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Caught in the Organ Draft?by Robert SilverbergLook there, Kate, down by the promenade. Two splendid seniors, walking side by side near the water's edge. They radiate power, authority, wealth, assurance. He's a judge, a senator, a corporation president, no doubt, and she's—what?—a professor emeritus of international law, let's say. There they go toward the plaza, moving serenely, smiling, nodding graciously to passersby. How the sunlight gleams in their white hair! I can barely stand the brilliance of that reflected aura: it blinds me, it stings my eyes. What are they, eighty, ninety, a hundred years old? At this distance they seem much younger—they hold themselves upright, their backs are straight, they might pass for being only fifty or sixty. But I can tell. Their confidence, their poise, mark them for what they are. And when they were nearer I could see their withered cheeks, their sunken eyes. No cosmetics can hide that. These two are old enough to be our great-grandparents. They were well past sixty before we were even born, Kate. How superbly their bodies function! But why not? We can guess at their medical histories. She's had at least three hearts, he's working on his fourth set of lungs, they apply for new kidneys every five years, their brittle bones are reinforced with hundreds of skeletal snips from the arms and legs of hapless younger folk, their dimming sensory apparatus is aided by countless nerve-grafts obtained the same way, their ancient arteries are freshly sheathed with sleek teflon. Ambulatory assemblages of secondhand human parts, spliced here and there with synthetic or mechanical organ substitutes, that's all they are. And what am I, then, or you? Nineteen years old and vulnerable. In their eyes I'm nothing but a ready stockpile of healthy organs, waiting to serve their needs. Come here, son. What a fine strapping young man you are! Can you spare a kidney for me? A lung? A choice little segment of intestine? Ten centimeters of your ulnar nerve? I need a few pieces of you, lad. You won't deny a distinguished elder like me what I ask, will you? Will you?· · · · ·Today my draft notice, a small crisp document, very official-looking, came shooting out of the data slot when I punched for my morning mail. I've been expecting it all spring; no surprise, no shock, actually rather an anticlimax now that it's finally here. In six weeks I am to report to Transplant House for my final physical exam—only a formality; they wouldn't have drafted me if I didn't already rate top marks as organ-reservoir potential—and then I go on call. The average call time is about two months. By autumn they'll be carving me up. Eat, drink, and be merry, for soon comes the surgeon to my door.· · · · ·A straggly band of senior citizens is picketing the central headquarters of the League for Bodily Sanctity. It's a counterdemonstration, an anti-anti-transplant protest, the worst kind of political statement, feeding on the ugliest of negative emotions. The demonstrators carry glowing signs that say:BODILY SANCTITY—OR BODILY SELFISHNESS?And:YOU OWE YOUR LEADERS YOUR VERY LIVESAnd:LISTEN TO THE VOICE OF EXPERIENCE· · · · ·The picketers are low-echelon seniors, barely across the qualifying line, the ones who can't really be sure of getting transplants. No wonder they're edgy about the League. Some of them are in wheelchairs and some are encased right up to the eyebrows in portable life-support systems. They croak and shout bitter invective and shake their fists. Watching the show from an upper window of the League building, I shiver with fear and dismay. These people don't just want my kidneys or my lungs. They'd take my eyes, my liver, my pancreas, my heart, anything they might happen to need.· · · · ·I talked it over with my father. He's forty-five years old—too old to have been personally affected by the organ draft, too young to have needed any transplants yet. That puts him in a neutral position, so to speak, except for one minor factor: his transplant status is 5-G. That's quite high on the eligibility list, not the top-priority class but close enough. If he fell ill tomorrow and the Transplant Board ruled that his life would be endangered if he didn't get a new heart or lung or kidney, he'd be given one practically immediately. Status like that simply has to influence his objectivity on the whole organ issue. Anyway, I told him I was planning to appeal and maybe even to resist. "Be reasonable," he said, "be rational, don't let your emotions run away with you. Is it worth jeopardizing your whole future over a thing like this? After all, not everybody who's drafted loses vital organs.""Show me the statistics," I said. "Show me."He didn't know the statistics. It was his impression that only about a quarter