Scarcity (Jack Randall #3) (15 page)

“Sounds pretty harsh. But I guess you have no choice.”

Dayo pointed his fork at Jack before swallowing another bite of his meal.

“It is harsh, no doubt about it. But with over 100,000 people on the list waiting for organs, we don’t have a choice. A lot of those people die while they’re waiting. We have to take into account everything we can when we make a decision. I’ve seen patients get moved down the list on the basis of how well they care for their teeth. If you can’t be trusted to brush your teeth, how can you be trusted to take care of a new liver?”

Dayo let the question hang while he moved on to his sandwich. Both cops couldn’t help but look into their coffee cups and wonder how clean their teeth were at the moment.

“So what happens at the committee meeting? Are the doctors there to lobby for their patients?”

“Sometimes. Most of the cases are pretty clear, though. There’s a scoring system here that we use. I can’t tell you how they might do it elsewhere. It’s a constantly evolving process.”

“So let’s say the patient makes the list, then what?”

“We send all the information to UNOS. That’s the United Network of Organ Sharing. They’re the ones who keep the master list, so to speak. All fifty-eight recovery regions in the United States check the list when they have a donor, and if they find a match they make what’s called an electronic offer to the transplant center. The transplant center will decide to either accept or reject the organ. If they reject it, then the next transplant center on the list gets the offer, and so on until the organ is accepted.”

“Why would you reject an offered organ if they’re so rare? I would think you’d want every one you could get?”

“Sounds simple, but it’s not. There are actually several reasons an organ can be rejected. Most of them are just due to compatibility issues. The patients have to be compatible as far as blood type. Height and weight have to be similar. For kidneys, there are what we call markers. Six of them total. We do what’s called a histo-compatibility study and the more markers that match, the less chance of rejection by the recipient’s immune system. For hearts we don’t have to be so precise. Blood type, height, and weight are usually enough. Transport time used to be a big factor. A heart was only good for about five hours outside the body. So we basically drew a circle around the hospital and the new heart had to come from inside that circle.”

“Used to be?”

“Remember when I said it was simpler a couple of years ago?”

“Yeah?”

“Let’s just say that sometimes technology works for and against you at the same time.”

“How so?”

Dayo swallowed his last bite of sandwich and looked around for any eavesdroppers before sipping his drink and continuing.

“You won’t read about it or hear anybody involved in the process claim that it’s true, but there was always a battle among the transplantation centers for donated organs. The shortage forced the large volume centers and locations with a low supply to compete against the small transplant centers with a large population base. Sometimes there was even a barter system going on. We’ll take this heart and we’ll owe you a kidney, that type of thing. Then you had the government trying to set rules as to whether to transplant the sickest patients first, or the less sick first as they had a better chance of surviving the procedure and the post-transplant period. It failed simply because each patient was different, and it was too easy for the doctors to change the definition of how sick their patient was. But that’s all in the past now.”

“How’s that?”

“About two years ago this company out of Indiana comes out with this new transport device for organs. They call it the POPS machine. Stands for Portable Organ Preservation System. It’s turned the transplant community on its ear. In the old days we recovered the organ from the donor, placed it on ice, then applied as much gas and jet fuel as we could to get it to the hospital in time to place it with the receiving patient. This new machine mimics the body’s natural functions. Instead of cooling the heart, they keep it at normal body temperature. They also withdraw a liter of blood from the donor and mix it with some anti-clotting drugs and some nutrients and hook it up to the machine. The machine circulates the blood and oxygenates it. They can even hook up electrodes and keep it beating. They’ve kept a human heart on the machine for over twenty-four hours, and the heart was still viable for transplant. The POPS machine expanded the circle of donors from a few hours flight time to include the whole world.”

“Amazing.”

“True. Until you realize that the technology has outpaced the system. Before the machine came along, one of our surgeons would fly to the donor, recover the heart, and fly back with it. Now I get a phone call with the message that a heart was found in Mexico or Europe or somewhere and it’s on its way. The heart shows up at the airport where a flight crew hands it off to one of our people. A chart about the donor may come with it, but unless you speak Spanish, and I mean medical Spanish, it’s basically worthless. So we really have no way of verifying anything about the organ we receive. Other than some papers we can’t read, and the assurance of the organization that handled the recovery, we’re basically operating in the blind.”

“So set up a system to verify the organs?”

“From what I’m reading, UNOS and Doctors Without Borders are working on it, but it takes time and a lot of connections. In the meantime, we just can’t turn down organs that show up on our doorstep, so to speak, just because we don’t have as much information as we would like about where they came from. How do I tell a patient that he’s going to die because of red tape? I’m not. I’m a surgeon. Someone else is going to have to come up with a solution.”

They all sat back and contemplated the doctor’s position. A heart transplant was obviously a far cry from swapping out an engine in a car. Lenny and Jack had no idea.

“So how did our boy Oscar get himself in the system?” Lenny asked.

“I don’t know, but he is. Everything checked out. There’s nothing in his chart that would make him ineligible for a transplant. Trust me, I know it frontward and back.”

“I can answer that one,” Jack cut in. “I’ve got a computer wiz on my team. He’s only 23, but whatever I ask him for, he always gets it. Sometimes it’s through normal channels and, I suspect, sometimes not. I prefer not to know. Anyway, one day I asked him how secure our computers were. He just shrugged and said they weren’t. He tells me a secure computer is an oxymoron, like child-safe plutonium. It doesn’t exist and never will. You said there were fifty-eight different recovery organizations in the U.S. alone? I’m sure they all have a hundred or so employees. That means there are plenty of computers to hack. Oscar just determined what he needed to get his new heart, created a profile that perfectly fit the bill, threw some money at it and inserted himself into the system. I wouldn’t even bother trying to track it down, be just a waste of time.”

