Black market organ donations.

I've been busy reading my old stash of Dean Koontz novels... He writes horror stories,  and a lot of them are on line as audiobooks at Youtube, but it's hard to fast forward the unpleasant parts as an audiobook, so I prefer to read them so I can skip the nasty parts.

But they are popular, and easily found in our used book kiosks here in the Philippines.

I was reading one I hadn't read before, Your Heart Belongs to me, is about hypertrophic cardiomyopathy and heart transplants. Interesting, because this is one cause of sudden cardiac death problems, and often isn't diagnosed until autopsy.

Because he is a novelist, he can describe how the symptoms affect a person: not just the pain but psychologically.

The protagonist is a nice guy who is a bill gates/Steve Jobs type... since Steve Jobs actually moved to a different state to get a liver transplant quicker, I suspect part of the story was inspired by is actions (although I'd have to check the dates for this).

Here is a 2009 article asking how he got on top of the list. Actually it makes sense. Not everyone is willing to donate an organ. And living in states where "good old boys" don't wear seatbelts and wreck their pickup trucks while smashing their brains is a good place to find an organ, especially since their good Christian parents will often sign for it, seeing an organ as a gift of life for someone else's child.

But it can look suspicious. When Pennsylvania Governor Casey quickly got a heart and liver tranplant, it did raise eyebrows. (His donor was a man who was mistaken for someone else and beaten up over a drug deal he had no part in).

But this also brings up another dirty little secret about transplants: Size.

Kidneys are place inside the abdomen, so no problem. Livers can be divided and given to several patients (and a parent can donate his left liver lobe to save his child's life... we sent one family to Chicago to do this, but alas the father's liver was damaged, and the child died of a brain hemorrhage relatedcd to the clotting problems of liver failure before they found another donor or decided his dad's bad liver was better than nothing). In transplants, sometimes the patient recovers too and lives longer without it, and in other cases, they have so many other problems they die despite transplant.

But for heart transplants, size is critical. Too small and the person can't survive, too large and it causes pressure on the lungs. And then there is the problem of splicing different size arteries and veins to each other.

A lot of transplant propaganda acts like people die "waiting for tranplant", but a lot of them don't fit the criteria either. I had one druggie who died in a prison hospital awaiting tranplant: he was just too sick and they couldn't find a liver... but I suspect his multiple problems were one reason someone else got the available organs (although since he was in prison, his unreliability was not an issue, but his other medical problems from drug abuse were).

Then we come to the "surprise surprise" part of the novel: The transplant was done in China.

This again is inspired by Harry's Kidney, a romp through China's organ donation system.

Romp is my word: The actual title states:

Larry's Kidney: Being the True Story of How I Found Myself in China with My Black Sheep Cousin and His Mail-Order Bride, Skirting the Law to Get Him a Transplant--and Save His Life

well selling kidneys in China, like selling them here in the Philippines, is no big deal, except that it exploits poor people. UKGuardian article here.

the dirty little secret is that China used organs from condemned prisoners.

Including those whose only crime was to belong to the Falun Gong, a Buddhist sect.

this was supposed to be stopped  awhile back, but this CNN article 2016 says it's still going on... and the number of transplants is grossly exaggerated by the Chinese government.

"The (Communist Party) says the total number of legal transplants is about 10,000 per year. But we can easily surpass the official Chinese figure just by looking at the two or three biggest hospitals," Matas said in a statement.
The report estimates that 60,000 to 100,000 organs are transplanted each year in Chinese hospitals. According to the report, that gap is made up of executed prisoners, many of them prisoners of conscience locked up for their religious or political beliefs.
China does not report its total number of executions, which it regards as a secret.
The report's findings stand in stark contrast to Beijing's claim that, since the beginning of 2015, China has moved from almost completely relying on organs from prisoners to the "largest voluntary organ donation system in Asia." 

Sigh.

So a famous novelist published a book about the problem.

But the book really about egotism, callusness to death, and...about redemption.

And in this one, the dog doesn't appear until the ending...

(Koontz joke: many of his novels have a dog companion to the good guys).