When your own heartbeat turns into a countdown clock, every unfinished conversation and every broken relationship suddenly matters in a way you can’t dodge anymore. The Color of Hope by Julianne MacLean says that DNA, luck and illness can shatter or save you, but the choices you make—about forgiveness, love, and organ donation—decide who you really become.
MacLean grounds Nadia’s viral myocarditis and heart-transplant journey in real medical detail: doctors explain that a “flu-like virus” can scar the heart, leaving Nadia with only “twenty-five percent” function and a likely need for transplant.
In the novel, Diana notes that in their country about “three thousand people are on the wait list for a heart transplant… and only two thousand donor hearts are available each year,” numbers that closely echo real-world donor shortages and waiting-list data. Contemporary transplant reports estimate roughly 5,000 heart transplants per year worldwide, with persistent donor scarcity.
The Color of Hope will land hardest with readers who like contemporary women’s fiction that mixes family secrets, medical drama, and a late-blooming love story; it’s less ideal for those wanting light escapist romance, tidy villains, or purely “feel-good” illness narratives.
Table of Contents
1. Introduction
Julianne MacLean’s The Color of Hope is the third novel in her bestselling Color of Heaven series, originally self-published in English in 2013 and now available in multiple languages and formats, including audio.
Set loosely within the same emotional universe as The Color of Heaven and The Color of Destiny, it can be read as a standalone; the story focuses on lawyer Diana Moore and her newly discovered twin, Nadia Carmichael, rather than on earlier protagonists.
MacLean is a USA Today bestselling author whose Color of Heaven books collectively have tens of thousands of ratings; The Color of Hope itself sits around a 4.4/5 average on Goodreads across more than six thousand ratings, which suggests a strong, sustained reader response.
Although MacLean is known for historical romance, this series leans toward mainstream emotional fiction with romantic threads, and this volume blends domestic drama, legal dilemmas and hospital scenes into a single arc.
The result is a novel that feels like a cross between a book-club family saga and a medical-ethics case study, but told with the pace and readability of commercial romance.
2. Background
The novel is set in contemporary North America—primarily Boston and Los Angeles—with flashbacks to childhood and young adulthood that track how adoption, class and geography split two genetically identical women into very different lives.
Diana grows up as the privileged daughter of a senator in New England, while Nadia bounces through foster homes and later scrapes by in LA; this mirror-image premise is made explicit when they finally meet and Diana realizes that seeing your “exact likeness” for the first time is both “frightening and disturbing” and weirdly joyful.
Heart transplantation is not treated as soap-opera decoration but as a complex medical system involving social workers, psychiatrists, transplant coordinators and wait-list mathematics, something Diana quickly learns when she researches the process and meets Nadia’s new care team.
Outside the novel, that medical background is grounded in reality: heart transplant remains the last resort for advanced heart failure, with only around 5,000 such surgeries performed annually worldwide despite increasing need, and donor scarcity is a major limiting factor.
At the same time, myocarditis—Nadia’s diagnosis—is a recognized cause of sudden cardiac death and heart failure in young adults, with global incidence estimates in the tens of cases per 100,000 each year and significant underdiagnosis.
So while MacLean is writing fiction, she is playing on very real fears: that an ordinary virus can quietly dismantle a healthy heart, that life-saving organs may never arrive in time, and that the line between “I’m fine” and “I need a transplant” can be disturbingly thin.
3. The Color of Hope Summary
Diana Moore begins as the woman who has everything: she’s a successful divorce lawyer from a politically connected Boston family, living in a beautiful city apartment with her handsome boyfriend Rick and assuming a proposal is around the corner.
Her work is emotionally taxing—she describes how years in family court have made her jaded and surrounded by “conflict and bitterness” —but she believes in helping clients rebuild their lives and, on the surface, hers looks enviably under control.
Then, on an ordinary day, everything tilts.
Across the street from her office, Diana glimpses a woman who looks exactly like her; when their eyes meet, she experiences a visceral somersault in her stomach and a shock so deep it’s as if she is staring into a living mirror.
Curiosity pushes her to follow this stranger into a bar, where the two women stand face to face, note matching hips, hair texture and even the veins on their feet, and finally test the obvious: “We’re definitely twins,” the other woman says, and they introduce themselves as Nadia and Diana, identical sisters separated by adoption.
The novel then braids together two timelines.
