“What’s puzzling about that?” John said.
“There are two primary methods of preserving an organ for transplant. Cold storage and machine perfusion. Cold storage is exactly what it sounds like. The organ is immersed in a cold solution of Euro-Collins or Viaspan and maintained at a temperature of two to six degrees Celsius.”
“That cold? Won’t everything turn to ice?” John asked.
“The reduction to the static temperature is gradual, one degree per minute. The preservative solutions prevent cell crystallization,” Dr. Kelly said.
“The second method you mentioned—that’s the machine?” Paula said.
“A perfusion pump with a plasma protein fraction perfusate solution. It’s cold, but not as cold as the cold-storage solutions. If properly maintained, an organ can be kept up to five days.”
“Why would our guy choose machine perfusion over the antifreeze method?” John said.
“I don’t know,” Dr. Kelly said. “That’s more of a detective thing if you ask me. From the standpoint of a pathologist, I can say that an organ is viable for transplant for a finite amount of time.”
“So he chose to keep the organ viable longer?”
“Maybe, but without the battery backup, the pump will fail. Without the circulating cooled preservative solution, the level of intracellular sodium increases. The tissue then draws water into the cell structure, resulting in lethal cell swelling. The organ ultimately develops delayed graft function and becomes useless.”
“Okay then, from a pathologist’s standpoint, what happens when one of these cases gets to its destination?” Paula asked.
“The activity starts long before that point,” John said. “Blood typing and tissue-matching data are collected and goes into a national data registry. UNOS, the United Network for Organ Sharing, manages the allocation of transplant organs across the nation. Patients connect with a transplant center and a surgical team and wait for a match. When information comes from UNOS, the doctors and patients get notified. Transplantable organs, the recipient, and the surgical team all converge at a hospital with a transplant center.”
Dr. Kelly’s eyes softened. “How is Tommy doing, by the way?”
“What? What about Tommy?” Paula said.
John sighed. “Tommy has end-stage renal failure. He needs a kidney transplant.”
Paula’s eyes betrayed her shock. “How long . . . ?”
John leaned against a counter and faced Dr. Kelly. “He’s hangin’ in there. It’s been three and a half years of waiting and transplant surgeries getting cancelled at the last moment. I can see why people turn to the black market to get around the UNOS wait list.”
Dr. Kelly leaned on a counter. “It’s not only the black market. There’s an explosion in demand for human tissue. It’s big business, especially in private hospitals overseas. It’s spawned an entire industry—transplant tourism.”
“Transplant tourism?” Paula asked.
“I’ve looked into it. Transplant patients travel to resort hospitals, get the surgery, and come back for postop care. China, Iran, Israel, and the Philippines have transplant destinations, and it ain’t cheap,” John said.
The doctor nodded. “Private hospitals, mostly. Iran’s system is operated by nonprofits in the country, and they pay the expenses for both the patient and the donor. Iran actually has a waiting list of kidney donors.”
“The catch is, you have to be an Iranian citizen. I checked,” John said. He gestured to the swollen hunk of flesh. “How much would something like that be worth on the black market?”
“Depends. I’ve heard it’s different from country to country, but on average, ten thousand dollars will get you one straight off the showroom floor,” Dr. Kelly said.
“I bet there’s no paper trail for that transaction,” Paula said.
John’s brow knitted. “Doc, if someone uses an off-the-books connection, how can they be sure where these organs come from? And what about the condition of the parts by the time they get there?”
“That’s the risk you take when you deal with those kinds of connections. The private overseas hospitals are legitimate, so your chances of getting a matched, viable organ are decent. The black-market transactions—well, let’s say, no one asks too many questions.”
“I’d imagine if someone paid enough to make sure they got a transplantable organ, they’d be pissed off when it doesn’t survive the trip,” John said.
“That’s where the black market works in your suspect’s benefit. He gets paid up front. He doesn’t have to worry about what happens when the organs are delivered, and there’s not much the receiving end can do about it. And if your guy is trafficking in Asia, India, or Europe, there may be no way to track his transactions.”
“But he only stays in business as long as the ‘merchandise’ meets expectations wherever he ships them to. If word got out that he sold bad product, that would be the end of his enterprise. That brings me back to the battery pack. A single battery, with no backup, means the shipment was not intended for a prolonged journey,” John said.
“Long enough. Mario Guzman told us he and Cardozo delivered their crates to the air cargo terminal. There would have been plenty of battery life to ship one of these to Asia. Or this creep just didn’t care,” Paula added.
“Could he get the organ into the legitimate medical supply chain locally? What kind of medical facility could pull off a transplant surgery?” John said.
“You’re talking about two points along a linear process, the beginning and the end. There is so much more that happens in between to ensure that the organ supply chain remains untainted. The UNOS processes exist to prevent someone from introducing contamination from a black-market connection where there is no telling what condition it’s in or the condition of the donor.
“A kidney transplant isn’t technically difficult. But what legitimate hospital would put their accreditation and license at risk?” Dr. Kelly asked.
