Authors: Hideaki Sena
With immeasurable gratitude
in his voice, Anzai thanked her and hung up.
“Mariko, you’re getting a
transplant! I never thought they’d find one this soon. You’ll be able to eat
tasty meals again!”
He looked at Mariko with a
smile, but she was trembling with a pale face that was far from rejoicing. She
shook her head from side to side. Anzai swallowed back his joy and extended a
hand towards her.
“What is it Mariko? They’re
going to fix everything. Aren’t you happy?”
“... no,” she said wearily.
Why was she being so
disagreeable?
“What’s with you tonight?
Everything’s going to be fine now. You were so happy the first time, weren’t
you?”
Mariko shook off her father’s
hand.
“No! I don’t want a
transplant!”
Anzai approached her, but she
only turned away, tears in her eyes. She began heaving up sobs. The sudden good
news must have confused her. He had no idea how to calm hen
“Mariko.”
With knees shaking, she
stepped back to the wall and screamed, “I’m not Frankenstein’s monster! I don’t
want to become a monster!”
7
Dr. Takashi Yoshizumi was
contacted by Odagiri at 11:30 pm with news of a donor from the university
hospital. Yoshizumi, who had just been looking over all the patients’ data
spread out over his desk, sat upright at the word “donor.”
“She’s a 25-year-old woman,
brain dead from an intracerebral hemorrhage. I met with her family this
afternoon and we have their consent.”
Nodding to the coordinator’s
every point, Yoshizumi jotted down a more abbreviated form of what she said in
a memo pad. Azusa Odagiri had assumed her position as coordinator just last
year, but she was already known for her meticulousness and her skill with donor
families. In recent cases Yoshizumi had handled, he owed much to Odagiri for
her sound dealings, which had enabled successful operations.
Yoshizumi worked at the City
Central Hospital, the main institution for kidney transplants in the region.
When the families of brain-dead patients offered for the deceased’s organs to
be donated, an attending physician made a call to the CCH. The transplant
coordinator then met with the family personally to explain the details of the
transplantation process. If they accepted her proposal, she obtained their
signatures on consent forms. The procedure was, in effect, no different for
patients who had registered at organ banks, because no transplant could really
be performed against a bereaved family’s wishes.
“We have a candidate
recipient. I’ll wire the data over to you.”
Yoshizumi nodded in approval
and pushed the startup button on his PC.
Now that the information was
being transferred, preparations were already half-finished. At the CCH, recipients
were usually chosen after the following steps. First, a sample of the donor’s
blood was extracted and sent to the lab to check its ABO and HLA types. A
routine test was also made for diseases like AIDS. With this data in hand, the
coordinator began the selection process.
At the CCH, designated the
regional center for kidney transplants, there were data on file from many
patients hoping for an organ. These included name, date of birth, nature of
compatibility, as well as histories of blood transfusions, transplants, and
dialysis. In the region alone, approximately 600 people were on the waiting
list for kidneys of the dead. The first to be chosen were those whose blood
types most closely matched the available donor. Then, from within that group,
candidates were ranked by HLA compatibility. Since there were two kidneys for
every donor, two different recipients were usually chosen.
It was customary for one of
them to come from Yoshizumi’s hospital, partly because it handled coordination
duties. His hospital’s two most highly compatible patients were summoned for
tests, and the more suitable one ultimately underwent the operation. If it
looked like there were no viable candidates in the local region at all, they
would search via the national hub of kidney transplants, Sakura National
Hospital in Chiba, to ship the kidneys to some other part of the country. When
the transportation of the organ could not be executed swiftly, however, chances
were that the kidney would not take. The organ lost its freshness and weakened
if it took too long to ship. It wasn’t without reason that recipients were
selected first by region.
Yoshizumi cradled the
receiver on his shoulder and began typing. The coordinator’s data appeared on
screen: a list of prospective recipients, ranked from highest to lowest by
compatibility. He scrolled down, briefly surveying the entire list.
“Number 1, Mariko Anzai, and
Number 2, Matsuzo Iwata, are the prospective candidates. Ms. Anzai will be
under your care.”
Yoshizumi had heard that name
somewhere before. He wrinkled his forehead, then gasped in surprise. After
taking a moment to collect himself, he scrolled up and peered closely at Number
1. Mariko Anzai. Yes, he knew that name. She was 14 years old and had already
had one transplant, at the CCH transplantation division. Yoshizumi looked at
Mariko’s HLA type. It was consistent with the donor’s. Zero mismatches.
Mariko Anzai.
There was no mistaking it
now.
It was the same girl
Yoshizumi had operated on two years before.
She had received her father’s
kidney, but the transplant had failed. The operation itself was a success, and
no serious rejection symptoms had appeared. Yet, the kidney did not assimilate
with her body and finally had to be extracted. Yoshizumi bit his lower lip. He
had much to regret about the case.
HLA, or Human Leukocyte
Antigen, is a genetic marker found on the surface of human cells. The HLA of
pathogenic cells differs from one’s own. When illness attacks, unrecognized HLA
types are regarded as intruders and subsequently destroyed as a natural immune
system response. Because HLA is also found on the surface of transplanted organ
cells, the organ is incompatible whenever its antigen type differs from the
recipient’s. For this reason, transplants between people of similar HLA types
are preferred. Only, unlike the simple ABO blood types, HLA types are quite
complex. There are six classes of HLA: A, B, C, DR, DQ, and DP, and each
encompasses ten or more subclasses. In transplant medicine, the most advanced
analysis compares A, B, and DR types. Each of these three antigen classes is
inherited, one from each parent. In other words, three classes and six pairs of
antigens can be analyzed. The abundance of antigen classes, however, was a
troublesome factor. Finding a donor with a sixfold match was not easy. Even
between siblings, the chances of full compatibility were only one in four, and
the probability of perfect compatibility with someone outside of the family was
less than one in ten thousand. Because of this, many transplants were performed
despite one or even two mismatches. This, however, meant that the organ had a
higher chance of being rejected.