“Yeah well, I have some people with time to waste. Not my call anyway,” Lenny replied.

Jack just absorbed the answer while he swirled the remains of his coffee around. It was an odd situation, one that he wasn’t sure how to approach. His thoughts were interrupted by the doctor.

“Is there any way we can keep this quiet if he does end up getting a heart? If it becomes public the whole organ donor program will be damaged. The campaign they have going to increase the number of donors is working, and I’d hate to see it take a hit because of this.”

“I don’t know, Doc. Is he going to get a heart?”

“No way to answer that. He’s at the top of the list, but he has an uncommon blood type. His chances are fair. I can’t take him off the list just because of who he is, or for the fact that he’ll probably be in prison soon. If anything, it gives him a guaranteed support system. Ironic, huh?”

“Paid for by us,” Jack echoed.

“Just who is this guy, anyway? I mean, is what I see in the papers true?”

Jack exchanged a look with Lenny. Getting a nod, he sat up to face the doctor directly.

“Who is Oscar Hernandez? The papers call him the Colombian Al Capone, but that doesn’t even scratch the surface. We think he killed his first man at age fourteen with some help from his brother. The two were a brains and muscle pair growing up in Medellin, and they quickly made a name for themselves. Oscar went from entering the cartel to running it in less than five years, and he’s been running the show for over ten now. He’s taken over one rival already when their leadership all died from a car bombing at the boss’s house. The bomb took out twelve women and children, too. He’s been tied to the deaths of three federal judges. They’ve tried to arrest him a few times for trafficking, but the witnesses always end up dead or just disappear. Flight 206 out of Cartagena blew up with 62 people on board back in 2002. There were three witnesses and their families on board coming to the States to testify against him. The papers never put it together, and we blamed it on the FARC to keep the reporters happy, but it was Oscar taking care of business. The goalie from the last World Cup team was murdered a week after they returned from Africa. Shot multiple times while walking down the street. Broad daylight. Evidently Oscar is quite the soccer fan and didn’t like the goal he let by in the finals. No witnesses, of course. We estimate he’s responsible for sixty percent of the cocaine that enters the U.S. annually. He has ties with the Zeta’s and the other Mexican gangs you’re hearing about in the papers. That enough for you, Doc?”

Dr. Dayo just nodded slowly as he absorbed the information.

“Yeah . . . Yeah, that’s enough.”

The two of them watched as the doctor bused his tray before standing.

“Gentleman, I should be getting back upstairs.”

“Thanks for the information, Doc.”

“Anytime.”

Lenny watched as the doctor made his way through the tables to the trash bin. He quickly dumped his tray before stuffing his hands in his pockets and weaving through the crowd.

“What do you think?” Jack asked.

“I’d say that’s a man with a lot on his mind. Can’t say I’d want to be in his shoes right now.”

“Yeah . . . me either.”

Drug Cartel Leader Escapes From Colombian Prison
Washington Post, January 12, 1996
 
 

—ELEVEN—

“H
e’s at the hospital again.”

Jimmy just grunted and made a notation in the notebook they were keeping. GPS was a godsend. They had moved to a second-rate motel just outside the District and had watched Lenny move about the city for a couple of days now. The room was unkempt as they had refused the services of the maid since their arrival. Empty pizza boxes and dirty clothes adorned the vacant chairs and every horizontal surface. The window was open as they were on the third floor and high enough to avoid any prying eyes. Jimmy sat in his boxers with the laptop on the bed in front of him. Manuel sat similarly clothed at the small table. They wanted to keep what clothes they had clean for as long as possible. So far they had three sites picked out as possible locations for their target, and Manuel had driven past a few of them. Nothing they could pin down so far. One had turned out to be a new restaurant that wasn’t in the GPS system yet, hardly anything to complain about.

They would change hotels again in another day to keep up appearances. Something with room service this time, as they were already sick of takeout. The days had become monotonous, but Jimmy kept them busy with contingency plans and scouting expeditions. While he had been to DC several times in the past, his partner had not. It was important for both of them to know the basic layout by heart if they had to make a rapid exit. Not to mention that security here was higher than what one would find anywhere else. So Manuel had spent several hours driving around town.

Jimmy had spent his time watching the tracker and surfing the internet. While information on Lenny was hard to come by, he had managed to find some bank accounts and had tracked the flow of money in and out of them. One of them had led him to an ex-wife. The money flowing into her account didn’t stay long. Most of it left within a day or two and moved on to an account in Raleigh, North Carolina. The name on the account was Mellissa Hill.

Lenny’s daughter.

While Lenny had no internet presence, his daughter was all over it. He soon had a complete profile of her including her class schedule, her position on the volleyball team, and even a copy of her last grades. Her Facebook profile provided an in-depth look into her social life. He knew who all her friends were, the name of her boyfriend, and all of her professors. He knew what bars she and her friends frequented, and even what her plans were for the upcoming weekend. Cracking her Twitter account provided a constantly updated monologue of where she was and what she was doing. It was almost too easy. He had already made a one page cheat-sheet of all of this information, as well as several downloaded pictures. He saved it to his thumb drive for printing next time they went out, before forwarding the information to their respective phones.

Manuel absorbed the information on the small screen in his hand and lingered on the pictures. Mellissa was a very pretty girl, a little on the young side for him, but nevertheless. He especially liked the pictures of her in her volleyball shorts.