The Dismantling

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When he first took the job, Simon wondered how he would possibly locate donors. Recipients he understood. These people talked to each other; there were message boards, forums, as well as old-fashioned word of mouth. Theirs was a community that traded in the currency of hope. Besides, Peter DaSilva had access, through his coordinating job at Cabrera, to two of the relevant waiting lists: the United Network for Organ Sharing’s and Cabrera’s own. He knew who needed a liver or a kidney, who wasn’t going to get one anytime soon, and who could afford to pay a lot of money not to wait any longer. When someone fulfilled all three criteria, he might offhandedly direct the candidate to one of a few online message boards populated by the transplant community, where, under pseudonymous handles, Simon posted testimonials describing how a friend or a spouse or an uncle had found the answer to his transplant troubles by contacting the good folks at Health Solutions. That DaSilva himself was involved with this company—was, in fact, its proprietor—never occurred to the candidates, which was, of course, exactly how he wanted things.

Donors though? It wasn’t as if Simon could just walk around Times Square, waving a wad of cash. This wasn’t Chennai or Manila in the nineties, where whole neighborhoods of young men, he’d heard, would suddenly exhibit the exact same scar in the exact same location on their torsos. During his first meeting, before DaSilva had finished explaining how Health Solutions worked, Simon imagined he’d have to fly to Brazil, Turkey, Syria, Moldova, offering a few thousand dollars and a trip to New York City to whomever was willing to part with a kidney. He’d imagined skulking around the worst neighborhoods of New York like a drug dealer or a pimp, trawling for the desperate, the easy marks. He didn’t know if he could bring himself to do it. The exploitation was too frank, the moral ambiguity of utilitarianism shading into the self-evident amorality of raw, unfettered capitalism.

But it turned out none of this was necessary, not anymore. Not in 2008. It turned out that plenty of people in what one might think of as the middle class—or people who were once in that class or who wanted to appear to be in that class—were open to the idea. Why not sell something that cost you nothing to own in the first place? It was a kind of entrepreneurship of the body, a utilization of previously untapped resources. These weren’t people in need of food or shelter. These were people in need of a car, college tuition, debt relief. Simon’s very first client wanted LASIK and a nose job; why not, she reasoned, let one surgery pay for two more? As the spring of 2008 slipped into summer, and now turned to fall, the list of people—American citizens, no less—who might be interested in the company’s services grew longer and longer, and Simon’s e-mail inbox began to brim with the kind of inquiries he’d feared he would have to sift through the most wretched corners of the third world to find. As the jobs accumulated, Simon’s ethical queasiness over his role in these transactions was calmed by his donor-clients’ embrace of a wonderfully mutable philosophy of self-empowerment, a worldview that made easy room for the conversion of flesh to cash, for the literal capitalization of the self. These people knew the score, knew what they were getting into, at least as much as they could without having gone through it already. Who was he to stand priggishly in judgment of them or of himself?

Also, he was making badly needed money—and fast—which didn’t hurt.