“I don’t understand.”
“You will in a bit. Let me start by explaining that my transplant recipients are extremely wealthy, Doctor. They’re typically older and have led indulgent, visible lives. Many of them have lost a step or two, but not all of them. They travel in the best of circles in all walks of life. Industrialists, entertainers, politicians, financiers, former athletes, and interestingly enough, some are doctors like you. The only real requirements I have are they must be able to afford the cost of the transplant without financial assistance, and they must remain discreet.”
“So they’re recipients who are bypassing their health insurance. That sounds like their surgeries are elective.”
“For most, yes,” Wally said. “But a few are too sick to wait on hospital-curated transplant lists.”
“So they go to the black market.”
“An oversimplified explanation, but close enough.”
Dr. Rakoso studied the bubbles as they rose in his champagne glass while he assessed Wally’s answers. He took another sip, then set his half-full flute down in a cup holder, out of the way.
“No more with the twenty questions, Mr. Lanakai. Give me all the details start to finish in one summary. Whatever you think I need to know to get me to sign on.”
“Fair enough. First, call me Wally. May I call you Umberto?”
“I’d rather you stick with ‘Doctor’ for the time being. So tell me what this is all about.”
Wally stayed on the recipient side of the equation to start. He, Wally Lanakai, had created a clandestine market for liver grafts, for people who would die without them, but also for indulgent people with a different agenda.
“The living-donor liver replacement approach,” the doctor said, familiar with the procedure. “The donors give up only a portion of their liver.”
“That is correct, Doctor. In this model, thirty-three percent of the liver is all we need. The donor’s liver will regenerate itself and return to its normal size. The alternative, full liver transplants, would leave the donors quite dead, if they weren’t dead already. This increases my pool of available livers. So aside from donors who suddenly check out, the ones in my business are all voluntary, and I pay them very, very well. And I would do likewise to the doctors performing the surgeries.”
The human liver. Also known as the human chemical factory for its ability to change internal substances into other substances that the body needed, by filtering the blood coming through the digestive tract. It also neutralized substances that the body needed to avoid.
“The recipient patient is taking a helluva chance,” the doctor said. “Grafting onto an existing liver doesn’t always work.”
“And in many instances,” Wally said, “there’s nothing wrong with the recipient’s liver.”
“Grafting onto healthy livers with other healthy livers? A big risk. Why do that?”
“It’s a risk worth taking for these people,” Wally said, about to drop the bomb. “Here’s why.”
No Alzheimer’s or other dementia, no polio, no measles, no mumps, no chickenpox, no AIDS. Pandemic-proof and disease-proof, generation after generation, Wally explained. The most enviable medical legacy on the planet in one small package, the human liver, as long as the liver graft came from someone native to one oddly idyllic Hawaiian island: Miakamii. Either from native islanders still living there, or from natives who emigrated elsewhere.
“Miakamii’s generational seashell thing,” Dr. Rakoso said. “I’ve heard it all before. A wonderful old wives’ tale. I admit the statistics are compelling. But medicine is far from embracing—”
“Medicine doesn’t need to embrace it,” Wally said, annoyed, “only my customers need to, and so far the reception has been outstanding. The statistics don’t lie, Doctor; the research bears it out. These organ donors don’t have these diseases, and they convey their immunity to the recipient. Apparently none of their Miakamiian ancestors had these diseases either. That’s what my customers see. And best of all…”
Dr. Rakoso sat transfixed. For the organ recipients, people who had money to burn, perception had become reality.
“… these livers can reverse age-related cognitive decline.”
“That’s preposterous. Cure patients of their Alzheimer’s?”
“You betcha.”
“Show me.”
Wally called to the front seat. “Pull over a moment, Magpie. Send me the list.”
Wally read from Magpie’s email. Four names, all prominent people who were highly visible: one old-money female socialite, one aging rock ’n’ roll diva, one retired senator, one actor. All had been on the slippery slope dementia-wise, well documented by family members. Over the past few months alone, all had come to Hawaii when called by Wally, and all left with partial liver grafts. “I have their contact info. I can get any of them on the phone. They will each vouch for their progress, or they have people who will do so for them.”
Dr. Rakoso studied the names. He knew these people. Media darlings plus other people who were very visible. Below the line were more names. “You have a waiting list?”
“Yes. Like I said, my own list. Separate, and very exclusive.”
The doctor counted the names; more than thirty, most of them public figures.
Wally pushed. “I can keep you as busy as you’d like, Doctor. I could become your biggest financial crowdfunding supporter. This is cutting-edge stuff. Sometime after this business gets its legs, the medical community will learn about it, embrace it. At that point there will be no reason for physician anonymity. On the contrary. The doctors performing these surgeries might even get heroes’ welcomes.”
They crossed into Lihue’s town limits, passing through plantation farmland once ripe with sugarcane but repurposed into grazing lands for roaming livestock, the local sugarcane industry gone. The cattle huddled under a few trees to keep out of the sun, grazed while their tails swished, were disinterested in the passing limo. Dr. Rakoso mirrored their disinterest, remaining quiet.
“Tell me what you’re thinking, Doctor.”
“I’m doing the math.”
Wally had a good idea what was in his guest’s head. What it would take to accomplish a
