patients suffering the side effects of blood dialysis, and he wanted to do something to give them a ray of hope. Consequently, he became one of the founders of the first organ transplant team established at Hualien Tzu Chi Medical Center in 1995.

In the second half of 1996, Li studied under Professor Li Bo-huang at National Taiwan University Hospital to learn how to transplant kidneys. In addition to acquiring actual surgical techniques, he also learned about patient selection, post-operative care, and medication.

In April 1997, Li performed the first kidney transplant at Hualien Tzu Chi Medical Center. As the lead surgeon for the transplant, he was anxious and excited all at once. As a precaution, he invited Drs. Hu Rui-heng and Cai Meng-kun from National Taiwan University Hospital to oversee the operations, but with Li's excellent skills, the operations went very smoothly. "After the surgery, I stayed up all night in the physician's duty room just to be close to the patients," Li recalls. Soon the patients were able to urinate on their own, an indication that the operations were successful.

The successful outcome of his first kidney transplant gave Li a big boost of confidence in his surgical talents. A week later he completed, unassisted, another nearly perfect kidney transplant. After these operations, he was more convinced than ever before that he had chosen "the right path."

In September 1997, Hualien Tzu Chi Medical Center sent Li to study at the University of Pittsburgh Medical Center. He studied under Professor Thomas E. Starzl, who had performed the world’s first liver transplant. In addition to clinical responsibilities, Li performed lab work and harvested organs from deceased organ donors. Studying in the United States, Li was in a unique position to compare the organ donation networks of the United States and Taiwan. "The network for organ donations in the United States is very well developed. The safekeeping, utilization, and distribution of organs are very efficient and fair," he observed. On the other hand, until just recently, patients in Taiwan suffered from the lack of such an extensive and efficient organ donation network. In the past, many recipients died while waiting for organs, even at the same time that many donated organs were being harvested. Fortunately, the Department of Health has recently established an Organ Donation and Transplant Registry. This is a huge step in the right direction that will greatly enrich the transplant environment in Taiwan.

A big test

In 2003, after having transplanted many kidneys, Li successfully completed his first liver transplant. "I did it!" he elatedly told Dr. Chien Sou-hsin (簡守信), the transplant team leader at the time (now deputy superintendent of Dalin Tzu Chi Medical Center).

"I'd like to thank the Hualien Tzu Chi Medical Center for sending me to study abroad, for giving me opportunities and a wonderful environment in which to work, and for supplying me with funds and equipment," Li exclaimed with gratitude. "This hospital is a very special place. As long as the physicians are willing, the hospital administration will do everything possible to accommodate their needs. It also has loads of genuine human warmth. The patients are the ones that benefit from all this. Saving lives is the highest priority here."

Although his first liver transplant went smoothly, he faced a daunting challenge while performing his second one. It began one afternoon in May 2003. At slightly past four, he received word of a brain-dead organ donor in Taidong, south of Hualien. Under pressure to act before the organs deteriorated, he quickly assembled a team to travel to the city to harvest the organs. It was three o'clock in the morning by the time the team returned to the hospital in Hualien with the harvested organs. Despite the late hour, Li immediately checked with a patient in need of a liver to confirm if he was still willing to proceed with the transplant. Finding the patient ready and willing, Li prepared for surgery. At 7:00 that morning, Mr. Chang, the patient, was wheeled into the operating room.

"Once we were deep inside Mr. Chang, we discovered that he had too many blood clots in his vessels to remove [making the vessels unsuitable to connect to the new liver.] What could we do? Despite the most precise and exhaustive pre-op evaluations and plans, there are always last minute surprises. A failure to connect the blood vessels to the organ, or even an insufficient blood flow, could have resulted in the rejection of the new liver and the death of the patient. It was a moment of life or death."

