The Angel Maker - 2 (18 page)

He explained, "I need to throw a hypothetical situation at you.

I'm involved in an investigation that is really more your field than mine, and I'm at a loss for specific leads to follow."

"A scent."

"Exactly."

"I'll do what I can."

"Let's suppose you're a transplant surgeon which you are-who, for one reason or another, finds herself in need of a great deal of money." "You're broke."

He nodded. "You're broke and you hear that overseas or maybe right here in this country, this city, people are willing to pay big money for certain organs."

"There's no evidence that in this country-" He raised a hand, interrupting; he didn't want her getting ahead of him. "Now as I understand it, in transplanting something like a kidney, you would want the donor to be blood type O."

"Not accurate: You would prefer the donor organ to match the recipient's blood group exactly."

"But to sell?" he inquired.

She bristled again. "Type O might indeed make it easier to sell," she agreed. "Type O is the largest, most common blood group, and Type O organs have the lowest rate of rejection in transplants into any other blood group."

He suggested, "So, if you put yourself in the roll of the harvester-"

"The procuring surgeon," she corrected. "We don't like the word

'harvester."' "Nor do I" He completed, "How would you, as the procuring surgeon, locate a potential donor with blood type O?"

"The procuring surgeon is looking for cadavers.

I suppose the first resources I would draw upon would be the hospital morgue, the Medical Examiner's office, and any of a number of mortuaries."

Boldt took notes. Miles took his pacifier out and threw it across the desk at Dr. Light Horse, who scooped it up, brushed it off, and offered it back to him. Miles liked that. He accepted it gladly and sucked noisily. Boldt asked, "And if those resources weren't available to you or were exhausted for one reason or another, what then?"

She offered him a cold and puzzled look. "You're not suggesting?"

"What am I suggesting?"

"Someone living?"

"It's possible, isn't it? I've read about Egypt, India ..."

"But those people are desperate for money.. "There are people desperate for money in this country as well-in this city as well."

"But it's different there," she protested, clearly upset, "in terms of professional health services. It's true that some Third World countries have limited resources, limited access to technologies such as dialysis. The reason for the high prices, for the whole transplant mess in these parts of the world is that without those transplants people die. It's different here.

Much different."

He admired her vehemence. She was morally and ethically undone by what he was suggesting. "Which means that your market is overseas, if I'm reading you right."

"Now you're scaring me."

"Good." He wanted her scared, because he felt scared for Sharon Shaffer, for whoever else was scheduled next for the knife.

"Here in Seattle?"

"You can't quote me on that," he said.

She thought long and hard. "Blood type? Depends what kind of resources you have, I suppose. You would need computer access, of course, but what comes immediately to mind are hospital records, the Red Cross, the insurance companies. Any of those databases would be likely to list blood type. / "A plasma bank?" he asked. "Just exactly how far along in this investigation are you?"

He handed her several autopsy photos of two of the incisions.

"Dixie suggested you have a look at these."

She studied them thoughtfully. "Anything special?" he asked.

She continued to look them over. "Perfectly competent closures.

Although the incisions are a little large."

As Boldt wrote this down, one of his notes caught his eye.

"What kind of team does he need? How many assistants?"

"It depends on which organ we're talking about and which procedure." "Kidneys," he said. "Harvesting kidneys."

"For a kidney procurement it's helpful to have an assistant.

But again, I'm thinking in terms of cadavers," she corrected herself. "A live procurement? An anesthesiologist, a surgeon, a nurse or two." "Could it be done with less?"

She nodded. "A surgeon and an assistant at the bare minimum."

She added, "You'd be busy."

Miles was getting restless. Boldt contained him, but lost his train of thought. "Have you thought about where this would be done?" she asked. "A location?" Then in a professorial tone of voice: "I see problems with this premise of yours. First, when a procurement is done in a hospital, the organ becomes part of the system. There's an airtight system in place. There has to be, because of the public's wariness about the whole transplant process. It's called UNOS-the United Network of Organ Sharing.