We learn that Diana was adopted as an infant into a loving, affluent home, while Nadia remained with their troubled birth mother longer, then entered foster care and grew up with instability and emotional neglect.
Nadia has clawed her way into adulthood as a makeup artist in LA; she drinks more, dates reckless men, and carries old wounds about being the “left behind” twin.
As the women swap life stories over dinner and wine, the contrast is stark but not simple: Diana’s charmed life has come with pressure, public scrutiny and high expectations, while Nadia’s hardships have given her a ferocious independence but also a deep fear of abandonment.
Their early connection feels intoxicating.
Diana is thrilled to discover a biological relative at last—“because I was adopted, this was a first for me,” she notes —and Nadia basks in being truly seen by someone who shares her face and history.
They trade secrets, visit each other’s cities, and introduce one another to friends and family. But fissures appear quickly: Nadia is drawn to Rick’s charm and status; Rick is flattered by this edgier version of Diana; and, in a disastrous moment in Las Vegas, Nadia ends up in an elevator making out with him, an act that detonates both the sisterly bond and Diana’s relationship.
Months pass with silence and resentment.
Diana moves back to Boston, throws herself into work and yoga, and tries to file both Rick and Nadia under “bad decisions.” Nadia, meanwhile, spirals into what looks like a better life—LA glamour, a relationship with Rick that turns briefly serious, and then an unplanned pregnancy—but under the surface she is fragile.
When what she thinks is a lingering flu turns into crushing fatigue and breathlessness, she lands in a Los Angeles hospital, gasping for air, and learns that an infection has severely damaged her heart muscle.
Her ejection fraction, the measure of how well the heart pumps, is about twenty-five percent; normal is around sixty.
The cardiologist, Dr. Vaughn, is brusque and tactless, telling her she has “had some bad luck” and that the damage is “usually permanent,” and he coolly warns that she will “likely need a heart transplant.” He also calls her unborn baby a “parasite,” reminding her that the pregnancy is draining her already-compromised circulation.
It is one of the ugliest and most believable scenes in the book.
Terrified, alone in a city where she has no family, Nadia finally picks up her phone.
In a series of increasingly desperate voicemails, she tells Diana that a “weird virus” called myocarditis has wrecked her heart, that she was “shocked back to life” with paddles, that doctors say she will need a transplant—and then, in another message, that she is six months pregnant and terrified her baby will be “left all alone in the world” like she once was.
Diana listens to these messages at her parents’ dinner table and feels the color drain from her face as her twin begs, “Will you take her if anything happens to me?”
From here, the book pivots into full crisis mode.
Diana flies to LA, sees the appalling bedside manner of Dr. Vaughn, and meets the obstetrician, Dr. Mills, who explains the brutal balancing act ahead: keeping Nadia alive long enough for the fetus to mature while not pushing Nadia’s failing heart past the point of no return.
An early delivery at twenty-four weeks would give the baby only about a sixty-percent chance of survival and a high risk of neurodevelopmental impairment, Dr. Mills explains; every week inside the womb buys better odds.
Nadia, exhausted and oxygen-dependent, agrees to aim for a C-section around thirty weeks if her heart can hold on.
But Diana is not content to leave her sister in that hospital.
Leveraging her legal skills and family resources, she transfers Nadia’s care to Massachusetts General Hospital in Boston, where she finds a high-risk obstetrician and a renowned transplant surgeon, Dr. Jacob Peterson, who has already successfully treated a pregnant myocarditis patient who delivered by C-section and later received a transplant.
Nadia moves into Diana’s Beacon Hill home, and the sisters live together while waiting for the baby and the transplant evaluation.
These domestic chapters are some of the most emotionally charged.
They negotiate chores, medications, diet and fear; they revisit the Las Vegas betrayal; they talk about their birth mother and the strange symmetry of their lives. Diana finds herself unexpectedly drawn to Jacob—first purely for his competence, then for his warmth and slightly offbeat charm—but she suppresses any romantic thoughts, aware that he is Nadia’s doctor and that Nadia herself is starting to see him as a kind of lifeline.
The tension eventually erupts in one of the book’s central fights.
Nadia, insecure and afraid of losing even the fantasy of a relationship with Jacob, accuses Diana of trying to “steal” him; Diana, furious, points out that Nadia once did exactly that with Rick.
