The Organ Broker

by Stu Strumwasser

  The driver will know the route to the hospital nearby. He’ll drive quickly. He will make the call to alert them that we’re just ten minutes away. We will enter through the delivery entrance near the large kitchen. There will be a gurney there for the client, and another for what was once Wallace Kendrickson. My friend in Brazil will have arranged it all. They will rush the client and Wallace toward the ORs. They will have four hours. There will be another patient, forming a domino chain wherein a donor and recipient who don’t match become part of a multi-party exchange. Wallace wasn’t a match for Philip, but he was for someone else waiting in that hospital. The heart that other recipient might have otherwise received could then later be gifted to Philip. Throw in plenty of forged paperwork and a few well-placed bribes … and no one goes to prison. This was the only way. It will work.

  After the ER personnel retreat back down the hall from which they came, with Wallace and the client, the client’s father and nurse trailing awkwardly behind, I will return to the limo. We won’t speak. He will drive me to Leblon, to my friend’s rarely used summer home. On the way there I will make the call that will soon burn down Royston, and Wolf and Kleinhans and all the finders they may know in the shanty towns. I am Robin Hood. I’m Batman. I’ll live in Leblon for some time, for months, maybe longer. I don’t know what I’ll do after that. I really do not know. I have no plan for that at all—perhaps that’s the only thing that might get me out of this alive. Having no plan for what happens after this also means that I won’t be disappointed. Maybe there’s a chance.

  PART III: NEW YORK JACK

  CHAPTER TEN:

  THE ADDRESSABLE MARKET OPPORTUNITY

  After the pre-surgery interview I went to with Kimball and the janitor eighteen years ago, I chatted up the doctor in the hall. He told me that, “Nearly 80 percent of the people waiting on those lists need kidneys. People have two of them so altruistic donors like your friend here are possible.”

  “And Billy’s cousin, Michael, he’ll be fine afterward?” I asked.

  “Should be.”

  “So why don’t more people do it?” I asked.

  “Would you?”

  I answered the question with another. “How long do people usually have to wait?” I asked Kimball’s doctor.

  “Usually over three years,” he replied. “A guy like your friend, in stage four or five, that’s a real problem. They can get bumped up the list, but it’s dicey.”

  ◆

  “Doc,” I asked, “what happens to people who don’t get one in time? What else can they do?”

  He shook his head slightly. “There’s nothing they can do.”

  That was eighteen years ago. The lists have gotten much longer since then. The average wait for a kidney now is around seven years. It could be ten years by 2020. Since NOTA was passed it’s against US law to receive “anything of value” for donating an organ. Like it always does, making any form of goods or services illegal instantly creates a black market for it. Such is the case with my industry. Whereas immunosuppressants made organ transplantation broadly possible after 1983, it was the passage of NOTA, three years later, that signaled the coming of the organ rush.

  ◆

  After that first kidney sale, I was struck by how I was able to find the merchandise with relative ease. About a month later, I put the word out to my Jersey guys that I might need one more thing like we’d gotten from Michael the janitor. Two days later one guy called and said, “Hey, Jack. You want to maybe stop by the place sometime tomorrow? Grab a sandwich? I might have something you’re looking for.”

  “Maybe sometime next week,” I said. “Would it be the same price?”

  “A little more probably,” he replied.

  “Oh. I was thinking a little less probably.”

  “Well, stop by. We’ll talk.”

  I was caught off guard. I didn’t think they could find something like that so quickly. It actually still surprises us sometimes (“us” being me and my colleagues) that organized crime hasn’t taken a greater interest in our little business. I figured that the Kimball transaction must have opened their eyes a little. But the word-of-mouth-disseminated-through-Jersey-based-coke-dealers methodology was obviously inefficient and unsafe, so I turned them down. I was optimistic that I could build a network of suppliers, but the tricky part was finding buyers in a safe and efficient manner. That was the rub. Kimball was an accident. He had come to me. That thought lingered in the back of my mind for years: if I someday figured out an efficient method of finding buyers, the business could explode.

  I changed my name to Jack Campbell. And I got started, right after leaving Blake & Holcomb. I got myself a shitty little office in The Garment District and set myself up offering “general services.” It was on 37th Street, a block where every storefront sold knock-off versions of designer clothing. I connected with a few local banks and mortgage brokers and got some spot work here and there doing residential real estate closings, but I was jazzed and gearing up for something bigger. I had cleared sixty grand in cash from the Kimballs and my mind was in business-plan mode.

  ◆

  When I returned from Tuscon I placed a call to the United Network of Organ Sharing, the quasi-governmental agency that oversees organ transplantation in the United States—and all of the lists.

  “UNOS. Paul Sheridan.”

  “Hey. Hi. My name’s Jack Campbell. My, uh, wife, she … I have some questions about, you know, to apply for an organ transplant—”

  “To get on a list, you have to coordinate it through your local hospital’s transplant center.”

  “Oh, right. Okay,” I said. “It’s just … well, our doctor, he told me there are like thirty thousand people on the lists. Is that true? Are there that many people waiting?”

