‘Organ donation can be incredibly positive - the one extraordinary thing that can come out of a terrible tragedy…’

Before opening the front cover of Rachel Clarke’s, The Story of a Heart - winner of the Women’s Prize for Non-Fiction 2025- I knew what the book was about, and I knew the ending. And yet it still captivated me. In essence, it is an account of two nine-year old children and the transplant of a heart, however the book contains much more than the journey of Keira’s heart into Max’s life. Just as a transplanted heart is sewn and carefully incorporated into its new donor home, Rachel Clarke stitches together the lives of all involved in the story of this heart; not only the children and their families, but doctors and nurses past and present, a scientific account of transplant surgery and intensive care, road safety in the UK, the pressures and triumphs of the NHS, and the symbolic ideas and imagery of the heart in human history. The Story of a Heart is an extraordinary book. It is both scientific and yet deeply person-centred. It is simultaneously an easy read and yet challenging. I found it intensely moving and yet educational. My pulse raced as I wondered will Max survive the wait for a heart. Will the operation be successful. The experience is, at times, as suspenseful as reading a thriller.

Clarke is a former journalist who trained as a specialist in palliative care. These two strikingly different knowledge bases weave together to give a solid foundation to the book. The sixteen pages of notes and references at the end of the book are a testament to the research undertaken and upholds the factual correctness of the technical information contained within. Previously, Clarke published three books exploring her own experience as a doctor working in end-of-life care, during the covid-19 pandemic, and as a junior doctor. I would argue that her openness in exposing her own emotion and vulnerability in memoire form gave her insight and empathy to how that might be for the families in The Story of a Heart . The historical account of trauma medical care, transplant experimentation, and current surgery were clearly written to meet the needs of a general reader. Medical terms, procedures, and concepts were communicated to be accessible to an untrained person. The doctors and patients were actualised, and described in the style of a story, making complex information more meaningful and easier to appreciate.

The pace and structure of the book is effective: it moves from the personal stories of the families to medical history and factual matters, therefore providing a respite from the emotionally impactful content which in turn allows the reader to begin processing the feelings raised. The interplay between the two family’s trajectories cleverly allows an insight into the gradual realisations of letting go and impending grief in juxtaposition to the sense of hope and promised life. Clarke’s empathy, compassion and sensitivity shines through in her thoughtful descriptions of the family relationships. She records distressing medical situations with gentleness and respect. In descriptions of Keira prior to the accident that took her life, Clarke portrays a vivacious child, full of life and vitality. It is written in the present tense, and I interpreted this as a tribute - a gift - offered to the Ball family, as a recognition of their daughter’s nine fun-filled loving years. Her unique humane and cognizant approach surely must have encouraged the two families to entrust the story to her.

After reading the book, I considered the role of the women portrayed in it. There are many positive representations of women in the book such as paediatric specialists, intensive care nurses, and organ donation coordinators. However, Clarke points out that although women make up over 50 per cent of medical students, in contrast, less than 10 per cent of cardiothoracic surgeons are female, highlighting the gender disparity in this specialism. Keira’s mother and her thoughts and feelings about what her daughter is going through, are conspicuous in their absence. Loanna Ball was severely injured in the car accident that caused Keira’s fatal injuries and was taken to a different hospital to receive treatment. As such she was not directly involved in the discussions around Keira’s potential organ donation. Loanna is absent from the symbolic ritual for grieving families, of making a memory box. However, her permission and consent to donation is sought and she is at least able to say goodbye to Keira briefly prior to the heart retrieval. In Max’s case, I felt that his father, Paul, takes the major role in the interactions. His mother, Emma, is described as ‘the strong one’ and this resonated with me.

The description of children in hospital in the 1950’s was particularly harrowing from my perspective as a mother. Clarke offers personal insights from former child patients as a response to the documentary A Two-Year-Old Goes to Hospital , which reveals the unintended cruel policy of isolating children from their care givers whilst in hospital in the 1950’s. The book contrasts this with the child-centred care Max and his family were able to access. Clarke writes of the pressure group, Mother Care for Children in Hospital , formed as a direct reaction to the documentary, and instrumental in changing the medical community’s policies around fulfilling a hospitalised child’s psychological needs.

In summary, The Story of a Heart is a compelling account, made more extraordinary because of the unique circumstances that are captured: the rarity of a near-perfect donor match, the publicity around Max’s story resulting in the unusual meeting of the two families, and the consequence of promoting a change in the law to an assumed consent (opt-out) system for the organ donation register. The book answers many questions about transplant surgery, covering both the pioneering history and modern manifestation of this discipline. Yet like all good books, it also raises questions and considerations, such as the importance we place on the heart as the source of life and the embodiment of human emotion. Often, we think our feelings but while reading I was able to be more present and less cerebral with my emotions. The experience of reading the book is at times heartbreaking, but the hope and compassion of the story shines through.