The argument exposes old resentments about privilege, adoption and who “deserved” a good life, and for a while it seems as if their reconciliation might collapse under the strain. Yet the gravity of Nadia’s condition keeps pulling them back together.
As the pregnancy advances, Nadia’s heart worsens.
Eventually, an emergency unfolds: she begins to decompensate, and the baby shows signs of distress. Jacob and his team rush her to an operating room for an emergency C-section even though she is not stable.
During the surgery, Nadia arrests; they “lose her” and have to shock her repeatedly to bring her back, while the premature baby is whisked to the neonatal intensive care unit. Jacob later tells Diana that Nadia is “a fighter,” but her heart function is now truly dire, and she will “definitely” need a transplant if she survives the next twenty-four hours.
The baby—a girl—is placed in an incubator.
When Diana finally sees her niece, she feels an “instantaneous” protective bond, imagining the child’s future as a rebellious teen and grown woman; Jacob gently urges her to reach through the incubator porthole so the baby can learn her voice and touch, and the scene becomes a quiet counterpoint to all the medical chaos around them.
Diana officially agrees to become the baby’s guardian if Nadia dies, promising that the child will “never be left alone” and that she will raise her as if she were her own.
Meanwhile, the transplant machine grinds into motion.
Jacob and the team complete Nadia’s evaluation, and Diana learns the hard numbers of the transplant world: thousands of people waiting, fewer donor hearts than candidates, and an unpredictable timeline that can mean months of limbo.
As Nadia lingers in intensive care, Diana even makes the ethically complicated decision to inform Rick, the baby’s father, of the situation; his main concern, it turns out, is whether he will be stuck with responsibility if Nadia dies, a selfishness that underlines how little emotional safety Nadia has beyond her sister.
The final stretch of the novel unfolds on two tracks.
On one, Nadia fights for each breath, her future chained to the hope that a compatible donor will appear; on the other, Diana and Jacob inch toward an honest romantic relationship, navigating Nadia’s feelings, professional ethics, and their own guilt.
There is no sudden miracle pregnancy-and-transplant montage; instead, MacLean shows the grinding uncertainty: pager duty, clinic appointments, medication side effects, and the psychological toll of wondering whose death will become Nadia’s chance at survival.
Eventually, a donor heart does become available.
By this point, Nadia has had some time at home with her daughter, Ellen, and one of the most moving chapters has her sitting on a quiet October beach at dawn, baby in her arms, feeling “closer to heaven” and reflecting that, if she died that day, she would at least have broken through the “walls of… childhood isolation” and learned how to love.
She goes into surgery determined to accept whatever comes, knowing that another family has just experienced shattering loss to make her operation possible.
In the epilogue, narrated by Nadia, we learn the outcome.
“It’s been three weeks since my transplant,” she writes, describing life back home with Ellen and Diana, taking anti-rejection drugs and slowly rebuilding her strength, while wondering about the anonymous donor and their grieving family.
She concludes that “every moment – every heartbeat – is a gift,” a line that crystallizes both the title and the entire arc of the novel: hope is not denial of risk but a choice to treat borrowed time as sacred.
The book closes with the promise that Nadia’s story will continue in the next volume, The Color of a Dream.
4. The Color of Hope Analysis
4.1 The Color of Hope Characters
Diana Moore is one of those protagonists who appears put-together but is actually hollowed out in subtle ways.
Her legal career, especially in divorce, has eroded some of her youthful optimism; she admits that she became “more jaded” over time as bitterness surrounded her, a self-diagnosis that rings true for many people working in high-conflict professions.
At the same time, she is capable of radical, almost reckless compassion: her instant decision to become her niece’s guardian—“some decisions… are simply made by the heart” —shows how deeply she values loyalty and how quickly she will shoulder responsibility when someone she loves is at risk.
Nadia Carmichael is more volatile and, at first glance, easier to judge.
She drinks too much, makes impulsive romantic choices, and commits the unforgivable Las Vegas elevator betrayal; for some readers she will initially feel like the classic “chaotic twin.”
Yet as the book peels back her history—foster care, instability, the sense of being the daughter who wasn’t chosen—her behavior looks less like moral weakness and more like the survival strategies of someone who never learned secure attachment.
When illness strikes, her stubbornness becomes courage: she fights to keep the baby, refuses to sugar-coat her fear, and still finds the humility to beg Diana for help even though she believes she doesn’t “deserve sympathy.”