  “Yeah. That’s about right.”

  “And most of those need kidneys?”

  “Yes. Is your wife in need of a kidney?” he asked.

  “Yeah.”

  “Well, a lot of people are getting them now. Your local hospital can help you through the paperwork and application process.”

  “And the rest, they’re mostly livers?”

  “That’s true,” he said, “but that won’t affect your wife.”

  “So most of the people on your lists need a kidney or a liver?” I asked.

  “Almost 95 percent.”

  “So, if 95 percent of the people on waiting lists need a kidney or a liver, and kidneys are redundant and livers regenerate, that seems like a lot of people looking for organs who could get them from someone alive. Right?”

  “I’m sorry. What did you say your name was?”

  “Jack. Anyway, Paul, is there any way to legally pay and somehow get an organ faster? To move up higher on the list? Like paying a rush fee?”

  “No. Of course not.”

  “But that’s a pretty big market then …” I said.

  “Market?”

  “I mean, it’s just a lot of people that need help.”

  “Yes. It is. Sir, what was your last name again?”

  ◆

  That conversation took place in the early nineties. Paul Sheridan. I loved that name. I used it for years when I used to reach out to potential clients posing as a guy from UNOS. Surely it got back to him a few times over the years—must have driven him crazy. Now, in 2011, the list is over 107,000. That makes for a little over 100,000 kidneys and livers. Do the math. What if the rate to save one’s life was $50,000? $100,000? It’s actually even higher. Then consider that the average commission for most goods and services ranges between 5 and 15 percent … And there you have the seduction … I earned far more than the surgeon on Kimball’s kidney transplant. I was the rainmaker. I had found my niche.

  ◆

  I started traveling to India, South Africa, and Brazil. I found doctors I could pay off, whole hospitals and transplant centers that were already on the take, administrators who could be gently greased to look the other way … I made trips to Thailand and the
Philippines, Indonesia, Eastern Europe, and later to China as well. In those parts of the world everyone knows what’s going on, and everyone accepts it as part of the way things are. It may not be discussed openly, but it is understood—like having a mistress in France, or not paying taxes on cash income.

  CHAPTER ELEVEN:

  RISK/REWARD

  Sometime late in ’93 I went to see a doctor at a hospital in Recife, Brazil. Recife is in the northeast part of the country. There are no direct flights, so you fly to Sao Paulo and then double back. Sao Paulo is as far south of Recife as Florida is south of New York, but it was either that or make three stops. The doctor I was meeting with, let’s call him Genaro de Mendoza. We had spoken on the phone several times and as I often did back then, I said I was looking to source a kidney for my sick wife. Once I got to the local market and met the local docs—and felt them out in person—only then would I decide whether to make a pitch, cold and off the cuff, or just politely excuse myself and glide out of their memories.

  Dr. Genaro de Mendoza wore a white lab coat and was seated behind his desk when I was led into his office. He wore glasses with large square frames, and his eyes were unsmiling behind them. His skin was dark and blotchy, his hair thin and swept sideways across his balding scalp, and he sat with his hands clasped in front of him on the desk.

  “So, Mr. ah… .” he began in English.

  “Just call me Jack.”

  “All right. So your wife, she needs a kidney transplant? That’s what you said?”

  “Yes.”

  “And your friend, your friend a nephrologist told you that you might have better luck finding a donor more quickly outside of the States?”

  “That’s right.”

  “Why here, Mr … Hmmm? Jack? What brings you to Recife? You have very fine hospitals in New York, don’t you?”

  “Of course, Doctor, but as I explained to you, this UNOS they have in the United States, it’s a terrible system.”

  “Yes, you did say that.”

  “It’s prejudicial, and my wife is not high on their list and I have tried to talk to them. I am willing to pay anything for the proper care but they say—”

  “Well, it’s not about money, Mr. Jack.”

  “Jack.”

  “Hmm?”

  “Just Jack.”

  “Yes. It’s not about money.” “Isn’t this a very expensive procedure?”

  “Well, yes, of course, but that has no bearing on who is chosen as the recipient.”

  “I understand that Doctor, but I’m just saying that I want to get my wife the very best of care.”

  “Well, Jack, we have done many kidneys transplants in recent years. We run an excellent facility here, so that much is true.

  “And you see, Doctor,” I said calmly, “if I were to bring Susan here—Susan’s my wife of course—if that went well, and your people were able to help us, I think that I might be able to refer you other similar patients from the United States. Perhaps that way everyone could benefit. Maybe many people.”

  “I’m sorry, Jack. I don’t understand. How might you refer patients? What exactly do you mean?”

  “I mean that we’ve met many people who are dealing with the same challenges we are. At home, back in NY, we’ve met others who need a transplant and are frustrated by the bureaucracy. Many are wealthy. Like me, they’d probably be very comfortable paying for the best care if they could get it expediently. They would probably pay a premium even. Do you think they could get that here? Expediency?”

  “Jack,” de Mendoza said without a smile, his voice soft and gravelly, “are you offering to pay me to get kidneys for people?”

