Corey Black walks with his nose tipped down to the ground but his eyes glaring dead ahead. His long black hair hides his pale hollow face from the sun, and it bounces with his stride. As he picks up speed outside the downtown library, his baggy black jeans and black button-down shirt press against his hungry frame. Then Corey stops short and with his right leg performs a snap kick.
Corey spends most of his time at the library. An overstuffed black backpack sags from his shoulders, and he could be a suburban high-schooler bound for Hot Topic. But Corey hasn't changed clothes in weeks. His hair is matted and dirty. He keeps his wallet on a chain because he often gets robbed. At 20, he's one of the youngest people living on the street. His pointy goatee and thin moustache are overgrown with peach fuzz.
Someone asks how he's doing. "Breathing," he says.
Corey's mood can shift unpredictably. His expressions change. But the look in his eyes is constant. It says, I'm smarter than you, and, you'll see.
Inside the library, Corey reads books such as Immortality: How Science is Extending Your Life and Changing the World and Quantum Evolution. He surfs the Web, and he hatches fanciful plans. He could work online. He could make $800 a week donating sperm. He could invent new medicine with his knowledge of herbs and plants. He could create the first carbon- and nitrogen-based hybrid life form.
One of Corey's fantasies is about to come true. He can sell his kidney.
Corey drifted into Houston from Kentucky about a year ago. He has since had a single source of occasional income. During Astros games and other big events, Corey says, he works under the table as a parking-lot attendant for a man named Albert Kalas. Kalas and his family own several lots around Minute Maid Park, along with a bar on Franklin Street called Eighteen Twenty and the adjoining arcade and pinball showroom, Joystix, where he keeps his office. According to county records, the Kalases own more than 20 commercial properties in Houston with a combined market value of more than $8.5 million.
Kalas, 72, is a gruff and stocky man who wears flannel shirts to work. He has a full head of black and gray hair, which he keeps slicked straight back. According to his son Charles, who owns and operates Joystix, Kalas emigrated from Greece at a young age with three dollars in his pocket, and from there he built himself into a successful and enviable businessman.
In the late 1990s, a local TV station filmed Kalas allegedly bribing three city building inspectors with free meals and drinks at a restaurant he owned then, which it estimated to amount to thousands of dollars. It also reported that the inspectors had not challenged code violations at some of Kalas's properties. The inspectors were subsequently disciplined and reassigned. Kalas, who wasn't charged, unsuccessfully sued for libel.
Corey got his job with Kalas through a man named Gilbert Coronado, a 29-year-old with a long rap sheet whom he met at the Star of Hope men's shelter down the street from Joystix. Corey says Gilbert approached him one day with a proposition. Kalas had a relative who was on dialysis and near death, and Kalas was looking to purchase a kidney. The initial offer, Corey says, was $10,000, and it later increased to $15,000. As Corey tells it, in February Kalas drove Corey and Gilbert to a local clinic so Corey could get his blood typed. He's Type O, the universal donor. With Kalas listening in on speakerphone, Corey says, he phoned St. Luke's Episcopal Hospital and made himself an appointment.
Buying or selling an organ is a felony punishable by five years in prison and/or a $50,000 fine — and it's believed to be rare in the United States. But it's also exceedingly difficult to prove. The 1984 federal law that prohibits organ sales has apparently never been litigated.
When contacted by the Houston Press on his cell phone, Kalas denied everything. He refused to speak in person to address Corey's claims. "Whoever's telling you that is full of shit," he said.
When informed of specific evidence collected by the Press, Kalas quickly ended the conversation. "I don't know what you're talking about anyway," he said, and hung up. Both Kalas and his son Charles refused additional requests for comment. Since it is not clear whether the kidney recipient knew of the circumstances leading up to his operation, the Press is not publishing his name.
In a recorded phone conversation, Corey and Kalas discuss the donation process and negotiate a bonus on the $15,000.
In another recorded conversation, Corey and Gilbert discuss the proposed kidney transaction in detail, mentioning both Kalas and his relative by name.