The procuring institution assigns the organ a UNOS number. The recipient of that organ is assigned that same number. It all has to match. There is a paper trail a mile long the moment an organ leaves a body-hearts, kidneys, livers, marrow, it doesn't matter. The procuring surgeon lists an organ's destination as part of that paperwork the name of the hospital or organ bank.

The paperwork follows that organ everywhere. The organ is transported in specially sealed and labeled ice chests. It's all computerized. UNOS does an incredible job. I just don't see how someone could get away with what you're implying."

"And if the procedure was not done at a hospital? Could I get an organ into the system?"

"That's just my point. You can't without a UNOS number. No surgeon is going to touch an organ without the proper paperwork. At the end of every year UNOS follows up on every single organ procured or transplanted. Numbers have to match.

If your numbers don't match, you come up for review-you're in deep trouble."

"And if it's not done in a hospital?"

She thought about this for a long minute. She nodded and nibbled at her fingernail, eyes on her desk. Boldt looked out the window at the weather. He felt tigbt-throated and hot. It was growing dark out there. More rain. She didn't say anything.

"You look puzzled." Frightened was more like it, he thought.

"The thing of it is," she said, "it's possible. You're right about the Third World. market. If I'm the procuring surgeon, I don't want to mess with UNOS-they would catch something like this. I don't want to get anywhere near the system. I'm telling you, the safeguards in this country are just too established.

But overseas? A kidney is good for sixty hours these days, that's plenty of time to reach any foreign destination. And the money-the money would be phenomenal, I should think. You hear about prices like fifteen- and twenty-thousand dollars a kidney. Cash, no taxes. No questions. A couple of those a month, and you're doing just fine."

Excitement stole into Boldt so that his writing was illegible.

He slowed and took down the same notes a second time. Miles snatched his pen and threw it to the floor. With the boy in the harness, Boldt couldn't lean down to reach it. Dr. Light Horse handed him a replacement. She seemed to be waiting for him to say something. He checked his notes once again. "So he does the harvesting outside a hospital?"

"Absolutely. This makes much more sense. But there would be a high risk of infection. Hospitals invest hundreds of thousands-millions-of dollars on their surgical suites.

Filtered air, double doors, regular cleaning. You can't duplicate that on your own unless you have more money than God."

Her fear fed his excitement. These were leads to follow, ideas to pursue. The more they talked, the more he saw an investigation developing. He now saw the investigation dividing into several areas: Connie Chi, the Bloodlines employee, these technical leads, and the bones that Dixie suggested might have started it all.

She looked even more frightened when he asked, "Could I lease such equipment?"

"The scent you were talking about ... something to follow?"

"Yes. "Not my field. But I would guess that you could."

"What about transporting the organs? How difficult is it?"

"Technically, it's not difficult at all. You can use anything from Tupperware to stainless steel. Some Viospan. Ice.

Depending on the organ, it'll keep anywhere from a couple of hours to several days." She added, "Ice chests igloo coolers or Styrofoam-are the most common ways to ship them. One of those small picnic coolers. UNOS uses disposable Styrofoam coolers with bright red labels sealing the joints. If you're going to walk a transplant organ through airport security, you're going to want a UNOS container. Now there is something you could check on." She brightened. "Stolen UNOS containers or labels.

Air-freight cd organs are usually handcarried by the pilot or another member of the flight crew. The legal ones are. But a passenger could do the same thing if he or she could get through airport security."

Boldt wanted to grab for the phone. He wanted to rush out of here and put a team on it immediately. He wanted to reach across the desk and kiss this woman. This was the exact information he had hoped for: a different angle. A different point of view. If they couldn't trace the victims to the harvester, perhaps they could trace the movement of the organs: a courier. He said, "My feeling is that you overrate airport security. As long as an object doesn't appear to be a weapon or a bomb, they're not going to stop it."

