I was intrigued to see a recent announcement that a pay-for-plasma clinic will soon open in Cambridge, Ontario. For too long Ontario’s poorer citizens have hoarded life-giving blood that would be better used by major pharmaceutical companies. Now these folk will be able to explore the fine line between financial stability and medicinal exsanguination.
Indeed, the various ethical hang-ups standing in the way of a free-flowing blood/plasma economy are part of a more general social issue, which is the unjust distribution of body parts. Why should some teenager enjoy perfect skin, a pain-free back, and functional joints when persons of my age could make much better use of these body parts? Yet such are the politically correct times in which we live that simply proposing, never mind implementing, mandatory organ1 donations is considered somehow controversial.
Science fiction can see past the squeamishness of short-term social fashions to the glorious world we might have if we were willing to apply technology in a socially responsible—which is to say, one that benefits the people in charge—manner. Consider these five classic tales.
“The Jigsaw Man” by Larry Niven (1967)
Advanced medical technology allows for large-scale organ transfer programs. Spiraling demand from the public for transplant organs is met by a responsive government; organs are harvested from prisoners who have run afoul of increasingly draconian laws.
Warren Lewis Knowles believes that the law under which he will be condemned and consigned to the organ banks is unjust. Legal reform is outside his resources but perhaps, if he does his utmost, Knowles can commit crimes worthy of dismemberment.
“The Jigsaw Man” is by no means the earliest organ bank story, but it is arguably one of the most famous, which is why I list it out of chronological order. Despite certain flaws in the premise2, “Jigsaw” came in in second to Ellison’s “I Have No Mouth, and I Must Scream” in the 1968 Hugo Awards. In addition to its organ bank fame, the story stands out in a different way: the government in this setting efficiently provides citizens exactly what they want, which is a phenomenon not exactly common in real life or science fiction.
The Reefs of Space by Frederik Pohl and Jack Williamson (1964)
The Plan of Man provides all the people of Earth with useful roles appropriate to their abilities. In the case of mathematician Steve Ryeland, that role is to serve as a living organ bank, to be harvested piece by piece until he dies. Luckily for Ryeland, the Plan of Man’s Planner has a particularly grandiose scheme in which Ryeland will play a central role. Ryeland’s life expectancy is still dismal, but exploring the reefs of space will be far more interesting than waiting for that final, lethal organ donation.
Reefs features an intriguing deep space ecology in no way inhibited by plausible science. The use of political prisoners as involuntary organ donors is much more plausible.
“A Planet Named Shayol” by Cordwainer Smith (1961)
Shayol provides the worlds of the galaxy with a convenient oubliette for political prisoners. There they play a vital role as unwilling organ donors. Better yet, this world allows for the regeneration of excised organs. The galaxy need never worry that the supply of parts will run short; the condemned will live in endless pain.
The administrators of Shayol manage a very difficult trick by story’s end. They manage to discover an application of Shayol’s peculiarities that is so outrageous as to offend the relentlessly pragmatic Lords of the Instrumentality. Given what the Lords are willing to turn a blind eye to, finding an offense that prompts an immediate response as soon as the Lords learn of it is rather remarkable.
“Beyond the Weeds” by Peter Tate (1966)
The crown declines to directly increase organ supply. Her Majesty’s government prefers to leave such matters to private agents such as Anton Hejar. Unhappy relatives of Hejar’s victims think turnabout is fair play. Thus, Hejar is given the opportunity to play a new role in the supply chain.
It seems a little odd that it’s the British author in this list who went for the private enterprise solution to organ supply, whereas American author Niven foresaw a carceral solution.
Star Well by Alexei Panshin (1968)
Remittance man Anthony Villiers extends his stay in the deep space hotel Star Well rather than admit that he cannot pay his bill. His hosts, hoteliers Godwin and Shirabi, are unaware of Villiers’ reduced circumstances and guess at another explanation: Villiers could be a covert investigator aware of their “thumb-running,” the illicit organ smuggling from which Star Well derives its income. The thumb-runners resolve that Villiers must die. This is only the first of a series of terrible decisions by Godwin and Shirabi.
