I mentioned a while back that I was having trouble with the setting that I had “developed” for my earlier piece of flash fiction.  I put “developed” in quotes because, let’s face it, I really just made stuff up and went with it at the time.  I didn’t care about making anything make much sense, I just wanted to follow the flavor that I had found in the first few moments of thinking about what I’d do with my catalyst phrase.

But I’ve been thinking further about the setting, and about what would be necessary to make a few basic tenets of the setting possible.  What do I know definitely exists?  It’s a little messy, but here’s a rough list:

• Brain transplants are possible, shifting from an old body to a new one.
• There are things called “chop-shops,” and chop-shop gangs, and they are basically analogous to auto chop-shops except that they deal with human tissue instead of car parts.
• Therefore, there is widespread black market expertise in surgery and tissue transplantation, and presumably lower rates of tissue rejection than there are in our current world.
• There is a notable criminal underground, and elements of it have penetrated and corrupted law enforcement.
• Criminal predation on civilians is fairly common, as witnessed by general warnings against travel through specific areas of the setting’s city.
• The city has dock and warehouse districts, which are strongly influenced (if not controlled by) the criminal underground.

If I want this to all fit together without it simply being bio-fantasy, I need to come up with some good reasons for these various things existing, let alone coexisting.

Starting with the brain transplants, I decided that it would make sense to say that there was some technology that made it easier to regenerate nerve tissue and repair damage.  As best as I understand from Wikipedia, we’re perfectly capable of putting a brain in a new body at present… the real problem is that we can’t hook up the brain to anything in the new body because we can’t regenerate nerve tissue.  So if I dream up a product called Neurogen (let’s ignore the fact that there’s already something by that name, I didn’t know that at the time that I came up with the name), we can pretend that it is essentially something that causes nervous tissue to regrow and form new connections with other nervous tissue in close proximity.  It is a modified function of the body’s normal growth, so this doesn’t solve neurological disorders.  It does, however, make it possible to reconnect severed nerves far faster and more easily than is currently the case.  Let’s just say that, as long as I’m dreaming up a miracle, it will also reduce the amount of time necessary to retrain newly connected nerves and muscles, dropping the necessary recovery time from years to … months or weeks, perhaps.  We’re already transplanting or reattaching limbs, so this seems like a mostly acceptable future jump.

This means that there are far fewer people with paralysis due to trauma, and spinal damage is far less debilitating in the long term than it used to be.  Maybe this enables more adrenaline junkies, but the treatment is probably also relatively expensive, and (based on my understanding of how this works) it won’t stop things like ALS.

On to the chop shops.  There are several things that stand out to me about the concept of human chop-shops: there are problems with disease transmission, there are problems with tissue rejection, there are societal conditions needed to make widespread black market transplants practicable, and there are technological barriers to maintaining healthy tissues beyond a just-in-time supply chain.

Taking those in order, I’m going to ignore the whole disease transmission problem.  I figure some chop shops will be more careful than others, and your chances of getting an infection will vary by where you get your new kidney.

With tissue rejection, I posit that advances in immunosuppression drugs should make this less of a concern.  We’re already fairly good at dealing with this, and (as I understand it) the health of the transplanted organ is generally more of an issue.  That is, more rejection problems and followup complications can be solved by improving tissue health prior to and during transplantation than would be quickly solved with better immunosuppression drugs, especially true given that immunosuppression drugs hurt the body’s chances of fighting off any infection introduced by the new tissue or during the transplantation.  That should be partially addressed by my consideration of the last point.

But what about those societal conditions?  Previous black market transplantation has thrived in areas with legal organ transplants, a sufficiently large body of medical knowledge, basic medical facilities, easy travel, and a relatively large disadvantaged population (prisoners, the unprotected poor, etc.).  My real life examples for this are India in the early 90s, China for an unknown period of time, and the Philippines until 2008.  There are reports of kidnappings in Mexico tied to organ trafficking rings, and regardless of how accurate those reports are I find that idea intriguing, so I’ll add kidnapping victims to that list.  To me, the simultaneous requirements for a large body of medical knowledge, medical facilities, easy travel, and a large vulnerable population suggest a society with a large wealth imbalance.  This goes nicely with the kidnapping idea, since the unprotected poor are more likely to be vulnerable to predation by criminal gangs associated with chop shops, and any roughly middle class kidnapping victim can be given the choice between paying ransom and being used for transplantation, if they aren’t simply given the millionaire’s tour.

Wealth imbalance coupled with weak public institutions lends itself to easy corruption of public institutions, since the average worker will be looking for whatever they can get to pad out their meager paycheck.  This means that there will be wealthy members of society with sections of the public security apparatus on their private payroll, and some of those wealthy members of society will be criminals (when you routinely break the law, owning the public security apparatus is a good business investment).  I think that’s enough on that topic for the moment, though it no doubt deserves further examination.

Which brings us to that last point, and the super cool heart-in-a-box.  We now have hardware that can maintain healthy function of organs post-removal, reducing the time pressure that normally surrounds any transplant operation and potentially giving doctors the opportunity to monitor extracted tissue and treat some pre-existing conditions prior to implantation.  Apparently this is an especially big deal with lung transplants.

I think that answers most of the issues above, if not all of them.  I’ll do more investigation on this topic later.

****

Well shit.  My friend just told me about 3D printing of organs.  I’m not sure what this does, though maybe this is a disruptive technology in this story world, one being fought by the traditional organleggers in a luddite-like response to the potential destruction of their source of revenue.  Time to go burn down the organ-printers, and chop up the scientists for their organs.  Or something.

I had previously disregarded the disruptive effects of cloning based on the premise that growing and maintaining most organs until they were sufficiently mature for healthy & functional transplant would be more expensive than grabbing “user-guaranteed” organs from a relatively healthy abductee.  But this 3D printing stuff may require me to start over with some of this in order to incorporate it without breaking the setting.  Or maybe I just need to break the setting after all.