Jacob Peterson, the transplant surgeon, is interestingly drawn.
He’s not introduced as a heart-throb but as a man whose intelligence and kindness radiate quietly; Diana notes that he is “not classically handsome” but finds that his attentive eyes, laugh-lines and gentle teasing make her feel unexpectedly safe.
His dual role—as Nadia’s doctor and Diana’s eventual partner—raises tricky ethical questions, and MacLean mostly handles this by stressing his professional boundaries and by postponing anything like a relationship until long after Nadia’s care is stabilized.
Secondary characters sharpen the moral texture of the book.
Rick functions as a kind of moral negative space: his selfishness and cowardice—paying Nadia to disappear, worrying more about child support than her survival—contrast with Diana’s growth and help keep the story from sliding into pure sentimentality.
Dr. Vaughn, the tactless LA cardiologist, is almost chilling in his casual cruelty, but he also feels uncomfortably believable to anyone who has encountered brilliant but emotionally tone-deaf clinicians.
4.2 The Color of Hope Themes and Symbolism
The most obvious theme is, of course, hope.
But MacLean deliberately complicates it. Hope here is not naïve optimism; it coexists with statistics like a twenty-five percent heart function, finite donor pools, and prematurity survival rates that make every decision feel like an odds calculation.
The Color of Hope argues that hope is a discipline: Nadia and Diana keep choosing to believe in a future they cannot see, whether that’s a hospital discharge, a donor heart, or a family that finally feels whole.
Identity and nature versus nurture are threaded through the twin motif.
Diana and Nadia share genes but diverge wildly because of adoption, income and geography, a structure that lets the book ask what parts of us are truly fixed.
Their reunion scene, with its almost forensic observation of matching features and habits, is a literalization of this question: they are fascinated by the small ways they are the same—beer versus wine, hair texture, body type—but the story ultimately suggests that their core identities are shaped as much by who loved them as by DNA.
Organ donation itself becomes both plot engine and metaphor.
On a practical level, the transplant wait list drives suspense; on a symbolic level, the idea that one heart can sustain two lives—donor and recipient—underlines the book’s belief that love outlasts individual bodies.
Nadia’s final reflection, that every heartbeat is a “gift” that must not be squandered, turns the anonymous donor into a kind of unseen character whose generosity ripples outward through Ellen, Diana and Jacob.
Finally, there is a quieter theme about decision-making and responsibility.
In several key scenes, characters confront choices that will shape other people’s futures—Diana agreeing to guardianship, Jacob deciding when to operate, Nadia choosing not to terminate the pregnancy—and MacLean tends to show these not as purely rational calculations but as moments when information, gut feelings and love collide.
5. Evaluation
Strengths.
The book’s biggest strength is emotional specificity.
Rather than offering a generic “sick character,” MacLean gives Nadia a clearly defined condition—viral myocarditis—and walks readers through the trade-offs of timing a C-section, managing heart failure symptoms, and navigating transplant evaluation, even including a compassionate explanation of support groups and psychiatric care for patients and families.
For many readers, this blend of medical realism and intimate family drama will feel cathartic rather than clinical.
The twin dynamic is another standout.
The early mirror-image scenes are vivid enough that you can almost feel the vertigo of seeing your own face on someone else, and the later fights never let you forget how much these women can hurt each other precisely because they are so alike.
Their eventual reconciliation—built not on easy apologies but on shared sleepless nights in ICU waiting rooms and nursery corridors—feels earned.
Weaknesses.
Not everything works perfectly. Some readers may find Rick’s villainy a bit one-note and wish for more nuance in his motivations.
At times, the pacing leans melodramatic: coincidence piles on coincidence (twins reunited, pregnancy, transplant) in a way that will be too much for those who prefer strictly understated realism, though it fits the Color of Heaven series’ overall style.
And because the book has to set up future series installments, the romantic arc between Diana and Jacob, while sweet, can feel slightly underdeveloped compared to the sister story.
Impact.
Emotionally, this is the kind of novel that leaves many readers teary but weirdly uplifted, a response echoed in online reviews describing it as “uplifting” and “engaging” despite the heavy subject.
Intellectually, it nudges you to think about donor cards, advance directives, and what you’d do if a sibling who had betrayed you later called from a hospital bed asking you to raise their child.