Isn’t “thumb-running” more pleasing to the ear than Niven’s “organlegging”? But for various reasons, Panshin’s Villiers books never won the prominence of Niven’s Known Space works, allowing organlegging to win out over thumb-running. SF authors, this is within your power to change!
These are but a few of the involuntary organ donation stories with which SF authors have delighted, entertained, and inspired audiences. (Oddly enough, such stories haven’t inspired any real-world legal reforms, that I know of.) If I happen to have overlooked your favorite works, feel free to mention them in comments below.
- Ontario students wishing to graduate are required to put in forty hours of voluntary community service. Requiring them to voluntarily donate various organs would be a simple extension of this practice.
- It doesn’t seem to occur to any of the citizens that having the death penalty for the most trivial of crimes could land them in the organ banks. An inability to do even the most rudimentary cost-benefit analysis is, of course, not limited to characters in SF stories.
I think it was Joseph F Delaney’s “To Fit The Crime” that had a similar setup to the Niven, but no organ banks – so all transfers of organs were directly from criminal to victim (an eye replaced for an eye damaged, etc.)
An oddity I forgot until just now: the now rather obscure UFO tv show had aliens raiding Earth to harvest organs from humans. Having only ever seen the pilot, I have no idea if the show ever explained how it was human organs could be transplanted into aliens.
Reminds me of the Vidiians, the Star Trek: Voyager civilization whose medical skill wasn’t sufficient to cure “the Phage” afflicting their people, but it was good enough for them to treat the symptoms by appropriating and adapting organs from other species.
Not obscure to Brits. I think it had a big following in its day, especially amongst people who liked women wearing skin-tight space suits and metallic wigs…
Don’t think it was mentioned explicitly, but there were hints the aliens were either incorporeal or infected other lifeforms so the organs were to keep the borrowed bodies running. One episode featured a probably posessed cat wandering round SHADO HQ.
One could populate this list many times over using Niven stories.
Involuntarily reaped organs were one of the trade items in Card’s A Planet Called Treason.
Niven wrote a few, but perhaps not many times over. I make it 6.
The Jigsaw Man
A Gift from Earth
The Organleggers aka Death by Ecstasy
The Defenseless Dead
ARM
The Patchwork GIrl
I wondered at the time if the Card was inspired by the Smith referenced above.
A much more recent example is the book and movie Never Let Me Go.
Oh wait – parallel universe TV series “Sliders” had a 1999 episode “My Brother’s Keeper” in a universe, an Earth, where spare-part clones, once again, were denied civil rights. And the Nobel Prize, unlike Mr. Ishiguro.
I think that’s kind of a secret.
A BBC radio serial “Jefferson 37” portrays a business which breeds adult-like clones of wealthy customers as organ donors, but of course the clones do not have human sentience (in fact they do, though they’re not terribly bright) and are treated with dignity (they’re not; imagine anything horrible that bored staff may be doing to them, you’re probably right). It’s dated the year after Kazuo Ishiguro’s “Never Let Me Go” – 2005, 2006 – speaking of release, not when the story is supposed to be happening. So the BBC show may be “inspired” by Ishiguro.
A character in “Star Trek: Deep Space Nine” murdered a clone of himself to fake his death and escape from police. Come to think, one of Roger Zelazny’s princes of Amber did pretty much that.
More recent that James’ examples is Bujold’s Mirror Dance, which could exemplify the trope of cloning bodies to use as organ donors.
I think anyone discovering they are a clone should immediately determine if their purpose is to supply parts for the original. There’s a story in Lee Killough’s Aventine collection about a clone who finds a workaround for that issue.
Nancy Farmer had a duology about this. I wonder if it would be a spoiler to post the title here?
Oh, I found the spoiler text
Which reminds of Bujold’s planet Jackson’s Whole in the Vorkosiverse, where they clone people to do brain transplants. Kind of the ultimate involuntary donation.
Organleggers! Organleggers!
I have to second Bladrack’s comment and add, James, that Kazuo Ishiguro’s novel Never Let Me Go should well serve as the seed of entire rhapsody from your pen.
IIRC, it’s been pretty well, if quietly, established that the PRC is using prisoners (political and ordinary) as involuntary donors.
There’s a sequence in the webcomic Strong Female Protagonist on this subject. It was deeply horrifying to me, and serves as a lesson in utilitarianism as a moral philosophy.