“How would they know?” John countered.
“You can’t simply walk in off the street with a human heart or kidney in a dirty Ziploc bag and expect the transplant team to accept it as legitimately donated tissue. It doesn’t work that way. The system tracks the tissue. There are tests and protocols,” Dr. Kelly said.
“Do they come with an ‘Inspected by Number 43’ sticker, like my boxers?” John quipped.
“In a manner of speaking, yes, smartass, they do. The data show the transplant center, when the organ was harvested, and where the organ came from. In some cases, there will be additional donor detail.”
“What kind of detail?” Paula asked.
“Anything that may assist the transplanting surgeon—live donor versus deceased or any health concerns that may require additional caution to prevent infection and rejection. The point being, the system alerts the transplant team to a specific organ tagged for delivery. The allocation protocols in UNOS are rigid to protect the patient from getting the wrong organ or one without any chance of viability after transplant.”
“If the transplant doctors got the alert from UNOS, they wouldn’t question the origin of the donated organ,” John said.
“That’s right. The notification comes through the UNOS system as an online message. It’s a closed system—a message goes to the transplant center, and a return message verifies the contact.”
“Okay, so I can’t call from the corner liquor store and claim I’m from UNOS with an organ to sell?” Paula added.
“No, and UNOS isn’t involved in any financial transaction. The system is designed to collect all the information regarding the need for various transplants across the country and then allocate and notify when a match occurs in the system,” the doctor said.
“If I wanted to get a harvested black-market organ to a legit hospital without the transplant center getting suspicious, how could I do that?” John asked.
“Someone on the inside would have to be deliberately manipulating the data, but no doctor would take t
he risk using something outside that protocol.”
“What if instead of our killer selling to someone on the inside, he had access to the UNOS database? He could use the data to hunt for potential clients. It explains how this guy knew about Tommy. My son’s need for a kidney is in the UNOS database.”
“How many people know about what he’s going through?” Paula said.
John rubbed the bridge of his nose. What he wouldn’t give for a cigarette right now. “Family and a few others. Melissa and I wanted him to feel like a normal kid as much as possible. He doesn’t need some Facebook stalker spreading his story all over the Internet.”
“Or friends at school treating him differently,” Dr. Kelly said.
“Exactly.”
“Insurance representatives, pharmacists, hospital staff, his doctors,” Paula continued. “Anyone involved in his care, or someone they talked to about him, knows what Tommy needs.”
“That doesn’t explain this,” John said, tapping the organ transport case with his finger. “This is more than someone talking about my son. This was damn near gift wrapped for him. Doc, can you tell me if this is a match for my son?”
“I’ll look at the tissue type against Tommy’s.”
Dr. Kelly placed the plastic-boxed kidney on the small pedestal and flicked a switch. A flat-panel monitor projected a display of the organ at higher magnification. “I’ll run what I can on this tissue and see if I can find out more. I doubt that I’ll be able to get any identification. Maybe DNA, but that could take days, if it’s even in the system. Whoever harvested this wasn’t too careful. There is some evidence of crushing on the main artery at the point of dissection. He used scissors rather than a scalpel.”
“So?” John asked.
“The damage to the vascular tissue was avoidable, if he knew what he was doing.”
“Either he didn’t care or didn’t know any better,” Paula said.
Dr. Kelly flicked off the light over the damaged organ, and the glisten that gave the tissue purpose faded.
“Who has access to the UNOS data?” John said.
“I’m not certain, but a number of people at the transplant centers have access to patient and donor information.”
“I’ve worked with the staff at Central Valley Hospital. It’s hard to think that any of them would be involved in black-market organ harvesting,” John said.
“Money is one hell of a motivator,” Paula said.
“Don’t forget Delta Medical Center and Southland Hospital have transplant programs too,” Dr. Kelly reminded them.
“The system is interconnected, right?” John asked.
“The transplant centers are connected to the same data, but it’s a closed system, so only they can access it.” Dr. Kelly grabbed a blank autopsy chart that depicted the outline of the human form, where lines and dots translated into graphic illustrations of gaping lacerations and gunshot wounds. She scribbled a note on the back of the form and handed it to John. “Trisha Woods works over at Central Valley Hospital. You know her?”
“Yeah, I do. She handled all the paperwork for us when the doctors put Tommy in the transplant program.”
“Tricia is the UNOS expert at the place. If there were a way to beat the system, she would know. And I trust her.”
“We’ll check in with her. Can you give her a call and let her know that we’re pursuing something related to UNOS and not . . .”
“Using her services for personal reasons?” Dr. Kelly finished.
“I can’t do anything to put Tommy’s place on the list at risk. If they thought that I tried to manipulate the process . . .”
“Don’t worry, I’ll make the contact. Now if you don’t mind, I need to get some tissue samples of this little bugger up to the lab,” Dr. Kelly said.
John and Paula left Dr. Kelly in the autopsy suite and meandered back to the parking lot. At the car, Paula looked across the hood and locked eyes with her partner.