or a fifth of the draftees actually got an organ call. That tells you how closely the older generation keeps in touch with the situation—and my father's an educated man, articulate, well-informed. Nobody over the age of thirty-five that I talked to could show me any statistics. So I showed them. Out of a League brochure, it's true, but based on certified National Institute of Health reports. Nobody escapes. They always clip you, once you qualify. The need for young organs inexorably expands to match the pool of available organpower. In the long run they'll get us all and chop us to bits. That's probably what they want, anyway. To rid themselves of the younger members of the species, always so troublesome, by cannibalizing us for spare parts, and recycling us, lung by lung, pancreas by pancreas, through their own deteriorating bodies.· · · · ·Fig. 4. On March 23, 1964, this dog's own liver was removed and replaced with the liver of a nonrelated mongrel donor. The animal was treated with azathioprine for 4 months and all therapy then stopped. He remains in perfect health 6-2/3 years after transplantation.· · · · ·The war goes on. This is, I think, its fourteenth year. Of course they're beyond the business of killing now. They haven't had any field engagements since '93 or so, certainly none since the organ-draft legislation went into effect. The old ones can't afford to waste precious young bodies on the battlefield. So robots wage our territorial struggles for us, butting heads with a great metallic clank, laying land mines and twitching their sensors at the enemy's mines, digging tunnels beneath his screens, et cetera, et cetera. Plus, of course, the quasi-military activity—economic sanctions, third-power blockades, propaganda telecasts beamed as overrides from merciless orbital satellites, and stuff like that. It's a subtler war than the kind they used to wage: nobody dies. Still, it drains national resources. Taxes are going up again this year, the fifth or sixth year in a row, and they've just slapped a special Peace Surcharge on all metal-containing goods, on account of the copper shortage. There once was a time when we could hope that our crazy old leaders would die off or at least retire for reasons of health, stumbling away to their country villas with ulcers or shingles or scabies or scruples and allowing new young peacemakers to take office. But now they just go on and on, immortal and insane, our senators, our cabinet members, our generals, our planners. And their war goes on and on, too, their absurd, incomprehensible, diabolical, self-gratifying war.· · · · ·I know people my age or a little older who have taken asylum in Belgium or Sweden or Paraguay or one of the other countries where Bodily Sanctity laws have been passed. There are about twenty such countries, half of them the most progressive nations in the world and half of them the most reactionary. But what's the sense of running away? I don't want to live in exile. I'll stay here and fight.· · · · ·Naturally they don't ask a draftee to give up his heart or his liver or some other organ essential to life, say his medulla oblongata. We haven't yet reached that stage of political enlightenment at which the government feels capable of legislating fatal conscription. Kidneys and lungs, the paired organs, the dispensable organs, are the chief targets so far. But if you study the history of conscription over the ages you see that it can always be projected on a curve rising from rational necessity to absolute lunacy. Give them a fingertip, they'll take an arm. Give them an inch of bowel, they'll take your guts. In another fifty years they'll be drafting hearts and stomachs and maybe even brains, mark my words; let them get the technology of brain transplants together and nobody's skull will be safe. It'll be human sacrifice all over again. The only difference between us and the Aztecs is one of method: we have anesthesia, we have antisepsis and asepsis, we use scalpels instead of obsidian blades to cut out the hearts of our victims.· · · · ·MEANS OF OVERCOMING THE HOMOGRAFT REACTIONThe pathway that has led from the demonstration of the immunological nature of the homograft reaction and its universality to the development of relatively effective but by no means completely satisfactory means of overcoming it for therapeutic purposes is an interesting one that can only be touched upon very briefly. The year 1950 ushered in a new era in transplantation immunobiology in which the discovery of various means of weakening or abrogating a host's response to a homograft—such as sublethal whole body X-irradiation, or treatment with certain adrenal cortico-steroid hormones, notably cortisone—began to influence the direction of the mainstream of research and... [ Pobierz całość w formacie PDF ]