That was the situation where Feral (the rapid healing Wolverine-analog) realized that vigilantism as a superheroine seldom effected real change. She retired, spent some time traveling the world, and eventually decided that she could do more good by donating her constantly-regenerating organs than by beating up bad guys. Unfortunately, her super-healing means she metabolizes all anesthetics instantly, so she is conscious as each organ is harvested. But she’s used to pain, so fully intends to spend the rest of her life in the hospital donating several organs each day.
Our titular hero is appalled, but supportive. Until one day she encounters a person with the ability to enhance other superpowers. She then literally strong-arms him into jacking up Feral’s healing abilities to the point where she is able to donate every one of her organs multiple times a day. Within a month she has cleared the global backlog of people waiting for organs and only needs to pop by the hospital every few months to provide for the most recent recipients in need.
The implications are staggering.
In George O. Smith’s “Venus Equilateral” setting – maybe specifically in the last story, set many years after the others – it’s reasonably routine that tricky surgery is done on a patient by matter-duplicating the patient first and testing the surgery on the duplicate. Not for donor parts, though, or even blood, and duplicating a live person is either illegal or extremely rude. And I think the protagonist has the shame of a natural-born twin brother.
See also Unwind (2007) by Neal Shusterman. A near-future dystopian YA novel, it’s set in the wake of a “Second Civil War” over abortion, that ended in part with a “compromise” that allows parents to consign “unwanted” (that is, rebellious or otherwise fractious) teenagers age 13 – 18 to be turned over to the state for their body parts to be harvested for transplant. Since over 99% of the body is used, it’s said they didn’t really “die,” they’ve been “unwound” and still live on in their components.
Yes, this is the series that came to mind when I saw the title. I couldn’t get past either the second or third book in the series. It was too horrifying to read.
Jack Vance’s “Freitzke’s Turn” involves a charmless villain with a confidence game involving organ transplants; detective Miro Hetzel arranges for him to make appropriate restitution, in a grand finale that make me go “oh, ick” really quite loudly.
Robert Silverberg’s “Caught in the Organ Draft” is about just that – a national draft program in which young people supply needed organs for transplant to their wealthy elders.
Written in the early 70s as I recall – the draft was still an issue in the US.
Wikipedia says the first successful kidney transplant was 1954 (between twins). I suppose it didn’t become routine until the ’60s, thus the dates of these stories. The Wikipedia article summarizes the donation policies of various countries – only one allows payment for organ donation.
The Unit by Ninni Holmqvist (2006) has a near-future setting where adults of a certain age (50 for women, 60 for men) who are single, childless, and whose jobs aren’t considered vital or necessary are escorted to a Reserve Bank Unit. Where they have good food, the constant attention of doctors, plenty of recreational activities, the company of others of their own age, never go outside (the Unit does not have windows), and are utilized as organ donors and test subjects repeatedly until they die. It’s mentioned in passing that the Units are so successful and test subjects are in such demand that the age ceilings may be lowered, and there’s a booming business in teen pregnancy and kidnapped babies sold to childless adults desperate not to be consigned to a Unit.
Also there is John Boyd’s The Organ Bank Farm (1972). I wasn’t a fan, but it certainly fits the bill.
If forced blood donation counts, James E. Gunn’s The Immortals is another example. But so are Dracula, The Vampire, Varney the Vampire, etc. etc…
Talking of vampires, there was an attempt to use Cordelia as an organ donor to build a perfect woman in one of the early episodes of Buffy the Vampire Slayer. And the floaty guys who stole human hearts in the Buffy S5 episode Hush.
There are “Involuntary” rather than “Mandatory” organ donations (ie, they’re illegal rather than government policy) in Robin Cook’s Coma, (1977), turned into a 1978 movie written and directed by Michael Crichton. Someone is deliberately putting otherwise fit (though injured) surgical patients into irreversible comas to be harvested for their organs at a later date. But I suppose this is more a medical-based thriller than a science fiction story per se.
I think it counts!
Nit: on Shayol, people are shown growing extra organs (as a result of bizarre local ~parasites); these, rather than organs currently in use, are what’s “harvested”.