"You're probably right." She picked up the autopsy photos and studied them intently. She was getting caught up in this as well. "That's a large incision for a kidney. Did I mention that?" "Large?" Boldt asked. "Is that significant?" She had mentioned it, he realized; he'd even made a note of it on the top of the page. Was the surgical method unique? Would it provide them with a "signature" that they could later use to prosecute a suspect? He caught himself holding his breath, waiting for her.

She appeared so deeply in thought for such a long time that he wondered if she had forgotten his question. She tested her coffee and avoided his eyes in a way that prevented him from interrupting.

Miles was being a real pain in the ass. He wouldn't hold still.

Boldt tried to occupy him with a plastic ring, but Miles wasn't having anything to do with it. He wanted some floor space. He wanted some moving room.

She finally said, "This incision is larger than necessary.

These closure techniques are antiquated. It's doubtful that this is the work of a contemporary surgeon. A retiree is more likely. Unless the surgeon simply doesn't care how it comes out. But cosmetics are an important part of any surgery: Keeping the scar small. The subcutaneous closure is a continuous-interlocking stitch. It's an unusual stitch, but very strong."

Boldt wrote down in large letters: STITCHING. Retiree? This meant something, though he didn't know what. More to investigate; more to work with. Impatience stole into him-a cop's biggest enemy. Where was Sharon Shaffer at this moment?

What had they done to her? What did they have planned for her?

Dr. Light Horse glanced at her watch, and Boldt took his cue.

He packed up Miles, put his notebook away. As she walked them to the elevator, he stopped and said, "Let me ask you this ...

If type O is the best blood type for transplants, why would this harvester want someone with type AB-negative?"

Bloodlines had provided Boldt with Sharon's records that included her blood type. The Professor had confirmed that the blood found on the chair in her apartment was also AB-negative.

She appeared puzzled. "Is this person soliciting organs?" He explained, "We believe he's kidnapped a woman. She's blood type AB-negative, not O." Her face tightened. "What is it?" he asked. "AB-negative is an extremely rare blood group."

"So I'm told. But what's that mean for a transplant?" She led him over to a string of seats by a Coke machine. He felt nervous, worried about Sharon. She obviously felt this would require some explanation.

Miles liked the lights of the Coke machine; he seemed mesmerized.

She explained, "The human body is blessed with an immune system to fight disease. The technical aspects of transplant surgery were pretty much worked out twenty years ago. Haven't been improved much since then. The main avenue of research has been into convincing the body's immune system not to destroy the transplanted organ. The body will reject any organ to some degree, unless it is from an identical twin. Blood is a tissue.

A transfusion is the simplest example of a tissue transplant.

Are you with me?" Boldt nodded. "We all belong to certain blood groups, and many of those blood groups are incompatible with one another. An organ is made up of both a blood type and several different tissue types, making matching-for the transplant surgeon-even more complex. The focus for the last twenty years has been to suppress the body's immune system far enough to accept a transplanted organ, but no so far as to allow infection. That's a fine line. in the past five years, drugs have come a long way in helping to accomplish that. One day soon, immune suppression may be a thing of the past. But for the present, in the more critical organs-the heart, the liver, the pancreas-you need an organ not only the right size but also the best possible tissue match. The closer the match, the less rejection; the less you have to suppress the immune system, the less chance of a fatal infection. Okay? We talked about kidneys. It is true that type O organs transplant well because O is accepted more easily by the other blood groups.

The body puts up less of a fight. If someone is selling organs, as you suggest, it makes sense to procure type O-it's your biggest market; not only the largest blood group but a good second choice if you don't have an exact blood-type match. Type ABNEGATIVE is less than four percent of the population. In the major organs, if you had an AB-negative recipient, you'd want an AB-negative donor to have any chance at all."

"A custom job, is that what you're saying?"

She cringed at the term. "It's a specific match. That is what I'm saying. A special order."

The elevator opened. Dr. Light Horse caught it and held it for Boldt and his restless passenger.