"The transplant team froze there for half an hour as they debated the best way to proceed," Li recalled. "The portal vein of the new liver needed to be connected to that of the liver recipient. We couldn't even find or establish a viable portal vein on the recipient. How could we possibly transplant the liver?" To work around this seemingly insurmountable challenge, the team searched elsewhere for a creative solution. Finally, they found a collateral vein near the spleen that could be used in place of the patient's useless portal vein. Thrilled with a surgical option that might save the donated liver and Mr. Chang's life, Li cut the collateral vein from the spleen and quickly sutured it to the portal vein of the liver. The surgical team heaved a collective sigh of relief as a torrent of blood gushed into the organ.

Once the donated liver was successfully transplanted, the surgical team had to then overcome new challenges created by removing the collateral vein by the spleen. Overall, it took 14 hours to complete the transplant and related operations. After over 30 stressful hours since the initial phone call, Li was physically and mentally exhausted. However, he did not leave for home until after the patient had come out of the effects of the anesthesia, several hours later. Except for making his required rounds at the hospital, Li stayed home and slept for the next three days.

"I am thankful that I came across such a challenging case. It taught us that it is necessary to do an MRI scan in addition to a CT scan. We must be more thoroughly prepared for future cases," Li said. "We must have a Plan B to handle every eventuality."

An impossible record

Dr. Li accepts challenges that are both highly technical and physically demanding. He seems to break his own records right and left. "I strive to learn new things to help even more patients. I hope to do more to relieve patients of their pain and suffering. In the past, a transplant project typically involved harvesting and implanting one organ. But we have become more efficient. For example, in 2003, an employee at Tzu Chi Middle School donated all of his organs upon his death in an automobile accident. Segments of bone were harvested by the Orthopedic Department, and I harvested his liver and kidneys. After obtaining the organs, I implanted the liver and one kidney into two recipients. The second kidney was sent to Dalin Tzu Chi Medical Center for a patient there. That was three operations in a row."

That record did not stand for long, however. In 2004, Mrs. Ruan, a Vietnamese woman living in Taiwan, was declared brain dead after an automobile accident. Overcoming his extreme grief, her husband agreed to donate her organs. Li harvested Mrs. Ruan's organs, and within hours he transplanted her liver and kidneys into three separate recipients, setting an "impossible" record of four consecutive operations.

These lengthy surgical sessions easily last more than 24 hours. Although Li is in his prime, not yet 40 years old, he is nonetheless thoroughly exhausted after such marathon surgical sessions. "These records indicate not my abilities but my perseverance, necessitated by the urgency so inherent in organ transplants. Patients are desperately waiting. How can I rest?"

Fortunately, relief is on the way. Dr. Chen Jing-liang, a member of the first graduating class of Tzu Chi Medical College and now a fourth-year resident in urology, said, "Two of Dr. Li's former students, Dr. He Guan-jin, now in Japan, and Dr. Wu Zhe-xun, at National Taiwan University, are training for organ transplants. When each of them is able to take full charge, 'The Boss' will be able to take a well-deserved breather."

Like a religious belief

Chen Jing-liang and members of the transplant team often refer to Li as "the Boss." It is a nickname given in admiration, not resentment. Chen fondly recalls that during his days as an intern with Li, the Boss was a charming physician, popular with students. "Wearing his black-rimmed glasses, Li seemed cool. But when he operated on patients, his eyes were focused and confident. He radiated a calming aura."

"Being on Li's surgery team is like traveling with him," Chen continued. "The first incision signals the departure of the train. Li's scalpel is precise, unobstructed and quick, like smoothly flowing water. When he sutures the incisions towards the end of an operation, it feels like the train is approaching its destination. Team members begin to relax and kid around with him. He's actually pretty fun to be around. He's a wonderful, poker-faced joke teller."

However, Li is also known for his quick temper. Oftentimes, people can hear him yelling in the operating room. According to Chen, "When others can't keep up with his quick pace, he lets them have it." Occasionally, he even personally demonstrates to the nurses how to handle an instrument: "Hold--it--like--this!"

Chen has been on the receiving end of Li's scolding too, but he accepts the occasional reproach without resentment. Chen knows that he is fortunate to have such a wonderful teacher, and he admits that Li directs his admonitions toward the mistakes, not the people making them. He never makes personal attacks. "He demands a lot of himself before he demands a lot of his students."