In Anzai’s case, the
transplant had taken place between father and daughter, and tissue compatibility
was high. It should have been a successful transplant. Yet, it failed, and the
reason was that Yoshizumi and his team had failed to gain the trust of Mariko
Anzai.
Yoshizumi breathed in deeply.
He gazed upon Mariko’s name at the top of the display and pressed his
fingertips around his temples to interrupt the unpleasant memories bubbling up
in his head. He told himself to concentrate on the work at hand and spoke to
Odagiri, who was waiting patiently. “So Mariko Anzai has no mismatches.”
“Correct,” she replied.
“There are no other recipients in this area with such perfect compatibility.
Please take some time to review the data.”
It was true. None with just
one mismatch, either. There were, however, five candidates with two mismatches.
One of them, the third name on the list, had been selected as the other
candidate for this donor’s kidneys. He was 51 years old, had a five-year
dialysis history, and was currently under care in a neighboring prefecture. A
woman who was number 2 on the list couldn’t be reached.
An estimated 20,000 people in
all of Japan were registered for kidney transplants. Yet, within that group,
the annual number who actually received organs hovered at around 200. Then
there were the dialysis patients, who numbered 120,000 nationwide. The
consideration awarded to transplants for patients with chronic renal failure
was too small. Compared to Europe and America, Japan was known for having an
extremely high dialysis patient-to-transplant operation ratio. By no means did
this indicate that Japan’s medical techniques were behind the times. Instead,
it was public unease about regarding brain death as actual death that was the
primary source of hesitation, for doctors and patients alike, to promote such
procedures. Praying for a new kidney, patients were forced to deal with a long
life of dialysis, a process both physically and financially straining, while
those fortunate enough to receive a kidney were able to enjoy a normal social
life.
“One more thing. Just in case
candidate Number 1 can’t accept the kidney, it’s been decided that Number 5
will also come to the hospital for testing,” said Odagiri. “She is 36 years old
with two mismatches and a three-and-a-half year dialysis history.”
“Got it.”
He printed out the charts for
the two main candidates. In the instance that Mariko had contracted some
serious illness, the 36- year-old woman would take her place on the selection
ladder.
Yoshizumi compared schedules
with the coordinator and solidified their arrangements. He was to perform the
extraction first, at the university hospital. He would then pass one of the
kidneys along to Odagiri, who would then ship it to the neighboring prefecture,
while Yoshizumi brought the other to the CCH to conduct an immediate transplant.
Odagiri planned everything in great detail. Time between the extraction and the
transplant was critical. Once the donor’s heart stopped they would be running
on a tight schedule. It was the coordinator’s responsibility to make sure all
the surgeons, assistants, nurses, and recipients were on the same page.
When all preliminaries had
been exhausted, Yoshizumi thanked her and hung up.
It seemed that Yoshizumi’s
chance at self-redemption had come at last.
Mariko Anzai. I’ll save the
kid if it’s the last thing I do.
8
Just two days after the
consent forms were signed, Kiyomi’s heart rate began its inevitable decline.
Her breathing maintained a certain regularity, if only through the respirator.
However, her body’s faculties were finally reaching their limits. Her vital
signs were falling.
“We’ve arranged for the
transplantation unit from the City Central Hospital to come here this evening,”
the doctor said to Toshiaki. “Once Kiyomi’s heart stops, we’ll need to extract
her kidneys promptly. We need to prepare her femoral artery beforehand. For
this purpose, we’ll be conducting a simple operation tonight. After her heart
stops, a cannula will be inserted into the artery to cool her kidneys.”
The securing of the arteries
was soon completed. When Toshiaki returned to the ICU, he saw that Kiyomi’s
thigh was marked for insertion of the cannula. Her medication had been stopped,
but her blood pressure remained steady, wavering around 100. The doctor
explained they would likely need to wait until morning.
And Kiyomi’s warmth
will last only just as long
, thought Toshiaki absently. Moment by moment,
her body was changing into a mere object for donation. Unable to shake the
reality of it from his mind, Toshiaki spent the night at his wife’s bedside.
At 10 pm the nurse came in as
usual. She emptied Kiyomi’s bed pan, swabbed her nostrils and the inside of her
mouth, wiped the perspiration from her back with a towel, and changed her body
position to prevent bed sores. She did all of this without the faintest sign of
annoyance. In fact, she sometimes cast a sympathetic smile at Toshiaki as she
worked.
Toshiaki had never been
seriously ill. He had, of course, spoken with many medical practitioners
throughout his career, but realized that he knew nothing, until now, of the
actual work that doctors and nurses did.
“I’m truly grateful,”
Toshiaki said, bowing his head. “I think Kiyomi is, too, for all you’ve done
for her.”
The nurse stopped what she
was doing and said, smiling, “I’m happy to hear that. I’m sorry we weren’t able
to help her.”
“It’s okay,” he countered,
flushed. “You did everything you could. All of you.”
The nurse’s smile turned
ambiguous. She looked away from him as she resumed her duties.
“Working in the ICU,
sometimes I just don’t know,” she said timidly, almost to herself. “You can
give your all to the patients.
They still die almost every
day. What are we doing here? It’s just too depressing sometimes. ICU nurses
quit much faster than in other departments. Still...” Her words cut off there
as she finished with the cleaning. She put Kiyomi’s clothing back on and turned
around to face Toshiaki, hands at her sides.