Neomorts

By Jane M. Orient, M.D., and Linda J. Wright

"She's been waiting for a heart for eight months!" Dr. Andra Morel said.

In fascinated dismay, journalist Jenna Dorn stared at the patient through a gap in the curtains. This certainly didn't look like the attractive young mother whose photograph smiled bravely in the MetroReport nearly every week. Her face was a puffy, blotchy mound with a green tube protruding from the mouth. Her eyes were closed, the eyelids purplish and swollen. She didn't move. Only her chest rose and fell, in time to the cycling of the ventilator. Fluid was dripping from a counting chamber into a line in her neck, and blood-tinged urine filled a plastic bag hooked to the siderails. There was no EKG monitor. Two thick tubes emerged from the front of her chest, in which Jenna supposed the Jarvik-Mitsumi was beating.

"How long can a person stay on the artificial heart?" she asked.

"We don't know for sure," said Dr. Morel, "and of course, we don't really want to find out. It was never intended to be more than a bridge to a living graft."

Jenna made a mental note to find out whatever had happened to the implantable nuclear-powered artificial heart she had once read about. Probably it languished on a shelf, thanks to antinuclear hysteria.

"We have used the Jarvik-Mitsumi for as long as a year," Andra continued. "But we only put one in as a last resort. Those patients have first priority for available donors, but it still can take a year to find them a heart."

Jenna's guide was deftly steering her away from the window, down the hallway that curved around the outer circumference of the Life Islands. Following Andra's brisk pace, Jenna counted about a dozen cubicles resembling the one where Angelique Juarez awaited her donor. A different rhythmic sighing emanated from each. Pastel curtains were pulled across many of the windows, but a few patients could be seen. One was actually sitting up in a chair, apparently watching the free access video. All had umbilical cords tethering their chests to machines.

"How many people are on the artificial heart now?" Jenna asked.

"Here at First National about 20," Andra said.

"So many?" Jenna asked, surprised.

"We simply can't keep up with the demand," Andra said. "And we also have about 40 patients in intensive care, who still have their own hearts. Plus 500 or so who need heart transplants but are not yet in critical condition. That is just at this facility! The Organ Transplantation Rights bill didn't pass a moment too soon!" Two spots of color burned in her cheeks.

Dr. Morel had been a passionate supporter of the bill, Jenna recalled. There had been plenty of controversy. The MetroReport had devoted miles of type to the brouhaha, and she had worked overtime writing photo cut lines and editing copy. But it seemed to her that there had only been a few people on the waiting list back then. She mentioned it.

"We're still catching up with the backlog," Andra said, a little sharply. "Remember that before the right to transplants was recognized, most insurance didn't cover them. People had to resort to fund-raising campaigns to come up with enough money. It was really degrading."

"They cost about $50,000, didn't they?" Jenna asked.

"Or more," Andra said. "An unconscionable amount to charge someone for a lifesaving procedure! But that's not the worst of it. Mrs. Juarez's family raised the money, but she still didn't get a transplant. We had an organ for her six months ago. But the donor didn't have his permit with him, so we couldn't use the heart. By the time we identified him and contacted his family, it was too late." She made a gesture of defeat. "The family was really upset about it too. They knew he would have wanted to give the gift of life. And it would have been such a comfort to them to know that, in a sense, he could have lived on."

Jenna thought she could hear a slight quaver of emotion in Andra's voice, even though as spokesperson for the Federal Transplant Registry, she must have told this story a hundred times. Jenna thought she recalled seeing the coverage on the 6 p.m. video. It had dominated the government-run information channel for weeks and had included the interview with the tearful mother whose son died without donating. She remembered now. Just before the Organ Transplantation Rights bill had come up for a vote.

"But perhaps it wasn't all in vain," Andra continued. "The story certainly struck a responsive chord in people, and may have been the only thing that kept the Committee for Private Property Rights from getting their way again. I just hope Mrs. Juarez can hold out long enough to reap the benefit."

"The Committee certainly made every effort to kill that legislation," Jenna agreed.

"What selfishness!" Andra said indignantly. "Can you imagine people being so callous as to deny another the right to a second chance at life!"

"Some of them were worried about how they could live in the next world without a heart or a liver, weren't they?" Jenna asked, probing a little.

"The Society of the Redeemed," Andra said impatiently. "Of course, people have the right to execute a refusal form. But

it's hard to understand why they would want to deny others the privilege of donating, just on the technicality of a missing informed consent. I'm convinced that religion wasn't the reason for most of the opposition to the bill. There aren't that many fanatics. No, I think there was an ulterior motive somewhere."

She motioned for Jenna to precede her into a little room next to the elevator, cutting off the question Jenna was about to ask. What ulterior motive, Jenna wondered.

"We can take off this paraphernalia now." Andra removed her blue mask, cap, gloves, booties, and gown with a practiced economy of motion.

Jenna followed suit, feeling distinctly disappointed. When they were donning all this clothing, to protect the patients awaiting transplant from contamination by outsiders, she had hoped to get a closer look. But this would have to do -- for now. And maybe that was for the best. She really couldn't write up a realistic description of things a senior surgeon had openly shown her. Not in the underground tabloid, the Eye. Somebody might figure out who must have written it, and refuse to grant further interviews. No, this was definitely a tour made to order for the government-supported MetroReport. Jenna had been working there only a year, and was happy to have been promoted from the tedious job of writing "Today's Health Tip" and photo cutlines to writing real, if tame, features. Of course, she would rather have been writing Angelique Juarez's story, but that, so she was sternly told, was too sensitive a story for someone of her inexperience. As to her current assignment, Mattson Gimble, her editor, would want to know about Andra's tasteful, well-tailored dress; her expensively cut black hair; her classical features; her healthful glow; the stylish, comfortable decor in the offices and wards of the transplantation service; the signs of efficient administration, such as the ubiquitous computer terminals; the continued acute need for donors; and of course the transplant doctors' compassionate concern for their patients. Gimble would not want the gory details, or any controversy that might offend certain important sensibilities. None of the things that interested Jenna -- and readers of the Eye -- the most.

"Now I want to show you the headquarters for the Federal Transplant Registry," Andra said, as she inserted her key to summon the express elevator. "It's the central nervous system for organ procurement in the entire nation. We generally don't show it to visitors, but I think the MetroReport should know about it. And I'm sure they'll be very interested."