Li holds clinics two days a week. Specialist nurse Zhou Gui-jun reports, "The Boss makes his rounds, no matter how busy he is, even on some holidays. He also personally dresses the wounds for some of his more problematic patients." The feedback from patients and the support from their families are the main source of strength that has kept him going without complaints and regrets.

The rest of his time is reserved for operations, between 60 and 80 general operations per month. Whenever an organ donor emerges, Dr. Li rushes to harvest and implant the organs while they are still viable. Although the consecutive operations typically last 20 to 30 hours, he has no complaints. "The conditions of the patients keep deteriorating. They can't wait, so I can't wait. If I don't do it, who will? Of course, I get very tired. But performing an operation is like a religious belief. I can't explain it, but I have to follow it."

From adversaries to advocates

In September 2001, the transplant team began recruiting for a coordinating therapist. Shi Ming-hui, then working in the Surgical ICU, expressed an interest in the position. She was married and longed for a job with regular hours. Even so, Shi's interest left many of her colleagues perplexed and worried. Referring to Li's quick temper, they asked her if she was out of her mind.

Shi understood her friends' concern. She had previously worked with and been scolded by Li. But she also knew that his temper was strictly non-personal and did not linger for long. She knew she could deal with it, and she accepted the position when it was offered to her. Now, more than three years later, the two of them get along and work well together.

Social worker Chang Mei-ru can offer a similar story. Her role on the transplant team was to work with the family of a potential organ donor, and she initially had a difficult time working with Li. Dealing with grieving families, Chang had to be very sensitive when discussing organ donation. She knew the subject had to be brought up in the right way and at the right time. Dr. Li, on the other hand, often rushed Chang to get a decision from the family as soon as possible. He was very impatient with Chang's approach.

One day the two of them taught at a basic training class offered by the Organ Donor Registry in Taidong. Chang discussed the nature of her work and the difficulties encountered in her role as a donor recruiter. In Li's presence, Chang told the audience, "I used to dislike Dr. Li quite a lot, because he didn't at all understand the difficulties I was facing." People giggled. Moments later Li took the stage and said, "Heaven is fair: I used to dislike Chang Mei-ru because she didn't understand my problems either." Chang and the audience burst into laughter, melting away any remaining misunderstanding between the two.

Li, Chang, and Shi all work together in the organ donation process. Now that they can understand each other, their working relationship is smoother. In fact, Chang and Shi concur that Li's temper has improved over time. Like the spokes of a wheel, each plays a separate but necessary role in saving patients' lives through organ donation and transplantation.

A donor family's dilemma

As an organ transplant surgeon, Li demands speed: hurry up and, in the shortest possible time, persuade the family to agree to the organ donation. It was easy for him to forget how difficult it was for the family of an organ donor to make the decision. However, he experienced first-hand the agony associated with deciding whether or not to donate a patient's organs.

This chapter in Li's career began with a routine kidney transplant. Su Lian-sheng of Hualien County had been on dialysis for several years before Li transplanted a kidney for him. After the transplant, they developed a very close patient/physician relationship. Although the transplanted kidney functioned for five years, it was eventually rejected by the patient's body. Despite the disheartening outcome, Su and his family were still very grateful to Li.

In May 2004, Su's daughter, Xiu-wen, was involved in a severe car accident. She was taken to Hualien Tzu Chi Medical Center, but was pronounced brain dead upon arrival. A graduate of the Tzu Chi College of Nursing, Xiu-wen had been a nurse at the Fenglin Veteran's Hospital. A few days before the fateful accident, she had gotten in touch with Shi Ming-hui and Chang Mei-ru because a veteran's family had agreed to donate his organs. When she went home that night, Xiu-wen told her parents, "After death, a person's otherwise useless body can serve a meaningful purpose again via organ donation." Little did she know that a few days later, she would be in that very same situation herself.

Knowing Xiu-wen would want to donate her organs to help others, her parents felt obliged to honor her last wish. "If the doctors cannot save her, why don't we let her save others?" Su and his wife notified the transplant team of their daughter's last wish to donate her organs.

