Authors: Hideaki Sena
Yoshizumi gave a quick word
to the head doctor. “We have one more procedure to attend to. We’re heading
back to the central hospital now. Thank you for all your help.”
The doctor responded vaguely.
Yoshizumi turned around and was about to go meet up with his assistants when
the doctor muttered something under his breath. “Why the liver...?”
“Hm?”
Not grasping the doctor’s
meaning, Yoshizumi stopped in his tracks and turned back, looking questioningly
at the doctor, whose brow was furrowed.
“It’s the donor’s family,”
said the doctor, sounding perplexed. “Her husband from the School of
Pharmaceutical Sciences, to be more exact. He requested that we remove the
donor’s liver as well... he wants her liver cells.”
“What for?” Yoshizumi’s eyes
widened. He could not even begin to fathom such a request.
“Dr. Yoshizumi!” his two
assistants called, waiting impatiently outside the door. He looked back and
forth between them and the doctor, whom he wished to hear out in more detail,
but there was simply no time to do so.
“If you’ll excuse me,”
Yoshizumi said and took off.
11
Soon after the kidney
extraction, Kunio Shinohara commenced perfusion of the liver.
Toshiaki had called him
around two o’clock to say that Kiyomi’s operation was soon approaching, and
Shinohara had been standing by in his office after finishing his usual
business. In order to obtain liver cells with high viability, they could not
afford to waste a second. Shinohara had made various preparations in advance so
that he could leave for the OR at any moment. He had also caught hold of one of
his medical students and primed him for assistance.
He was contacted again by
Toshiaki at 5:50 when the extraction was underway. Shinohara, along with the
student, brought everything to the hospital. He placed cultivation liquid into
an incubator, setting it to 37° C. He put on an operating gown and awaited word
that the transplant crew had completed their operation. Shinohara then entered
the OR at 6:15. He laid out a plan of action to his student, allowing him to
ready the perfusion equipment and HEPES buffer solution.
[11]
Kiyomi’s abdomen was left
open. The liver shone with a tan color and looked to be in good condition. It
appeared to have no imperfections of any kind. The transplant team had been
very expeditious. It would be easy, he thought, to procure viable, fresh cells.
He felt strangely moved by
the thought that Toshiaki’s wife had been beautiful down to her liver.
He wiped the area around the
organ with care and judged arterial elasticity by pushing with his fingertips.
Meanwhile, his student led a tube from the buffer, passed it through a pump,
and attached it to a polyethylene cannula. After clamping back the liver
artery, Shinohara cut away the hepatic vein on the left side and swiftly
inserted the cannula. The student flipped on the pump switch. Blood flushed out
from the left side of the liver; it gradually turned a yellow ochre, the organ’s
actual color. The student confirmed the flow rate as adequate and the buffer
was circulated for twenty minutes.
Primary cultures on liver
cells were a standard procedure in modern-day laboratories all around the
world. Liver cells were extracted and cultured, then subjected to drugs and the
changes observed to investigate their various regenerative mechanisms. However,
procuring cells from living people was difficult unless you had ties to
clinical medicine, so the many researchers, like Toshiaki Nagashima, who worked
in pharmaceuticals used raw materials from rats. Though they were good to work
with, rat liver cells were of a slightly different structure than human cells,
especially in the arrangement of their enzymes.
Currently, the most popular
way to get liver cells of high viability was to take them from transplant organ
donors. The quality of the cells differed according to age, so in most cases
donors from about age 18 to 30 were preferred. Many of the donors selected were
those who had died in car accidents. They differed from patients who’d died of
illness in that they had not been receiving any drugs for treatment. There were
no worries as to the effects of such drugs on the liver.
The perfusion was running
smoothly. Shinohara’s assistant removed a second buffer from the incubator,
into which he had mixed a collagenase
[12]
and sodium chloride solution. The perfusion solution was then exchanged with
this mixture. They waited for yet another twenty minutes. The collagenase would
ease the unbinding of the liver cells.
Shinohara gazed somewhat
hesitantly upon the innards taken from Kiyomi’s covered body. The sheets did
nothing to hide her delicate curves. He thought back to the wedding two years
ago between Toshiaki and the corpse that now lay before him. As the best man,
Shinohara, who wasn’t used to giving speeches, spoke nervously in front of the
entire gathering. Kiyomi had just turned twenty-three, but her carefree
expression and the innocent look in her eyes had been more that of a high
school student. When he complimented her on being such a ravishing bride, this
corpse had blushed and looked over bashfully to Toshiaki. How had things been
going for them? Shinohara couldn’t seem to recall any details.
The left side of the liver
now appeared nominal. He pushed around gently. It felt soft to the touch,
indicating that the collagenase had done its job. Shinohara checked his
stopwatch. The perfusion period was complete. As he prepared some Leibovitz
solution, he told his student to inform Toshiaki, who was waiting outside, that
it would only be a little longer. Shinohara cut off the left side of the liver
with a scalpel. After checking its weight, he transferred it into the
temperature-controlled Leibovitz solution. When he shook the flask lightly, the
liver sample broke up slowly. Some more shaking would do it. The rest was lab
work.
Before leaving the OR,
Shinohara capped the flask to prevent bacteria from getting in. Toshiaki, who
was leaning against the wall in the hallway, snapped to attention like a rubber
band and ran up to Shinohara. His face was jaundiced and lifeless, but as soon
as he recognized what was in Shinohara’s hand his bloodshot eyes livened up
immediately. He sighed with joy.
“Everything went well,” said
Shinohara as coolly as possible. “I haven’t washed it yet, though. Be gentle
when running it in the centrifuge.
[13]
About 50 G’s should do it. And be sure to dispose of any debris that seeps
through the gauze. I assume you know all this already, but I just want to make
sure...”