And hospital records show that on March 5, Corey walked into St. Luke's to begin the process of donating his kidney to a man he says he has never met. All he had to do was lie his way through.
"How much blood you got?" Mary wants to know, four days later.
Corey and his girlfriend are sitting, as usual, inside a study room in the library. Corey commands two laptops, at the helm of an online RPG (role-playing game). He is a vampire.
"2,635," he says.
"You been bitin'."
Mary is 29 and homeless, with five young children in the state's care. It's not clear that Corey likes her. She's black; he says he's racist. He just needs the company. And once a month Mary gets a disability check in the mail.
Corey is chipper today. He believes he aced the donor screening at St. Luke's. Pending some more lab work and additional blood pressure tests, he expects to be on the operating table by the end of the month. It's Monday. The donor coordinator presents his case to the medical review board on Wednesday.
"I was an ex-co-worker of [Kalas's relative], and I'm technically a friend of his — that's the line," Corey says. "See, I don't know the guy exactly, so I can't really say I'm just doing it because they told me to, because if I do they'll ask me why, and if I tell them I'm getting paid, then they'll stop it."
Corey met with a financial adviser first, to go over how the recipient's insurance would foot his bill. Then he was evaluated by a nephrologist, or kidney doctor. His primary foe during the screening was the social worker.
"She pretty much wanted to make sure I'm in the right state of mind — I'm not crazy, nobody convinced me to do it," Corey says. "So I had to convince her. I pretty much had to explain that to her without being riddled into a confession."
Corey believes he can manipulate almost anyone. One day during a fight with Mary, he convinced her he is really a 30-year-old man named Gary Chillings. Gary is the love of Mary's life. He appeared one day on the playground when she was a child, kissed her and vanished. Mary believes they've been reunited.
Mary has been in and out of the local psychiatric wards, and she may have even run off once or twice. Her claim to fame around the local homeless community is biting a Metro cop. She becomes frantic at the drop of a hat. She threatens suicide.
Corey's own mental history stems from a horrifically abusive childhood. He's been off his medication for over a year. He believes it makes him into a "zombie" — which is "what the government wants." He has post-traumatic stress disorder, and he's bipolar. He also has a "schizotypal" personality, a less serious offshoot of schizophrenia that sees him withdraw from the real world and into his own fantasies.
On Wednesday, after he and Mary share a lunch of canned sausages, peanut butter crackers and chocolate cake, he picks up his cell phone and calls Marta Zeledon, his donor coordinator at St. Luke's.
The only place where the hospital almost stopped him, Corey says, was his blood pressure. It was too high. He attributed it to nerves, and was instructed to do follow-up tests, which St. Luke's allows patients to administer on their own. Corey used the blood pressure machines in the tunnels beneath the library. He had planned to lie if they were too high, even though he suspected that, with just one kidney, high blood pressure could kill him.
"You live, you die. There's no meaning, there's no reason," he had said. This is one of his favorite maxims.
Now he decides against lying. In a different mood, he acknowledges that the money will be no good to him dead. Zeledon records the results, which are still a little high. She will meet with the board later in the day and let him know.
Corey says that Kalas has promised to pay him just before the surgery, by taking him to the bank, helping him to open an account and writing him a check. Corey fantasizes about outsmarting him. He takes the money. He freezes his account. He gets on the operating table. At the last minute, he tells the doctors he can't go through with it. Then he makes off like a phantom and disappears forever.
He knows this will never happen.
Corey says Kalas has offered a raise on the promised $15,000 if he moves quickly through the process. He calls to make sure.
Corey: Hey Albert, this is Corey.
K: Yeah, Corey, what's going on?
C: Um, I talked to the doctor earlier today, and I did both the blood pressure things, and they...
C: ...said they were going to talk to the board and call me back later.
K: Great, great.
C: Um, question —
C: Remember when I was talking to you earlier and you said that I was pretty close — er — if I did it quickly, that you would increase it to 25...
Corey's voice weakens. He's nervous.
C: ...Er — not 25, but a bonus for the 15? My bad...
C: Am I doing it quick enough?