When Li heard the news of the accident, he was stunned. He went to the ICU to see Su Xiu-wen. Not able to contain his emotions, Li lamented to her parents: "How can this be? Maybe we should wait a bit longer to see if we can revive her. Maybe there will be a miracle." He dreaded the prospect of losing Xiu-wen as if she were a member of his own family.

"When the family of a brain-dead patient was facing the dilemma of whether to donate or not, I used to encourage the family to hurry to a decision lest the organs deteriorate beyond use. Amazingly, now I'm standing in the place of the grieving family, hoping that Xiu-wen hangs on to the thin thread of life and survives. And I don't even know her as well as her own family."

Xiu-wen eventually died. The transplant team managed to harvest her heart valves and bone segments. Her heart, liver, and kidneys had unfortunately deteriorated and could not be saved. Soon after, perhaps because of the good karma that Xiu-wen merited with her good intentions, Su received a well-matched kidney from another donor. Dr. Li transplanted a kidney into Su for the second time, making Su the first person in eastern Taiwan to ever receive two kidneys.

Su is a beneficiary, his life prolonged by other's organs. He in turn donated his daughter's organs to extend the lives of others. In the process, they have taught Li what it is like to have to make those difficult decisions.

Remembering Cai Hui-yi

The death of organ recipient Cai Hui-yi led Li to appreciate the limitations of his capabilities. "Although Hui-yi passed away, we are still very grateful to Dr. Li," Xu Li-qiong, Hui-yi's mother, said.

All three of Xu's children had problems with their kidneys. The eldest daughter, Hui-yi, started dialysis while in junior high school. The second daughter began dialysis in 2002, and the baby boy had also started taking medication to control his conditions. Xu recalls, "The girls went through a lot. During the time they were on dialysis, they each also had operations to remove their parathyroid glands and repair hernias. Dr. Li led all four operations. He is a superb surgeon, and he is kind and gentle. He treated us like his own family."

In July 2004, a nurse at the Dialysis Center called Xu: "We have a kidney match for Hui-yi. Would you like her to have a transplant?"

"Yes," Xu replied without hesitation, "I hope that Hui-yi will be free from the suffering of dialysis once she has a new kidney."

After the transplant surgery on July 8, Li said to Xu, "It went very smoothly." When she came out of anesthesia, Hui-yi cheerfully held up two fingers in a "V" sign and talked positively with the caregivers in the intensive care unit.

Unfortunately, Hui-yi took an unexpected turn for the worse. On the third day after the operation, she started to show signs of pneumonia. The disease progressed rapidly despite efforts to contain it. On day five, her heart began to fail. Despite all attempts to reverse her downward spiral, her condition continued to deteriorate. Heartbroken, Li informed Xu, "I'm sorry, but you need to expect the worst."

Xu asked her husband, who was working in Taichung, to hurry home. Not long after, with her parents standing at her bedside, Hui-yi left this world. Her parents wailed in grief. Xu embraced Dr. Li in tears and said, "I know that you have done your best, but Hui-yi's time in this world was up. Thank you all the same. Please cheer up and carry on. Another kidney recipient is awaiting your help. Go, Dr. Li, go."

Leniency and legacy

Hui-yi's parents donated her corneas. With the money her school collected for her funeral, they also established a scholarship for the poor. Li sent a cute stuffed Winnie-the-Pooh bear to be cremated with Hui-yi, something to accompany her forever.

Even with the full understanding and support of Hui-yi's family, Li almost collapsed from the grief he felt at Hui-yi's sudden passing. Several times, sitting in a quiet corner, he cried out of control. He repeatedly flashed back to the operation, stepping through the surgery in his mind, wondering to himself if it would have turned out better if he had reviewed and planned a little more carefully, tried a little harder, taken a different approach...

Totally dejected, he kept thinking about how the young girl had perished right before his eyes. Over 40 previous successful transplants had given him complete confidence in his abilities. During the surgery and for a couple of days afterward, everything seemed to be under perfect control. Why the unexpected and disastrous outcome? Li finally had to face the reality that a physician is not a god. This case taught him what fear is. This case taught him that even he was limited in what he could do for patients.