It also quietly educates: terms like myocarditis, ejection fraction, and transplant waiting list become part of the narrative vocabulary without ever turning the book into a textbook.
Comparison with similar works.
If you’ve read other medically focused family dramas like Jodi Picoult’s My Sister’s Keeper or Ann Packer’s Some Bright Nowhere, you’ll recognize the blend of ethical gray areas and domestic intimacy here.
Compared with those, The Color of Hope is less procedurally detailed on law and more unapologetically romantic in tone, but it’s playing on the same terrain: who gets to decide, who sacrifices, and how a family rearranges itself around serious illness.
6. Personal insight
In real-world terms, Nadia’s story sits at the crossroads of three urgent issues: women’s heart health, organ donation, and how families make decisions under pressure.
Myocarditis and other inflammatory heart diseases remain under-recognized, especially in younger adults; recent global analyses estimate hundreds of thousands of prevalent myocarditis cases and millions of new cases annually worldwide, with incidence rates around 10–20 per 100,000 depending on the study and age group.
At the same time, the global demand for organ transplants continues to rise—one World Health Organization–backed report estimated more than 170,000 solid-organ transplants in a recent year, a 9.5% increase over the previous one—but supply still lags far behind clinical need.
That mismatch is exactly what haunts Nadia and Diana when they stare at wait-list statistics in the clinic.
Educationally, the novel could work beautifully in interdisciplinary classrooms that pair literature with public-health or ethics modules: students could read The Color of Hope alongside basic resources on heart transplantation from reputable medical sites (for example, the British Heart Foundation’s statistics compendium or the Wikipedia overview of heart transplantation, which synthesizes registry data and outlines typical survival rates.
They could then debate questions very close to the novel’s plot: Should pregnancy change how we prioritize transplant candidates? How do we weigh a parent’s risks against a fetus’s prospects? What makes a “good” decision when every option carries serious harm?
There’s also a subtle link to the kind of decision-science writing covered on Probinism—books like Nudge or Noise that explore how context shapes judgment.
Nadia’s doctors are constantly constructing a choice architecture around her: the way they present survival statistics, the language they use (“parasite” versus “your baby”), and the resources they offer (support groups, social workers) all steer her toward or away from certain decisions.
Using the novel as a case study, readers can see how clinical facts and narrative framing collide, and why compassionate communication can literally change what patients choose.
7. The Color of Hope Quotes
- On the shock of meeting her twin: Diana admits that seeing her exact likeness across the bar is “frightening and disturbing,” yet she finds herself smiling as she walks toward Nadia.
- On finally naming their bond: when they shake hands—“I’m Diana… I’m Nadia”—Diana notes that their hands are “an exact fit,” and she feels as if she has found the sister she’d been “grieving for” all her life without knowing it.
- On guardianship and love: when Nadia begs her to take the baby if she dies, Diana promises that she will “scale mountains” so the child is never left alone and will raise her “as if she were my own,” concluding that some enormous decisions “are simply made by the heart.”
- On the invisible donor: after surgery, Nadia wonders about “the person who signed the donor card that saved my life” and hopes that their family somehow knows how grateful she is.
- On the novel’s central philosophy: one of the most quoted lines from the book sums up its stance on mortality—“life is short and death comes to us all. So what’s the point of living, if we’re not going to experience real joy?”
- On hope itself: in the epilogue, Nadia writes that “every moment – every heartbeat – is a gift,” urging readers not to forget that “even when life seems hopeless”—especially then—because life can “take a sudden turn for the better.”
8. Conclusion
Taken as a whole, The Color of Hope is an emotionally direct, sometimes melodramatic, but ultimately sincere exploration of how family can be both the wound and the cure.
Its greatest strengths lie in the twin relationship, the careful use of medical detail, and its willingness to sit with morally messy questions about loyalty, guilt and second chances; its weaknesses are mostly in its occasional reliance on coincidence and a slightly undercooked romantic subplot.
For readers who enjoy contemporary women’s fiction with a strong emotional arc—especially fans of Jodi Picoult–style ethical dramas, hospital settings.
Most importantly, the book leaves you thinking not just about Nadia and Diana but about your own donor status, your own grudges, and the conversations you might want to have before life forces your hand; in that sense, The Color of Hope lives up to its title by nudging readers toward gratitude, reconciliation, and a more deliberate way of spending whatever heartbeats they have left.