“Yes, of course.”
Toshiaki plucked the flask
from Shinohara’s hand and placed it into an ice box. He grasped it like some
sacred object and thanked
Shinohara earnestly as he
made to leave. He would now return to the lab to purify the cells. Was he
deceiving Kiyomi’s parents by doing this? Toshiaki kept close watch over the
box, an overt obsession in his tear-stricken eyes. No matter how Shinohara
looked at it, these were not the actions of a sound human being, and he
suddenly regretted what he had done. He tried to convince himself that he had
not just taken a vital organ out of his friend’s dead wife, that he had not
yielded to Toshiaki’s insane desire.
“Nagashima, you sure you’re
okay? Is that all you need?”
Toshiaki stopped. He turned
around slowly and glared back at Shinohara, then spoke in a low voice.
“Why wouldn’t I be okay?”
“Don’t you feel like you’re
doing something weird here? Are you just going to leave her folks behind? How
about her remains? Shouldn’t you want to be with her right now?”
“Her remains? What are you
talking about?”
He seemed taken aback by the
question. Shinohara felt cold. Toshiaki’s face slowly changed in appearance as
he gazed pitiably upon the box clutched at his side. His harried expression was
gone. Toshiaki stroked the box quietly and there was a disturbing gleam in his
eyes.
“I’ll be back in three
hours,” Toshiaki said. “But please, don’t be mistaken. Kiyomi isn’t dead yet.”
He left Shinohara to stand
there by himself with only the sound of hurried footsteps fading along the
wintry hallway of the ICU.
12
Yoshizumi rushed to the CCH
via ambulance. The kidney transport cooler lattered as the vehicle swerved left
and right throughout its thirty-minute journey.
Before such advanced
containers were invented, kidneys were toted in cold storage boxes. In
principle, these more primitive containers differed little from the coolers we
bring to the beach. Time was precious and, in those days, the chances of a
successful trans plant were relatively low. The perfusion methods in current
use were a significant improvement. Not only was the organ’s structure kept
intact, but its freshness was also better preserved.
Yoshizumi was sitting on a
padded seat, arms folded and eyes closed. In transplantation medicine, such
moments were the only opportunities for respite. Because the hospital was
within city limits, the transportation time was fairly short, but airplanes
were used in cases when kidneys needed to be sent in from other prefectures. A
two-hour trip in the sky was like an oasis in an otherwise arid landscape of
stress. There was no point being on the edge during the transportation stage.
It was better to rest one’s mind in these blessed intervals so that no mistakes
would be made during the operation itself.
Organ extraction from
brain-dead patients had yet to be wholly accepted in Japan. Consequently,
transplant doctors were forced to wait until the donor’s heart stopped and an
investigation into the cause of death was completed before the actual operation
could be performed. Such organs were naturally more susceptible, but this could
not be helped. Only when brain death was recognized legally, thought Yoshizumi,
would the percentage of successful kidney transplants rise to a more reasonable
rate. The organs would be generally fresher, and, more importantly, there would
be more donors. This would lessen the chances of recipients requiring
long-distance donations.
Until just a few years ago,
Yoshizumi and his fellow staff had even gone through the trouble of obtaining
kidneys from America by air. Though problems of morality were imposed upon the
medical community when it tried to extract organs from brain-dead ¡patients in
Japan, it was able to find some of the organs it needed ¿overseas. At that
time, Yoshizumi thought Japanese society odd for being so sensitive about
Japanese donors when it quietly accepted organs from the States. At any rate,
the results were not good because of the lengthy transportation time. The
recipients, waiting for their urine to flow, would fret, panic, and weep when
it did not. All recipients believed that a rosy life awaited them once they got
their transplants. They never suspected that the operation might end in
failure. Yoshizumi’s heart sank whenever he had to inform a recipient, about a
malfunctioning kidney in need of extraction. Some recipients would ask for
another transplant, and some of them would indeed get another kidney and be
cleared from the hardships of dialysis. Others would shake their heads and say
they never wanted to go through another transplant.
The face of a former patient
came to his mind. A single woman in her thirties, she stood before him, her
hair loose and unkempt. She spoke with a hint of scorn as a wary smile rose to
her lips. “I’ve had enough, doctor,” she told him. “It’s not like I’m getting
any younger. I won’t be able to get any good jobs now, and I’ve already given
up on having children. I’m fine with dialysis. I don’t need this false hope
anymore. You keep telling me someday I’ll be able to eat whatever I want again
and even travel abroad. Don’t mislead me with your lies. Do you have any idea
how I felt when you told me it had to be removed? I wish I’d never heard of
transplants. If I knew only about dialysis, I wouldn’t have had to go through
that
.
Enough, doctor. I’m too tired...”
The ambulance turned a sharp
curve. His eyes still closed, he took a deep breath. He knew this curve well.
It belonged to the road leading to the hospital.
A completely naked Mariko lay
face up on the operating table covered by a cloth. Her body was still innocent
and childlike and had changed little from two years ago. The anesthesia tube
extended from her face into a machine. The anesthesiologist stood by to keep a
close eye on things.
Nearly everything was
prepared before Yoshizumi’s return and Mariko’s body was now thoroughly
cleansed. In a sterilized room, the only sources of bacteria were human beings
themselves, so hygiene was especially important. It was necessary to disinfect
the recipient’s skin assiduously before the operation. The assistants had
applied an antibacterial solution with a brush, similar in shape to a scourer
one might use to clean the dishes, scrubbing Mariko’s lower abdomen and thighs.
Any bodily hair, such as pubic hair, hindered the operation, and had been
shaved off the day before. And, because bacteria could infect razor nicks, her
lower body had been protected throughout the night and day with a sterile
towel.