Some people suggested that Xu should sue Hualien Tzu Chi Medical Center and Li for compensation. Xu has adamantly declined such action. She says she knew that all operations carry some risks. "No doctor or hospital would intentionally kill a patient. If the doctors and the hospitals were sued for every unsatisfactory outcome, who would dare to be a physician?"

Xu reflects, "I know everybody loved Hui-yi and nobody had wanted this outcome. The nurse at the Dialysis Center blamed herself for suggesting the transplant. She felt that had she not called, none of this would have happened. Dr. Li also blames himself, and he couldn't get over Hui-yi's death for a long time. But all of this is unnecessary. I'm still grateful for their help."

As a volunteer fire fighter, Xu has seen her share of death, but now she fully understands the sadness of losing a loved one. She also understands the importance of organ donation. Since her daughter's passing, she has turned in her own organ donation card and introduced the concept of organ donation to her friends and relatives. She hopes that all of them will embrace organ donation and join in the efforts to promote it.

Recently, Xu returned to Hualien Tzu Chi Medical Center for an organ donation memorial concert. Three months had passed since the death of Hui-yi. At the hospital, she saw Li. Walking toward each other, they embraced in silence. Knowing what the other was going through, no words were even necessary.

The "alumni association"

Traveling southbound on Route 9 just past Shoufeng Road, one can see a sign for Fuli Fishermen's Village Restaurant. This day, few patrons are present; in fact, there are only four couples sitting and talking with one another. The couples are present for the same reason: a reunion of people who have received a new lease on life.

Chen Wei-liang, the restaurant proprietor, explains: "We're all organ recipients. Our organs all came from the same donor. So in our new lives, we're quadruplets!"

Chen suffered from liver cirrhosis and had received care at the Mennonite Christian Hospital for ten years. Due to his deteriorating condition, his physicians suggested that a liver transplant was the only option. Without a new liver, they gave him less than a year to live.

"I asked many physicians about the best place to have a liver transplant," said Chen. "They unanimously recommended Dr. Li Ming-zhe of Hualien Tzu Chi Medical Center. So, I become his patient."

In 2004, Chen got a call from Shi Ming-hui. She informed him that the transplant team had received a donated liver that matched his. Chen hurried to Hualien and asked Li what sort of side effects could be expected with a liver transplant. "The worst one is death on the operating table," Li answered bluntly. Only by such a direct answer could Li be certain of ascertaining the recipient's true intentions. His frank and straightforward answer actually helped Chen make up his mind. "I'll take a chance! Without a transplant, I have only one year left anyway," Chen reasoned. Moreover, Li conveyed a sense of full confidence.

Luckily for Chen, the surgery was a complete success and Chen recovered as predicted. Chen cherishes the fact that he is still alive. "I've got a new lease on life. I'm 'born again.' My thanks go to the donor, to Tzu Chi Hospital, and to Dr. Li."

Although some of the donor's organs were sent to other hospitals, three other patients at the hospital in Hualien also received organs from this donor. While hospitalized during post-op recovery, the four organ recipients developed a subtle, intimate, and close relationship. Given a new lease on life through the generosity of an anonymous donor, they became fast friends. They stayed in touch with one another after leaving the hospital, and even scheduled their follow-up appointments with Li for the same day. This allowed the group to meet at the hospital and share their experiences with each other. After each clinic visit, they and their families would oftentimes enjoy a meal together.

Needless to say, the transplant changed Chen's life. Soon after recovering, he joined Tzu Chi and now donates monthly to the foundation. He closed his Internet cafe and turned it into a computer classroom which he offers to local students as a learning laboratory. He is also planning a five-hectare ecological wildlife habitat. The transplant has also changed Chen's attitude about life. "I've gotten my second chance. My outlook on life is very different now. Making money is no longer my goal. Instead, I think about how to live this life to its fullest."

"He knows how to pay back to society," Li said of Chen, taking pride and comfort in this transplant success story.

All sorts of wild ideas

Li has transplanted more than 40 kidneys and six livers over the past eight years. He says that every transplant recipient becomes a part of his life.

