Caught in the Organ Draft

What are they, eighty, ninety, a hundred years old? At this distance they seem much younger—they hold themselves upright, their backs are straight, they might pass for being only fifty or sixty. But I can tell. Their confidence, their poise, mark them for what they are. And when they were nearer I could see their withered cheeks, their sunken eyes. No cosmetics can hide that. These two are old enough to be our great-grandparents. They were well past sixty before we were even born, Kate. How superbly their bodies function! But why not? We can guess at their medical histories. She's had at least three hearts, he's working on his fourth set of lungs, they apply for new kidneys every five years, their brittle bones are reinforced with hundreds of skeletal snips from the arms and legs of hapless younger folk, their dimming sensory apparatus is aided by countless nerve-grafts obtained the same way, their ancient arteries are freshly sheathed with sleek teflon. Ambulatory assemblages of secondhand human parts, spliced here and there with synthetic or mechanical organ substitutes, that's all they are. And what am I, then, or you? Nineteen years old and vulnerable. In their eyes I'm nothing but a ready stockpile of healthy organs, waiting to serve their needs.
- From Robert Silverberg's "Caught in the Organ Draft"

Yesterday Wired published an in-depth report on the growing scandal around the illegal organ trade in India. Hundreds of poor Indian women have been convinced to illegally sell one of their kidneys. One such woman, named Rani, decided to sell a kidney to pay for medical treatment for her daughter. After receiving an initial upfront fee, it was made clear to her that if she tried to back out "thugs" would "sort out the situation with violence."

The surgery went according to plan, but the recovery was more difficult than she had expected. Her neighbor sat by her bedside day and night. But after three days -- with her wound still draining liquid -- the hospital sent her home. When she went back to the hospital a week later for a checkup, the doctors pretended not to recognize her.

The organ broker vanished before she received the remaining payment for her kidney. Rani is just one of hundreds of poor Indian women with similar stories.

Of course India isn't the only place you can buy a kidney. There are many countries, from Russia to South Africa, where the wealthy can purchase organs, and not just kidneys, but lungs, livers and hearts (which, for obvious reasons, come from cadavers rather than live donors). One of the biggest organ suppliers is China, where "donors" are often executed prisoners. The system is ripe for abuse even where it is well regulated - see, for example the recent case in San Luis Obispo (Southern California), in which a surgeon has been accused of hastening the death of a 26-year-old patient so as to harvest his organs more quickly. It's not so hard to imagine a scenario in which criminals kill to harvest organs which they then sell to the highest bidder.

The shadier side of organ transplantation has long been a staple of medical thrillers and the more horrifying tales of science fiction. A few of note:

• One of the earliest stories I know of that involves involuntary organ donation is Larry Niven's "The Jigsaw Man" (1967). This Hugo-nominated short story takes place in Niven's Known Space and introduces the terms organlegging and organlegger. As in today's China, organs are harvested from executed criminals, but, at least in Niven's universe, as demand outstrips supply the powers-that-be keep expanding the list of capital crimes. Meanwhile, the organ bootleggers obtain black market organs by any means they can, knowing that if they are caught they will become "donors" themselves.
  

  The organlegger was officially dead.

  His heart went into storage immediately. His skin followed, most of it in one piece, all of it still living. The doctor took him apart with exquisite care, like disassembling a flexible, fragile, tremendously complex jigsaw puzzle. The brain was flashburned and the ashes saved for urn burial; but all the rest of the body, in slabs and small blobs and parchment-thin layers and lengths of tubing, went into storage in the hospital's organ banks. Any one of these units could be packed in a travel case at a moment's notice and flown to anywhere in the world in not much more than an hour. If the odds broke right, if the right people came down with the right diseases at the right time, the organlegger might save more lives than he had taken.

• "Caught in the Organ Draft" by Robert Silverberg (1972) takes the premise of mandatory organ donation literally. I won't say any more, since it's free for the reading at SciFiction.
  
• In Frederick Pohl's Hugo and Nebula-award winning novel, Gateway (1977), a terminally ill son sells off his organs to get his family out of debt. It's pretty chilling:
  

  "He didn't want us to spend the airbody money on Term Medical for him. It would have just about paid for the surgery, and then we would have been broke again. So what he did, he sold himself, Bob. He sold off all his parts. More than just a left testicle. All of him. They were fine, first-quality Nordic male twenty-towo-year-old parts, and they were worth a bundle. He signed himself over to the medics and the _ how do you say it? - put him to sleep. There must be pieces of Hat in a dozen different people now. They sold off everything for transplants, and they gave us the money. Close to a million dollars. Got us here, with some to spare. So that's where our luck came from, Bob."

  Meanwhile, the characters are risking it all trying to make their fortune, in part so that they can afford Full Medical, which includes "transplants to keep us young and healthy and beautiful and sexually strong."
  
• Coma by Robin Cook (1977) is the classic of organ farm fiction. When I read it as a teenager it almost scared me away from hospitals permanently.
  
• The X-Files episode "Hell Money" is set in the gambling dens of San Francisco's Chinatown and has the usual supernatural edge to it. It's certainly not the best X-Files episode, but I liked it for the creepy urban atmosphere (in contrast to the usual creepy forests, creepy farms and creepy suburbs).
• I suppose I should include the Voyager episode "Phage, " in which disease-ravaged aliens steal Neelix's lungs. The biology of that episode is so ridiculous (organs being cross compatible between species with completely different anatomies, for example) it grates on me more than usual.
  

My hope is that, in the not too distant future, human organ transplants will be made obsolete by the development of artificial organs, organs grown in the lab, or animal-human xenotransplants. While the research is promising, Isaac Asimov's commentary on "Caught in the Organ Draft" (in the the eponymous anthology Caught in the Organ Draft) is a reminder, that at the present time transplanted organs were once part of another living human being.

There have been numerous cases of heart transplants, kidney transplants, liver transplants, and corneal transplants.

We can't help but look at that sort of thing with approval, for we tend to visualize ourselves as potential receivers of transplants and if we need something vital, we would want it available. For every receiver, however, there is a donor, and it is that point Silverberg takes up in "Caught in the Organ Draft".

Tags:science fiction, biology, organ transplant