The price of a long life is that you forget the titles of stories and books. Wasn’t there a short story by Brown which involved patients meeting their hospital bills by allowing their (eye in this case) injury to be repeatedly created and healed for teaching purposes? Perhaps not directly relevant. And I vaguely remember another where clones were bred as replacements – in this case for a boy who has lost both legs while trespassing on a railway. He meets his clone and refuses to accept the transplant as I recall.
Ishiguro’s Never Let Me Go?
Robin Cook’s Coma (book and film) – terrifying.
I love that all of the above stories are from the 1960s. That is, before immunology had been studied enough to know how unlikely and/or impossible the organ transplants described in these stories would work to affect society.
I read Niven’s stories, mostly. I was required to take Immunology as a course in pharmacy school. It was the single most complicated subject we learned, in my opinion. I spent time working as a transplant pharmacist afterwards, and none of Niven’s stories mention transplant rejection symptoms or immunosuppressive side effects. Doing so wouldn’t necessarily make for good science fiction, though.
Yeah, before genetic fingerprinting happened in real space, Larry Niven’s future Earth used “tissue rejection spectrum” to identify biological samples with the people that they came from.
I’ll be lazy and not look up the name… sometime between let’s say 1984 to 2020, I believe a female scientist, British, claimed to have a promising technique basically to wash the rejectability out of transplant organs, so you might not need an exact tissue match or possibly drugs. Obviously that isn’t available after all. However, in F. M. Busby’s “The Proud Enemy”, a humanoid alien transplant patient is discharged from alien hospital with wearable machinery that does something like that to the transplant tissue and that eventually can be removed.. Of course, alien biology is alien.
Big fan of “Caught in the Organ Draft” by Silverberg. I used to teach it at every opportunity. “The old people will sacrifice your future for their present! Don’t forget!”
MIRROR DANCE by Bujold talks about the organ clone trade on Jackson’s Hole, and Mark Vorkosigan’s deal with the Duronas to undercut it (eventually) by providing better long-life therapies.
It’s amusing in retrospect how much SF in the ’60s-’70s made horrific predictions about how the new science of organ transplants would take away our humanity or be used to victimize us or whatever. In addition to the cited stories, there was Parts: The Clonus Horror and Robin Cook’s Coma. Even the Cybermen in Doctor Who were originally meant as a cautionary tale about how organ replacement and artificial life support could be taken to a dehumanizing extreme — which seems rather ludicrous and paranoid if looked at from a modern perspective, when so many lives have been saved by organ transplants and improved by prosthetics.
This is why I think genetic engineering and transhumanism will eventually be accepted despite present-day fears. We always fear the worst of new advances, and write cautionary tales about how they can be abused, but they often end up being taken for granted by later generations when the doomsayers’ predictions aren’t borne out and the benefits become evident.
The frequently used idea of entire living clones being grown as slaves to be harvested for organs strikes me as particularly silly, because if you can clone a whole person, why not just clone individual organs as needed? Growing entire people to be harvested for parts is like building entire cars to be harvested for spare car parts. Why not just build the parts individually? It’s far less wasteful.
Also, in that Shayol story, if the technology exists to regenerate the organs of the unwilling donors, why do they need organ donors at all? Just regenerate the sick or injured person’s organs. Or is that the point, that the forced donation is no longer necessary but they keep doing it for purely punitive reasons?
In Doctor Who, the Daleks were dehumanized with artificial life support first. The Cybermen… I’m not clear that they had any meat parts left when we met them first, just an AI perhaps supported by mechanical simulation of human organs. They did intend to convert Earth people to be “like us” and they usually started with anyone who wasn’t running away fast enough, so someone you met at the start of a story would go missing and reappear with a personality change and metal arms.
Like them, human 1.0’s problem with our transgenic and transhuman super-descendants may be to persuade them that we belong in the brave new world at all. Particularly in present numbers. Ordinary people have struggled to respect everyone’s right to live. Not all ordinary people worldwide do respect it. Some of us think the world would be better if other somes of us weren’t here. Someone whose home land the rising sea is overwhelming may wish almost everybody else gone. Or course, as things are, the sea rise will continue even then. My point is that beings objectively superior to us may be unsentimental about 8 billion of the older product.