"The post-op follow-ups cannot be taken lightly. A patient not only needs to come back for scheduled follow-ups, but also needs to notify me of major events, such as plans to become pregnant or even travel out of the country. I need to evaluate if the patient is up to the added burden, or if there is sufficient medication for the trip abroad. I also need to consider the weather and sanitary conditions at the intended destination, given the patient's condition."

Dr. Li is infamous for the stringent requirements that he places on his transplant patients. But he knows that a life is on the line; there is no room for mistakes or carelessness. On the other hand, he is famous for the tender loving care he shows to his patients. He likes to chat with them and tirelessly answers all kinds of questions from them.

Patients regard him as a friend and often bring local products as gifts when they return for follow-up visits. The true, unmasked graciousness from these unsophisticated country folks always warms his heart.

Li lists off some of the special gifts he has been given: farm-fresh corn, peanuts, pomelos, clams, shrimp, fish just out of patients' ponds, tea leaves, and lotus flowers. "A patient once told me that he could not afford a costly gift, but he was going to give me something 'better than anything else in the whole world.' He gave me some guavas that he planted himself. Bless his heart."

Li's "registered trademark" is his long, curly hair. One patient proffered her business card and said, "Come by the salon and I'll fix your hair, free of charge, of course!"

Another patient, Li Qiu-xiang, was diagnosed with terminal cancer three years after receiving a donated kidney. In her last moments before passing away, she asked to see her beloved physician. In a weak but clear voice, she told Li, "I am most grateful to you. Oh, I'd like to bother you with one more thing: please remove all my useable organs for those in need." With tears in his eyes, Li replied, "We'll meet again in the future." Li Qiu-xiang died the next morning. According to her last wishes, her corneas were donated.

Don't waste life

"When patients see the Boss, they seem to see a god--watever he says is like a royal decree," said Chen Jing-liang. But Li counters, "I am merely doing my job as a physician. Nothing more, nothing less than that. They should thank Master Cheng Yen, all the medical teams at Hualien Tzu Chi Medical Center, and especially all the organ donors and their families. Without them, there would be no organs, however skilled the physicians."

Some patients are afflicted by failing organs and can only survive with new ones. Unfortunately, organs are very scarce. Many patients die while waiting for a suitable organ. Li explains, "Currently, there are about 10,000 dialysis patients in Taiwan. This translates to a need of 8,000 donated kidneys a year. Unfortunately, we have only about 100 kidney donors a year. More proponents should band together to bring the concept of organ transplant to the forefront of public dialogue. We should also discourage people from going out of the country to obtain transplants."

In the United States, organ donors can indicate their wishes directly on their driver's license. Spain leads the world in popularity of organ donation, as every person that dies must either donate their organs or be autopsied. Corneas from donors in Sri Lanka are being donated to recipients all over the world. Li feels that Taiwan should make an effort to catch up with the progress in these countries.

With six successful liver transplants under his belt, Li can now apply for a permit to conduct living donor liver transplants. This will push organ transplants to a new height. "After a transplant, a patient is changed from being cared for to caring for others. The vitality in that family will reemerge, productivity will soar, and medical expenditures plummet. True to its original mission for building Hualien Tzu Chi Medical Center in eastern Taiwan, Tzu Chi is caring for many aborigines and low-income families. True to my own mission of studying medicine to help others, I am willing to devote my prime years to help the people of eastern Taiwan."

With a cool head, a warm heart, and consummate surgical skills, Li has used his scalpels to sculpt one loving tale after another. He is the life-giving benefactor of his organ patients. He is also the best witness to the selfless Great Love of those donors who gave up their organs in death to help others regain their lives.

Perhaps one day, hopefully soon, organ donations will become commonplace. People may or may not remember Dr. Li then, but no matter. What will matter is that there was an organ transplant pioneer at Tzu Chi Medical Center at Hualien, a pioneer that helped improve the lives of many patients and their families, a pioneer that helped improve the organ donation network in Taiwan. Through his surgeries, Li brought life to those facing certain death. Through those lives, Dr. Li Ming-zhe will be forever remembered as a hero.