“Were you ever gonna tell me about Tommy?”
“What’s to tell? It’s not your problem.”
“That’s not what I meant. I’m your partner now.”
“What would telling you do? He’d still need a kidney.”
Paula’s eyes narrowed. “You should have said something. Your son is on a transplant list, and our killer knows about it. If you could get Tommy on the top of the list, would you?”
“Start screwing around with that list and people die. Who could live with that?”
Paula nodded and silently got into the car.
John didn’t know if his answer satisfied her. In truth, he wasn’t sure how far he’d go.
THIRTEEN
Most evenings in the Penley home consisted of frantic meal preparation and homework before settling into a mellower pace. Melissa loaded the last of the dinner dishes into the dishwasher with Tommy’s help before he went to finish his homework. Kari avoided eye contact with her mother and kept her head bent over her cell phone, thumbs pecking away on the keyboard at a speed that signaled the teen’s world was out of balance—again.
John came in the front door, opened the closet, took off his jacket, and hung it on a hook. On the floor, he noticed a remote-control airplane kit that he had promised to put together with Tommy. One more thing put off. How many more chances would he squander?
“I have a plate warm in the oven for you. Wasn’t sure when you’d be here,” Melissa called out.
John strolled into the kitchen past a sulking Kari, who tapped away at another text message. “What’s up with her?”
Melissa gave him an eye roll, an exact duplicate of the expression Kari worked like a world-class artist. Kari could execute a dozen variations of the eye roll. A roll one way meant exasperation, while another warned of a dark, hormonal storm on the horizon. This one was definitely of the latter variety.
John used a dish towel to pull the hot plate from the oven and pulled back the foil. He carried the dish to the counter next to Melissa and tilted his head toward Kari.
“She’s been texting her friends since she got home. Something about a new school dress code. I haven’t seen anything from the school about one.”
Molten, cheesy strands hung from John’s fork to the enchilada on his plate. He maneuvered the forkful and let it cool. “Figures that Kari and her fashion police would be the first to discover the plans to quell their freedom of expression.”
“Can you imagine Kari and her friends in uniforms?” Melissa said. “I think I’ll volunteer that day so I can watch the fireworks.”
John polished off his enchilada and rinsed the plate in the sink. He leaned back against the counter, snaked an arm around Melissa’s waist, and exhaled.
“What? I know that sigh,” she said.
“I got a call from the bank today. They won’t approve our loan. We don’t have the equity in the house that we did a couple of years ago.”
Melissa swiveled around and faced him. “They didn’t even approve a loan for a smaller amount? I mean, nothing? We needed that to cover Tommy’s expenses. What are we supposed to do now?” Her eyes misted over.
“We’ll figure it out,” John offered.
“That second mortgage on the house was our best option.”
“It was the option we wanted, but it’s not the only one we have.”
“The social worker and financial advisor at the hospital ran the numbers for us. After the insurance pays their part, we’ll have over a hundred thousand dollars in medical costs. That doesn’t include the antirejection medications that Tommy will need for the rest of his life.”
“I might be able to cash out my retirement accounts.”
“That won’t be enough,” she said.
“We’ll find a way to make it happen. We still have that list of foundations that the hospital gave us.”
“I never thought we’d have to take donations from charity.”
“Me neither. How do you think it makes me feel that I can’t provide for my family? If it takes swallow
ing some pride and asking for help to get Tommy what he needs, I’ll do it.”
Melissa nodded. “If that’s what it takes.” Eager to change the course of the conversation, Melissa called out to Kari, “Did you finish your homework?”
“Almost,” Kari said while she tapped out another text.
“Put the phone away and get to it,” Melissa said.
Kari strode off to her room and announced her displeasure with a thud of her bedroom door.
“Exactly like her mother,” John said.
Melissa grabbed a dish towel from the counter and snapped John’s thigh. “Better watch yourself,” she said before setting off across the kitchen.
John grabbed a bottle of water from the refrigerator and briefly laid it across his forehead to act as a cold compress against the tension headache that threatened to burst from behind his eyes. “When did life get so complicated?”
“It makes you appreciate all the small things,” Melissa said.
“Thank you, Zen Master.”
“Quit being a smartass and go see if Tommy needs help with his homework. He has a science test tomorrow.”
John found his son tucked behind the family’s laptop computer in the office. The boy navigated the web browser through page after page of search-engine results until he settled on a link that promised a study guide to photosynthesis. The guide, posted on his science teacher’s resource web page, included last year’s test answers.
“Isn’t that cheating?”
“No. If Mrs. Brown didn’t want the test out there, she wouldn’t have posted it,” Tommy said as he clicked the link.
“Shouldn’t you study the material instead of the test answers?”
“It doesn’t matter; I know that stuff anyway. This is like checking my work. I’m getting the right answers.”
“Oh yeah? Let’s see.” John swiveled the laptop away from Tommy and started peppering him with questions from the test. After ten straight correct responses, John said, “Okay, you know this stuff. But tell me—how did you find this website?”
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