  “Of course not, Doctor. That’s not legal in your country or mine. But my friends would surely pay you an appropriate fee for a costly operation. And to get better care sooner than they would in the States, from a system that is arbitrary and inefficient.”

  “I see,” he said, still speaking softly and in perfect English. “Could you excuse me for a moment? I have to consult with a colleague regarding a patient. I won’t be long.”

  “Of course.”

  He got up and walked out of the room, through the exterior office and into the industrial-looking hallway. Twice I noticed his secretary glancing up at me. I thought about bolting but only moments later de Mendoza returned with another doctor, also wearing a white lab coat, over a button down shirt and slacks. He was stout and broad-shouldered, with a friendly air, and he was trailed by a security guard. My pulse may have barely moved but intellectually I immediately grasped that I had fucked up and overreached. “Mr. Jack,” the other doctor began in a rich, almost melodic voice, smiling genuinely, “may I speak with you for a moment?”

  “May I ask who you are, Doctor?” I said casually, also smiling.

  “I am Doctor Juan Guillermo. I am the hospital administrator,” he said. The security guard stepped forward and took up a position beside him. De Mendoza had returned to his desk and was seated again. I looked back at the security guard. He was shaky, and his shirt was creased and stained. He rested one hand on the gun in the holster on his hip, but he wouldn’t shoot a man for this. I could rush past him—there might be no other way.

  “Please Mr. Jack, may I speak to you in the hallway?” Guillermo asked again, still smiling broadly.

  “Sure,” I said and exhaled. “You can speak to me in the hallway. What’s the security guard for?”

  “Him?” Guillermo chuckled, “he’s for de Mendoza. This debil mental,” he said in Porteguese, motioning at de Mendoza, “he doesn’t understand capitalism. Idiota. Do you like rum, Jack?”

  “Well, I prefer scotch. Scotch whiskey,” I said, standing.

  “Okay, this way,” he said and clapped me on the shoulder.

  That’s how I met my friend Juan Guillermo. I’ve bought about a hundred kidneys from him since then. Still, it wasn’t long before I learned that it was safer to talk on the golf course.

  ◆

  Sellers are everywhere, all over the globe, easy to find, easy to line up, and easy to pay off with chump change. You simply bait them with money. From the time I started in 1993 until ’97 or ’98, the challenge was always finding buyers. Once I did, negotiating the price was not that difficult. “No” is illogical. It means death. I have never, in my eighteen years, met a single buyer who could fund the purchase but who decided, in the end, that he would rather pass the wealth down to his kids than stay alive. Never.

  In the mid-nineties I still had to be very creative to find clients, and take some risks. I sometimes paid off mid-level administrators at transplant centers here in the States for names on their lists. A few times when business was slow I even placed ads in newspapers. What cop doesn’t know that every, “exotic massage studio” advertising on the inside-back page of the newspaper classifieds is actually granting rub-and-tug happy endings to anyone with the nerve to ask? Who believes that there is a single “Escort Service” that actually sends young, beautiful women to “escort” older, rich gentlemen to functions? No one cares. And no one seemed to care about my vocation either.

  Transplant Consultant for Hire

  If you are waiting for an organ transplant we can help expedite getting the lifesaving help that you need. We work with a global network of high-quality healthcare providers to secure you a good match and provide the very best care. If you are currently on dialysis that poses no restriction. Any stage of renal or liver disease can be considered. Call Jack Thompson, at 1,2,3,whatever-the-hell-my-number-was-that-month …

  ◆

  By 1996 or so I completely stopped practicing any kind of law and I was obsessed with solving the international marketing challenge for organs. In 1997, I did. Not too many years ago there were personal ads in the classified sections of newspapers. Eventually, most classified ads migrated to the Web. The Internet launched the organ rush into high gear the way the railroad did for the gold rush in the middle of the eighteen hundreds.

  Suddenly, finding customers
was easy from behind hidden IP addresses in cyberspace. UNOS launched its first website for people interested in organ transplantation in ’95. Two years later I began hunting there too. Here’s my analogy: UNOS is the Mexican government and guys like me are the drug cartels. The cartels usually win. In fact, it’s usually a blowout. Once, back in 1999, I got a memorable invitation to an Instant Message chat:

  W: I saw your ad online.

  Jack: Which ad?

  W: Is this the transplant consultant? The listing on the Internet?

  Jack: Yes. How can I help you?

  W: I need a kidney. Can you help me with that?

  Jack: I can advise you, yes. I can help direct you on where to obtain the organ you need.

  W: How can you do that?

  I hesitated. I was rotating cell phones. IP addresses were essentially impossible to pinpoint then, but still …

  Jack: I work with hospitals and transplant centers around the world. I represent them and sometimes I can arrange travel for patients from the States.

  W: You represent them?

  Jack: Yes. Why?

  W: Hmm. It’s just that I actually represent this buyer. It’s not for me. I represent them.

  Jack: In what capacity?

  W: Representative.

  Pause.

  Jack: I’m Jack.