By Rob Brunet
While Stu Strumwasser researched and wrote THE ORGAN BROKER, the waiting list for organs in the U.S. grew by more than thirty-five per cent. For most people, that means years of anxiety, diminished health, or even death. Where wealth meets entitlement, however, there’s an alternative: the global black market for body parts.
Like any market, each transaction takes a buyer and a seller, and both are featured in Strumwasser’s debut thriller, THE ORGAN BROKER. Doctors and other health care professionals are part of the cost, of course, but the serious money is made by middle men with the seemingly innocuous title of “transplant tourism director.” Jack Trayner is one of them, and THE ORGAN BROKER is his story.
Stu took time out as his debut novel launches to talk to The Big Thrill about Jack’s reality, and what’s driving a growth industry most people wish had no need to exist.
Stu, your story sits astride the very real need for organs and the desperation of those who would sell theirs. How much moral ambiguity do you find there?
A tremendous amount! The organ shortage crisis in America and other wealthy nations, combined with the fact that selling an organ is illegal in almost every country in the world, has created a black market. It leads to the exploitation of poor people in many third-world countries. While brokers charge American and European buyers perhaps $150K for “transplant tourism” (all-inclusive trips to go overseas and come home with a new kidney) the sellers usually receive little more than a thousand dollars. The money helps, for a time, but is rarely transformative. However, the after-effects of surgery and little or no aftercare can be. Many are left sick, crippled, or shunned by their communities, and some even die of infection or other complications. Nancy Schepper Hughes, the professor from Cal Berkely who often writes about the black market for organs, calls it “neo-cannibalism” because the most common reason given for selling an organ is “to feed my family.”
Most Americans know little about the organ shortage crisis, but the waiting list has ballooned from a little over ninety thousand names to around one hundred and twenty-four thousand, just in the last seven years (since I began my research for the novel.) Obesity causes diabetes, which sometimes results in end stage renal disease, which leads some people to need a kidney transplant to survive. The wait is now around seven years, and about twenty one people die each day because an organ wasn’t donated in time (about eighteen of whom needed a kidney). There are some who think there should be a legal (and regulated) market for the sale of organs. In an article in Salon.com last year, I proposed a three-pronged legislative solution. One thing we can all agree about is that something needs to be done, and those lives should be saved. I think that begins with awareness. And individuals should please go to www.donatelife.net and register to be an organ donor. Doing so might someday save the lives of eight people.
As waiting lists for organs grow longer, brokering them is bound to be a growth industry. That attracts investment. Did your research uncover any surprises in terms of who plays in field?
The biggest surprise, for me, was confirmation that “transplant tourism directors” (Americans who arrange for wealthy people in need of organs to travel overseas to buy them) actually exist. That was the fascinating aspect of this that attracted me to the story in the first place. The black market is sexy, and scary, and titillating in a way, but what was most interesting to me was the guy. The broker. Who would become such a guy? I think we can understand why a resourceful and ambitious person in a poor country might become a finder, connecting desperate sellers with buyers for their kidneys and other organs. But who in America or Europe or Israel might venture into that business? What about him, or the events of his past, might lead him to such a strange career destination? New York Jack gets there by accident, opportunistically, but only after the stage was set and he was ripe for the seduction. I’ve met a couple of transplant tourism directors and they had equally strange back stories. However, to really ask the question in a meaningful way might require asking it of an investigative journalist like Scott Carney or the New York Time’s Kevin Sack. I know them both and they have traveled overseas and gotten into the muck of this thing much more than I ever did—I made things up!
How far into the western world does the black market for organs reach?
It reaches very deeply if you consider the buyers. They mostly come from developed “first world” nations. However, most of the business takes place overseas where there are plentiful sellers in certain places, and transplant hospitals who have grown quite adept at looking the other way for a few bucks. There are rumors about sellers in the U.S. posing as altruistic sellers who simply want to do something noble and then, after connecting with a potential recipient (perhaps on the Internet) they inform them that their gift would be “easier” to make if they maybe got a little fifty grand gift in return. Surely that happens, but it is less common here.
The book is billed as Jack Trayner’s confession. Without giving away too much, can you tell us about what triggers his need to come clean?