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Caught in the Organ Draft?by Robert SilverbergLook there, Kate, down by the promenade. Two splendid seniors, walking side by side near the water's edge. They radiate power, authority, wealth, assurance. He's a judge, a senator, a corporation president, no doubt, and she's—what?—a professor emeritus of international law, let's say. There they go toward the plaza, moving serenely, smiling, nodding graciously to passersby. How the sunlight gleams in their white hair! I can barely stand the brilliance of that reflected aura: it blinds me, it stings my eyes. What are they, eighty, ninety, a hundred years old? At this distance they seem much younger—they hold themselves upright, their backs are straight, they might pass for being only fifty or sixty. But I can tell. Their confidence, their poise, mark them for what they are. And when they were nearer I could see their withered cheeks, their sunken eyes. No cosmetics can hide that. These two are old enough to be our great-grandparents. They were well past sixty before we were even born, Kate. How superbly their bodies function! But why not? We can guess at their medical histories. She's had at least three hearts, he's working on his fourth set of lungs, they apply for new kidneys every five years, their brittle bones are reinforced with hundreds of skeletal snips from the arms and legs of hapless younger folk, their dimming sensory apparatus is aided by countless nerve-grafts obtained the same way, their ancient arteries are freshly sheathed with sleek teflon. Ambulatory assemblages of secondhand human parts, spliced here and there with synthetic or mechanical organ substitutes, that's all they are. And what am I, then, or you? Nineteen years old and vulnerable. In their eyes I'm nothing but a ready stockpile of healthy organs, waiting to serve their needs. Come here, son. What a fine strapping young man you are! Can you spare a kidney for me? A lung? A choice little segment of intestine? Ten centimeters of your ulnar nerve? I need a few pieces of you, lad. You won't deny a distinguished elder like me what I ask, will you? Will you?· · · · ·Today my draft notice, a small crisp document, very official-looking, came shooting out of the data slot when I punched for my morning mail. I've been expecting it all spring; no surprise, no shock, actually rather an anticlimax now that it's finally here. In six weeks I am to report to Transplant House for my final physical exam—only a formality; they wouldn't have drafted me if I didn't already rate top marks as organ-reservoir potential—and then I go on call. The average call time is about two months. By autumn they'll be carving me up. Eat, drink, and be merry, for soon comes the surgeon to my door.· · · · ·A straggly band of senior citizens is picketing the central headquarters of the League for Bodily Sanctity. It's a counterdemonstration, an anti-anti-transplant protest, the worst kind of political statement, feeding on the ugliest of negative emotions. The demonstrators carry glowing signs that say:BODILY SANCTITY—OR BODILY SELFISHNESS?And:YOU OWE YOUR LEADERS YOUR VERY LIVESAnd:LISTEN TO THE VOICE OF EXPERIENCE· · · · ·The picketers are low-echelon seniors, barely across the qualifying line, the ones who can't really be sure of getting transplants. No wonder they're edgy about the League. Some of them are in wheelchairs and some are encased right up to the eyebrows in portable life-support systems. They croak and shout bitter invective and shake their fists. Watching the show from an upper window of the League building, I shiver with fear and dismay. These people don't just want my kidneys or my lungs. They'd take my eyes, my liver, my pancreas, my heart, anything they might happen to need.· · · · ·I talked it over with my father. He's forty-five years old—too old to have been personally affected by the organ draft, too young to have needed any transplants yet. That puts him in a neutral position, so to speak, except for one minor factor: his transplant status is 5-G. That's quite high on the eligibility list, not the top-priority class but close enough. If he fell ill tomorrow and the Transplant Board ruled that his life would be endangered if he didn't get a new heart or lung or kidney, he'd be given one practically immediately. Status like that simply has to influence his objectivity on the whole organ issue. Anyway, I told him I was planning to appeal and maybe even to resist. "Be reasonable," he said, "be rational, don't let your emotions run away with you. Is it worth jeopardizing your whole future over a thing like this? After all, not everybody who's drafted loses vital organs.""Show me the statistics," I said. "Show me."He didn't know the statistics. It was his impression that only about a quarter