C: All right.
K: So from 15 to 20, that's what it is. Okay?
C: All right.
K: All right.
And Kalas ends the call.
Dr. Arthur Matas thinks people should be paid for their kidneys.
The director of renal transplants at the University of Minnesota is the de facto leader of a growing pro-compensation contingent. When he began advocating for it six years ago, he says, his proposal was met mostly by shock and anger. He still tries to avoid public forums and the popular passion they can encourage. Slowly but surely, though, the medical community is coming around — at least to the idea of trying it out.
That's because chronic kidney disease has become an epidemic. The waiting list for kidney transplants in the United States has reached 78,000, and about a third of the people on it will die before they get one. The average wait is now three to five years.
"In general, most people who are involved in this debate are talking about a regulated system of compensation [that comes from the government]. It's not rich buying from poor. You can have control, regulation and long-term follow-up," Matas says.
"I think you have to get rid of the rhetoric and simply say, what's worse?" he says. "Maintaining the status quo, where the patients are suffering and dying on dialysis, or taking a big step and at least trying?"
Part of the spike in demand results from improving transplant work. And better medicine in general means more people reach end-stage kidney disease. Mainly, though, Americans keep getting fatter. The causes of kidney disease and failure are more prevalent than ever, and expected to double in ten to 15 years. Even children now have high blood pressure and diabetes.
Dr. A. Osama Gaber chairs the Texas governor's task force on chronic kidney disease and says this state is in especially bad shape. He is leading an unprecedented push for state-level data collection and eventually prevention. But the best hope remains in finding more living donors, and this has inspired some bold initiatives in the transplant field.
As transplant director at Methodist, Gaber has been using "paired" donations, where people with willing but incompatible donors effectively swap them. He is also laying down the infrastructure for kidney chains, in which an unsolicited kidney from a purely altruistic donor can be used to leverage further donations. The massive database needed to fully implement these processes at a national level is just getting underway. Even when clicking on all cylinders, Gaber says, this will only make a dent in the demand (see "You Want A Piece of Me? Let's Make A Deal").
"Would they solve the problem? I don't think anything would solve the problem."
But Gaber maintains this doesn't mean all options should be on the table. He says the compensation debate is one he tries to avoid, because his view — that it should be forbidden at all costs — is no longer popular.
Gaber believes that operating on a donor motivated by anything other than altruism would violate his Hippocratic Oath. And he says compensation would bring about one of two uncomfortable realities. The government would be forced to regulate an organ market — "a pretty grim thing to do." Or, he says, "You would do what the transplant society says shouldn't be done, which is take the bodies of the poor and put them in the rich."
Dr. Benjamin Hippen, a nephrologist at the Carolinas Medical Center in Charlotte, North Carolina, believes this is already happening — that the vast unmet demand for kidneys in rich countries creates black markets for them in poor ones. He became involved in the compensation discussion specifically to address the specter of transplant tourism. It is currently not illegal in the U.S. to travel abroad and buy an organ.
As for whether illegal purchases happen here, Hippen, like most nephrologists, says it's possible but probably rare.
The basis for most opposition to compensation, Hippen says, is what he calls the "yuck factor." People conflate selling one's kidney with selling oneself, and they worry about exploitation of the poor.
"It's surely the case that marketing organs could be degrading and alienating," Hippen says. "But it need not be."
To start, Hippen believes people living in poverty should not be allowed to donate at all — simply because chronic kidney disease disproportionately affects the poor, and the usually small health risks that accompany donation become much greater for them.
But beyond that, Hippen suggests nontransferable, nonmonetary forms of government compensation that, as he puts it, "demonstrate the type of respect for a person selling their kidney that tossing a couple of bucks on the ground doesn't."
These could be anything from pension plans to lifelong health care. He says pilot projects are the best way to determine what, if anything, works best.
Late last year, Republican Senator Arlen Specter of Pennsylvania sponsored a bill that would amend the 1984 law against compensation to allow for exactly that. It's up for consideration this session.
