‘Do you think Katie Dubois might have been killed to harvest her heart for a transplant?’
Spencer looked up. ‘You mean as part of some sort of black market in organs?’
‘Yes.’
‘The answer is no.’
‘Why not?’
‘Couldn’t be done.’
‘You said yourself removing a heart wasn’t that difficult.’
‘It’s not. Any reasonably well-trained surgeon or pathologist can do it easily. Harvesting the heart isn’t the problem.’
‘So what is the problem?’
‘There are a lot of problems. For starters, there isn’t a transplant facility anywhere in this country that would accept a harvested heart without knowing precisely where it came from and under what circumstances the donor died, or without the participation of an organization called the United Network for Organ Sharing, which works through various regional OPOs – organ procurement organizations.’
‘That’s where you get your harvested hearts?’
Spencer seemed relaxed, on his own turf. ‘That’s where we have to get them. No choice. The OPOs have a monopoly. There are a couple of dozen of them in the United States. They divvy up the country geographically. Cumberland is the only hospital in Maine doing heart transplants, and all our hearts come through the New England Organ Bank in Newton, Mass.’
‘How does it work?’
‘When a heart becomes available, let’s say somebody is injured in an auto accident, they’re taken to the nearest hospital, which is probably not a transplant center. Then a lot of ifs come into play. If the patient dies and if the heart is healthy. Or if the patient is brain dead and if the heart is healthy. If the hospital’s trauma team can get permission from the victim’s family to harvest the organs. If all those ifs fall into place, the hospital informs the New England Organ Bank and prepares to harvest all usable organs, including the heart.’
‘Who decides who gets the heart?’
‘On any given day, the New England Organ Bank has a backlog of approved transplant patients waiting for hearts or, in some cases, for a heart-lung combination. Those who’d die first are at the top of the list. Geography is also a consideration. You don’t want the heart traveling any farther than it has to. Time in transit is an enemy to a successful transplant. When that’s all sorted out, the heart’s offered to the highest-priority patient with the right blood type and compatible tissue located in the nearest transplant center. Right now, today, there are over twenty-five hundred very sick people in the United States waiting for hearts. Many if not most of them will die waiting.’
‘An ideal situation for a black market, wouldn’t you say?’
‘For the sellers, sure.’
‘Also for the buyers,’ said McCabe. ‘You just said yourself a lot of people die waiting. Wouldn’t a few of them be willing to pay a substantial amount for a chance to jump the queue?’
Spencer paused for a minute, studying McCabe. ‘I’m sure they would,’ he said in a considered voice, ‘but who’s going to perform the transplant, and where? Any recognized transplant center would be crazy to even think about it. So would a qualified surgeon. The operation can’t be done by a surgeon acting alone, no matter how skilled or experienced, and it can’t be done on a kitchen table. When I transplant a heart, there are ten to twelve specialized people in the OR. All critical to the procedure. Plus a lot of sophisticated equipment. Most important is a heart-lung machine and a perfusionist to run it. The heart-lung machine circulates and oxygenates the patient’s blood and keeps him or her alive between the time the sick heart is removed and the healthy heart goes in and begins beating.’
‘What else is required?’
‘What else?’ Spencer shrugged. ‘A diagnostic lab to perform pre-op and post-op tests. A well-stocked blood bank. A facility for postoperative recovery and one-on-one care for at least a few days. You need an array of monitors. You need someone to prescribe and administer antirejection drugs and to watch the patient for signs of infection due to a compromised immune system. You need to be able to follow a fairly rigid postoperative protocol. I just don’t see how some kind of rogue surgeon could put all that together on his own.’
‘How long is a living heart viable after it’s harvested?’
‘Not long. Four or five hours. Our heart in New Hampshire will be placed in an iced saline solution in an ordinary picnic cooler, put on a helicopter, and flown directly here. While that’s being done, we’ll remove our patient’s diseased heart and attach him to the heart-lung machine until he receives his new heart. It’s all very tightly coordinated.’
Four or five hours. Terri Mirabito estimated Katie’s time of death as forty-eight to seventy-two hours before Lacey found her in the scrap yard. Since her body was found around 8:00 P.M. Friday, a transplant would have to have taken place sometime between 8:00 P.M. Tuesday and 8:00 P.M. Wednesday. Twenty-four hours. A big window.