or a fifth of the draftees actually got an organ call. That tells you how closely the older generation keeps in touch with the situation—and my father's an educated man, articulate, well-informed. Nobody over the age of thirty-five that I talked to could show me any statistics. So I showed them. Out of a League brochure, it's true, but based on certified National Institute of Health reports. Nobody escapes. They always clip you, once you qualify. The need for young organs inexorably expands to match the pool of available organpower. In the long run they'll get us all and chop us to bits. That's probably what they want, anyway. To rid themselves of the younger members of the species, always so troublesome, by cannibalizing us for spare parts, and recycling us, lung by lung, pancreas by pancreas, through their own deteriorating bodies.· · · · ·Fig. 4. On March 23, 1964, this dog's own liver was removed and replaced with the liver of a nonrelated mongrel donor. The animal was treated with azathioprine for 4 months and all therapy then stopped. He remains in perfect health 6-2/3 years after transplantation.· · · · ·The war goes on. This is, I think, its fourteenth year. Of course they're beyond the business of killing now. They haven't had any field engagements since '93 or so, certainly none since the organ-draft legislation went into effect. The old ones can't afford to waste precious young bodies on the battlefield. So robots wage our territorial struggles for us, butting heads with a great metallic clank, laying land mines and twitching their sensors at the enemy's mines, digging tunnels beneath his screens, et cetera, et cetera. Plus, of course, the quasi-military activity—economic sanctions, third-power blockades, propaganda telecasts beamed as overrides from merciless orbital satellites, and stuff like that. It's a subtler war than the kind they used to wage: nobody dies. Still, it drains national resources. Taxes are going up again this year, the fifth or sixth year in a row, and they've just slapped a special Peace Surcharge on all metal-containing goods, on account of the copper shortage. There once was a time when we could hope that our crazy old leaders would die off or at least retire for reasons of health, stumbling away to their country villas with ulcers or shingles or scabies or scruples and allowing new young peacemakers to take office. But now they just go on and on, immortal and insane, our senators, our cabinet members, our generals, our planners. And their war goes on and on, too, their absurd, incomprehensible, diabolical, self-gratifying war.· · · · ·I know people my age or a little older who have taken asylum in Belgium or Sweden or Paraguay or one of the other countries where Bodily Sanctity laws have been passed. There are about twenty such countries, half of them the most progressive nations in the world and half of them the most reactionary. But what's the sense of running away? I don't want to live in exile. I'll stay here and fight.· · · · ·Naturally they don't ask a draftee to give up his heart or his liver or some other organ essential to life, say his medulla oblongata. We haven't yet reached that stage of political enlightenment at which the government feels capable of legislating fatal conscription. Kidneys and lungs, the paired organs, the dispensable organs, are the chief targets so far. But if you study the history of conscription over the ages you see that it can always be projected on a curve rising from rational necessity to absolute lunacy. Give them a fingertip, they'll take an arm. Give them an inch of bowel, they'll take your guts. In another fifty years they'll be drafting hearts and stomachs and maybe even brains, mark my words; let them get the technology of brain transplants together and nobody's skull will be safe. It'll be human sacrifice all over again. The only difference between us and the Aztecs is one of method: we have anesthesia, we have antisepsis and asepsis, we use scalpels instead of obsidian blades to cut out the hearts of our victims.· · · · ·MEANS OF OVERCOMING THE HOMOGRAFT REACTIONThe pathway that has led from the demonstration of the immunological nature of the homograft reaction and its universality to the development of relatively effective but by no means completely satisfactory means of overcoming it for therapeutic purposes is an interesting one that can only be touched upon very briefly. The year 1950 ushered in a new era in transplantation immunobiology in which the discovery of various means of weakening or abrogating a host's response to a homograft—such as sublethal whole body X-irradiation, or treatment with certain adrenal cortico-steroid hormones, notably cortisone—began to influence the direction of the mainstream of research and... [ Pobierz całość w formacie PDF ]