Growing yourself a healthy new organ may be tricky if you’re already sick. Spare-part clone stories are basically a horror setup but also basically slavery. Human beings without human rights. That is not a new concept. How clones are born may be hazy, in Star Trek you can create an adult duplicate in a machine or spare parts as a pill or a “hologram”, duplicate the brain as well, but in other settings, people have to be grown basically the same way as now although they are someone else’s generic duplicate. In 2024 this is solved in animals. It just happens to be illegal in humans. Of course, with no accelerated growth at all – and that depends – spare part clones are a long term and very expensive product. Like teenagers. Full size fresh organs come in full size humans, if not necessarily with full size brains, And humans eat. You can offset cost if they actually are used as slave labor too. But then maybe that’s dangerous work. so you need several copies of each original person. And as workers, they’ll eat more. For slaves and the rightless to outnumber the full citizens also isn’t without precedent. The United States of 2024 would stagger if rightless adults were removed. But I think our transhuman masters won’t bother to have therapeutic clones of us in the first place. Some humans in 2024 clone a beloved dog, most don’t, we just get another dog.
Clones with restricted height might be safer and cheaper and may and may not be medically suitable but, unfortunately for serious SF and social parable, funny by default.
The original “Mondasian” Cybermen of “The Tenth Planet” were clearly part-organic; they had exposed human hands, and their faces were more like cotton-mesh bandages with mouth holes than rigid masks. The later, more robotic redesign was more about the practicality of the suits than anything else. Kit Pedler, the show’s science advisor at the time (the show actually was relatively scientifically literate during his tenure), was a science writer and medical scientist, and it’s well-documented that he created the Cybermen as a representation of his concerns about how medical advances like artificial life support and transplantation could be abused or end up dehumanizing people.
The Daleks are overtly an allegory for the Nazis. Their travel machines are not artificial life support (the mutants inside can thrive and be quite dangerous without them) but more like personal tanks, symbolizing their militancy and deliberate isolation of themselves from contact with others.
“Growing yourself a healthy new organ may be tricky if you’re already sick.”
When did I say anything about doing it yourself? What I’m saying is that, if there are medical institutions advanced enough to grow and maintain full living clones of people, those same institutions could simply grow individual organs as needed. Presumably healthy individuals would donate stem cell supplies that would be preserved at a hospital, like donating blood to a blood bank, and if a person needed an organ replaced, the hospital could grow or 3-D bioprint a replacement organ from the patient’s own stockpiled cells.
I think organs will go on being tricky to grow or build in a laboratory for a while. Organs grow best inside organisms, You can feed them on blood in a machine but I think it’s obviously not solving the problem.
In April 2024, Richard “Rick” Slayman was discharged from Massachusetts General Hospital with a genetically altered pig kidney beating in his chest, or whatever a kidney does and where. Anyway, for real, but does that sound to you like chapter one of something? Like “The Slayman #1: I Am A Chimera”. “The Slayman #2: I Ham What I Ham”.
Yeah, but my point is that cloning entire human beings is likely to be even harder. After all, these stories about clones created to be slaughtered for their organs usually assume the clones are grown technologically rather than in mothers’ wombs. So I find it implausible that a future society with the technology to clone entire people technologically would not find it easier to do so with individual organs.
Technology aside, like I said, growing entire people just for individual organs is incredibly inefficient and overcomplicated. Even if it was initially easier to grow and harvest whole clones, I’d think the profound wastefulness of the process would be a strong incentive to develop a way to clone individual organs instead.
Besides, you don’t need to grow the organs if you have 3D bioprinter technology. You just need to culture the individual cell types and print them layer by layer in a biodegradable matrix that gives the organ its shape.
We’re not at a point to “just culture the individual cell types and print them” yet, or I say again, soon, particularly if you want me to culture your cells and build you a kidney or liver without a rejection problem. Cells inside an organ are very specialised, they only live inside that organ, and that organ needs most of the other organs for it to exist.
Whereas you can get a genetically altered pig now, or at least, probably before you die. Although I’m sorry to say that Rick Slayman has passed away, in May 2024, seven weeks after the transplant, rather less time since he was released from hospital. More time, they say, than he’d have had without the surgery. Medical science advances. Anyway, I don’t know if you’d herd.