Compensation's fiercest and most powerful opponent says the bill will never pass. As president of the United Network for Organ Sharing (UNOS), which collects and manages all transplant data and oversees the waiting list, Dr. Francis Delmonico holds considerable sway over transplant policy. While he challenges the idea of black markets, and even the size of the waiting list, his primary contention is that any organ market would be impossible to regulate. A situation like Corey's, he says, "becomes a reality in markets."
"Once you have markets, there are markets. Get over it," he says. "Why should I have to go through [the government's] system?"
There is an almost imperceptible mark on Corey's wrist that testifies to one of his many abortive suicide attempts. He was about ten years old and locked alone in a room in the basement of a foster home. He tried to peel back his skin with a plastic knife and sever the artery.
Corey seems to have spent much of his childhood locked away — in mental hospitals, in principals' offices and in his mother's home in Louisville, Kentucky.
He claims his mother started beating him when he was very young. He was born on February 6, 1989, to a woman who'd had a fling with a much older man named Ernest Black. She kept custody, and Corey rarely saw his father, who died in 2006.
Judy Wooden, who lives in Louisville, didn't even know six-year-old Corey existed until her uncle Ernest brought him by one day. Wooden, who was a mother of two, remembers reaching over to pat Corey on the back. He jerked away. Beneath his shirt she found a line of scabs running down his spine. Soon afterward she filed for custody.
Corey brought in $800 a month from his father's workers' compensation, so his mother fought to keep him, Wooden says. According to both Corey and Wooden, his mother, who is white, identified only with black people. All of her other children were biracial. She resented Corey. He was seldom allowed to leave his room.
Corey says he began hitting his mother back when he was six. Her response was always more pills.
"The doctors, the only thing they would do was listen to his mother and give him more medicine," Wooden says. "He was on so much Zoloft he was just a zombie. He would just go to sleep."
When Wooden finally won custody, about a year after meeting Corey, she set him up with his own room — a nice bed, a TV. The first night, she bent down to tuck him in, holding a few coat hangers in her hand.
"Please don't," Corey said.
Corey terrified people. He would vow to kill himself. He climbed onto Wooden's lap, put his fingers to her throat and threatened to choke her. Her children had never seen anything like it.
"But he never applied any pressure, and I just held him really tight and sat in the chair with him and told him I loved him," Wooden says. "He needed that, you know? He had to put up that front to see who really cared."
Wooden's husband was verbally abusive to Corey. Corey would go to school and describe in gruesome detail how he had murdered him and Wooden's two children. Wooden was once called in from work to find Corey locked in the beleaguered principal's office, tearing up a textbook under the desk.
Wooden's work schedule and Corey's trouble with her husband forced her to give him up to the state after three years. It was a succession of hospitals and boys' homes from there.
Shortly after his 19th birthday, Corey went to stay with his mother. He says he found her smoking marijuana rolled in papers laced with crystal meth. He left after only a week to begin the trip that would eventually bring him to Houston.
By Wednesday evening the deal is off. Kalas's relative already has his new kidney. When Marta Zeledon, the donor coordinator at St. Luke's, walked in to address the medical review board, she learned that the relative was preparing for surgery. Luck had struck. A matching cadaver had arrived.
Kidneys from living donors are far superior to kidneys from cadavers. Transplants have better success rates, and they last longer too. But the Kalas family decided to go with the cadaver.
Mary is catatonic. She stares blankly into her lap, her crew-cut head lolling from side to side, mumbling about things that are too good to be true. Corey is growing frantic. He tries to call Kalas, over and over, but gets no answer. He even tries Kalas at home. He leaves a panicked message for Gilbert. He wonders if the cadaver's kidney might fail, and he might still get paid.
But a written report of Corey's assessment by the donor team at St. Luke's, which was obtained through his medical records, shows that he was very unlikely to make it past the review board. Corey hadn't been as persuasive as he'd thought.
Aside from his blood pressure, Corey was physically fine. But his unstable mental and social background did him in. Both the nephrologist and the social worker state that he is not a suitable donor.
