Harvest

'Outside call for you, Doctor,' said the operator. 'Let me put it through.' There were a few transfer clicks, then a woman said: 'Dr. Abby DiMatteo?'

'Speaking.'

'This is Helen Lewis at New England Organ Bank. You left a message last Saturday about a heart donor. We expected someone at Bayside to call back, but no one did. So I thought! should check back.'

'I'm sorry. I should have called you, but things have been crazy around here. It turns out it was just a misunderstanding.'

'Well that makes it easy. Since I couldn't find the information anyway. If you have any other questions, just give me a-' 'Excuse me,' Abby cut in. 'what did you just say?'

'I couldn't find the information.' 'why not?'

'The data you requested isn't in our system.'

For a solid ten seconds Abby was silent. Then she asked, slowly, 'Are you absolutely certain it's not there?'

'I've searched our computer files. On the date you gave for the harvest, we have no record of a heart donor. Anywhere in Vermont.'

CHAPTER TWELVE

'Here it is,' said Colin Wettig, laying open the Direcwry of Medical Specialists. 'Timothy Nicholls. BA, University of Vermont. MDTufts. Residency, Massachusetts General. Speciality: Thoracic Surgery. Affiliated with Wilcox Memorial, Burlington, Vermont.' He slid the book onto the conference table for anyone in the room to look at. 'So there really is a thoracic surgeon named Tim Nicholls practising in Burlington. He's not some figment of Archer's imagination.'

'When I spoke to him on Saturday,' said Archer,'Nicholls claimed he was there at the harvest. And he said it took place at Wilcox Memorial. Unfortunately, I haven't been able to find anyone else who was in the OR with him. And now I can't get hold of Nicholls. His office staff tells me he's taken a prolonged leave of absence. I don't know what's going on, Jeremiah, but I sure as hell wish we'd had nothing to do with it. Because it's starting to smell pretty rotten.'

Jeremiah Parr shifted uneasily in his chair and glanced at attorney Susan Casado. He didn't bother to look at Abby, who was sitting at the far end of the table, next to the transplant coordinator, Donna Toth. Maybe he didn't want to look at her. Abby, after all, was the one who had brought this mess to everyone's attention. The one who had initiated this meeting.

'What exactly is going on here?' Parr asked.

Archer said, 'I thinkVictorVoss arranged to keep the donor out of the registry system. To shunt the heart directly to his wife.' 'Could he do that?'

'Given enough money — probably.'

'And he certainly has the money,' said Susan. 'I just saw the latest list in Kiplinger's. The fifty wealthiest people in America. He's moved up to number fourteen.'

'Maybe you'd better explain to me how donor assignments are supposed to work,' said Parr. 'Because I don't understand how this happened.'

Archer looked at the transplant coordinator. 'Donna usually handles it. Why don't we let her explain?'

Donna Toth nodded. 'The system's pretty straightforward,' she said. 'We have both a regional and a national waiting list of patients needing organs. The national system's the United Network for Organ Sharing, or UNOS for short. The regional list is maintained by New England Organ Bank. Both systems rank patients in order of need. The list has nothing to do with wealth, race, or social status. Only how critical their conditions are.' She opened a folder and took out a sheet of paper. She passed it to Parr. 'That's what the latest regional list looks like. I had it faxed over from the NEOB office in Brookline. As you can see, it gives each patient's medical status, organ required, the nearest transplant centre, and the phone number to contact, which is usually the transplant coordinator's.' 'What're these other notations here?'

'Clinical information. Minimum and maximum height and weight acceptable for the donor. Whether the patient's had any previous transplants, which would make crossmatching more difficult because of antibodies.'

'You said this list is in order of need?'

'That's right. The number one name is the most critical.'

'Where was Mrs Voss?'

'On the day she received her transplant, she was number three on the AB blood type list.'

'What happened to the first two names?'

'I checked with NEOB. Both names were reclassified as Code 8's a few days later. Permanently inactive and off the list.'

'Meaning they died?' Susan Casado asked softly. Donna nodded. 'They never got their transplants.'

'Jesus,' groaned Parr. 'So MrsVoss got a heart that should have gone to someone else.'

'That seems to be what happened. We don't know how it was arranged.'

'How did we get notified of the donor?' asked Susan.

'A phone call,' said Donna. 'That's how it usually happens. The transplant coordinator at the donor hospital handles it. He or she will check the latest NEOB waiting list and call the contact number for the first patient on the list.'

'So you were called by Wilcox Memorial's Transplant Coordinator?'

'Yes. I've spoken to him before on the phone, about other donors. So I had no reason to question this particular donation.'

Archer shook his head. 'I don't know how Voss managed this. Every step of the way, it looked legal and aboveboard to us. Someone at Wilcox obviously got paid off. My bet is, it's their transplant coordinator. So Voss's wife gets the heart. And Bayside gets suckered into a cash-for-organs arrangement. And we don't have any of the donor paperwork to double-check this.'

'It's still missing?' asked Parr.

'I haven't been able to find it,' said Donna. 'The donor records aren't anywhere in my office.'

VictorVoss, thought Abby. Somehow, he's made the papers disappear. 'The worst part,' said Wettig, 'is the kidneys.' Parr frowned at the General. 'What?'

'His wife didn't need the kidneys,' said Wettig. 'Or the pancreas or the liver. So what happened to those? If they never made it to the registry?'

'They must have gotten dumped,' said Archer.

'Right. That's three, four lives that could have been saved. And got tossed instead.'

There was a ballet of shaking heads, dismayed expressions. 'What are we going to do about this?' said Abby. Her question was met with a momentary silence.

'I'm not sure what we should do,' said Parr. He looked at the attorney. 'Are we obligated to follow up on this?'

'Ethically, yes,' said Susan. 'However, there's a consequence, if we report this. I can think of several consequences, in fact. First, there's no way we can keep this from the press. A cash-for-organs deal, especially involving Victor Voss, is a juicy story. Second, we're going to be, in a sense, breaching patient confidentiality. That's not going to sit well with a certain segment of our patient population.' Wetfig snorted. 'Meaning the bloody rich ones.'

'The ones who keep this hospital alive,' corrected Parr. 'Exactly.' Susan continued. 'If they hear that Bayside spurred the investigation of someone like Victor Voss, they're not going to trust us to keep their records private. We could lose all our private-pay transplant referrals. Finally, what if this somehow gets turned around? Made to look like we were part of the conspiracy? We'd lose our credibility as a transplant centre. If it turns out Voss really did keep that donor out of the registry system, we'll be tainted as well.'

Abby glanced at Archer, who looked stunned by the possibility. This could destroy the Bayside transplant