Jack was always conflicted. No one thinks they are a bad person and few people do bad things without thinking that they have some justification that rationalizes it all. Jack is complicated. Like all of us, he is neither black nor white, but gray, when it comes to morality. He never intended to hurt anyone, and like other brokers, tried to justify what he was doing with the twisted logic that he was actually helping to save lives. He comes from a past that was painful and relates to the world as a victim. However, the toll of his actions starts to weigh on him, and when a former client dies it triggers something in him. Then, when he meets the son he never knew he had it opens him to a different perspective on right and wrong, and the life he has chosen. He explains that, “doing the right thing, when it’s convenient, tells you nothing about a man’s character.” Only when an action requires a sacrifice of some kind does it matter. Before it’s too late, he feels compelled to seek some minor redemption.
What about the family of organ recipients? How do they balance their care for their loved ones vs. the cost?
I infer that you mean the families not of those who received organs legally, on waiting lists, but rather, those who purchased them on the black market. If so, I don’t really know. Again, these questions might be better posed to an investigative journalist than a novelist. I would imagine that any family member whose family could afford $150,000 would balance it quite easily. A recipient who gets a well-matched kidney and gets reasonable aftercare can live a long and healthy life. While $150,000 is a lot of money, for many Americans that’s a bargain of a price if it would keep a wife, son, sister or dear friend alive. I have two ten-year-old sons. If one of them needed a life-saving organ transplant, and we couldn’t get one through conventional methods, and someone told us that for a price we could buy exactly what he needed, and that he might be fine afterward, and that the seller knew what he or she was doing and was doing it voluntarily, and I could afford it. . . Well, you see where I’m going here? What would you do?
If you could get any one (or any one group) to read THE ORGAN BROKER, who would it be? [If that’s too political a question, ignore it.]
This is not too political a question. It’s excellent. The answer, without hesitation, is Sylvia Burwell, the head of Health and Human Services in the US Government. When the National Organ Transplantation Act was passed in the 1980s, empowering HHS to provide a non-governmental agency with the contract to “improve access to organs for those in need,” a non-profit quasi-governmental agency called the United Network for Organ Sharing was created. At the time, there were a few thousand people who needed organ transplants and the wait was a few months.
For about the last thirty years, UNOS’s contract has been renewed, year after year, and I don’t believe that there has even been competitive bidding for the business. How are they doing? Well, the list has grown to over one hundred and twenty-four thousand names, and the wait has now surpassed seven years. As I mentioned, around twenty-one people die every day because an organs wasn’t donated in time—because there isn’t enough “access” to organs. I didn’t know that when I sat down to write a fictional story about a conflicted guy.
When I learned these facts I was shocked. It gets worse. Most socio-political problems are hard to solve because doing so is expensive and someone has to pay for it. In this case, it is the opposite. Creating better access to needed organs, and getting people off dialysis (which costs around eighty thousand dollars a year on average, and about eighty-five per cent of which is paid for by U.S. taxpayers through Medicare) SAVES us around two hundred and fifty thousand per patient on average—while also saving lives. That sounds like the most obvious win-win. The growth of diabetes in the U.S. is accelerating—so are those lists.
Dialysis now costs taxpayers over ten billion dollars a year, and what massive initiatives are underway at HHS and UNOS to fix this? I’m not sure, but I sure haven’t read about any in the last seven years. Yeah, I hope Sylvia reads my book. Better yet, I hope she reads my article. If she wants to chat about it she should email me: firstname.lastname@example.org. I’d like to help.
What comes next for you?
I just completed the first draft of what I think is the first indie political thriller. It’s about the man who accidentally and reluctantly becomes the leader of the independent political movement that takes down the two-party system and fixes broken government. I’m trying to stir up some shit.
Stu Strumwasser studied creative writing at Cornell University and went on to pursue dual careers on Wall Street and as a musician. Stu was the founder, drummer and primary songwriter in the well-regarded indie rock band Channeling Owen in the 1990s (see picture and songs below). He also continually honed his craft as a writer of socially-relevant fiction. In 2006 Stu left Wall Street and founded Snow Beverages to make natural soda. While at Snow he raised $3.5 million in angel financing and served as the company’s CEO for six years, personally selling in the product line to leading regional and national chains. A passionate entrepreneur, Stu then co-founded Tengrade in 2011. Tengrade is the social rating tool for the internet, mobile devices and social networks, providing users with “Real Ratings” from their friends and people like them, on anything. Stu was born in Queens, raised in Lynbrook, and now resides in Brooklyn, New York with his two school-age, identical twin sons. The Organ Broker is his first published novel.
To learn more about Stu, please visit his website.