In her report, Paula Waller, the social worker, politely notes the obvious — that Corey smells, spends time in homeless shelters and has none of the support network he would need to recover from serious surgery. Waller writes that Corey "made a number of odd, irrelevant remarks" during his interview. Among other things, he told her that Mary had recently lit his hand on fire to see how much pain he can handle.
Corey volunteered his mental history, but he was dismissive of it — he particularly dislikes the "schizotypal" label. Waller found it accurate. "[T]he patient's general presentation fit the definition of a schizotypal personality disorder quite well," she writes. "The disorder is characterized by a need for social isolation, odd behavior and thinking, and unconventional beliefs."
The situation was very obviously wrong.
Even so, neither Waller nor anyone else suggests anything unsavory is afoot. In her conclusion, Waller writes that, while Corey should not be permitted to donate, "his intentions are admirable."
St. Luke's would not permit its staff to comment about specific patients, despite Corey's willingness to sign a release. But it did allow general interviews with Waller and Penny Powers, who recently retired but was the transplant director at the time.
Waller says that her interviews are designed to educate the potential donor about the risks involved, and to make sure he understands them — as well as to gauge his mental and social situation, as she did in her report. Without having someone come right out and admit that he had been offered compensation, she says, challenging his motivations "would just be supposition on my part. I wouldn't have any proof."
Powers does not remember an instance of compensation having arisen in her 24 years in the hospital's transplant department. If one did occur, she says, she would refer the problem to the hospital's risk management and legal teams.
By law, donor and recipient teams are kept separate, to make it easier for donors who feel pressured to opt out. What the transplant community terms "coercion" — which can be anything from offers of compensation to guilt-tripping — can take place even within families. If a donor decides to opt out, the recipient is told only that he wasn't a suitable candidate.
But this separation means that the appearance of a suspicious unrelated donor such as Corey would not put any red flags next to the recipient's name the next time around.
(Corey thinks there were other employees of Kalas's trying to donate for money. He believed that he was competing with a woman who had been ordered to lose weight in order to be approved as a donor.)
"I think you have to say that every donor is treated equally," Powers says.
Its blood pressure standards notwithstanding — at Methodist, for instance, potential donors needing follow-up are given a machine to ensure accurate results — the screening process at St. Luke's mirrors those at other major hospitals.
Dr. Matthew Cooper, the director of kidney transplants at the University of Maryland, who chairs the Living Donor Committee at UNOS, says he has seen potential donors ruled out for trying to sell their kidneys.
"We do our best as a transplant community to try and weed that out when we have someone that comes forth as a donor that has no biological relationship and no significant emotional relationship to the recipient," he says. "As you can imagine, it's a very difficult thing to prove."
Hospitals are usually content, he says, with stopping the process.
Zeledon didn't tell Corey about any problems with his evaluation. She called to let him know about the cadaver, and left it at that. By Wednesday evening, Kalas's relative is said to be recovering nicely. Corey finally gets a call back from Gilbert. He tells him a cadaver came in. Gilbert is confused.
"A dead body showed up and they're taking a kidney from the dead body and giving it to [the relative]," Corey says.
"Soooo, we're out of money." Gilbert sighs loudly into the phone. "We ain't going to get paid now."
"What do you want me to do?"
"There ain't nothing we can do," Gilbert says. "So, I don't know. We're fucked. They're just gonna pay us for the time we did put in it."
The next day, Corey fans five crisp $100 bills in front of his face, like a rock star.
Kalas called him over to Joystix about 3 p.m., Corey says. They went back to his office. Kalas pulled out a white piece of paper and made Corey sign it, to confirm that he'd been paid. Then Kalas put the paper on his desk and sent Corey off with the money.
Corey ignores repeated calls from Gilbert, because he owes him a meal at Burger King. And he says he's through with Mary.
Corey imagines how his life might change. He calls his online girlfriend, who lives in Massachusetts. He can take a Greyhound to meet her, and they can get a hotel room together, and he can look for work. He figures out the next morning's bus schedule.
Corey knows a hotel near the highway where he'd like to spend the night. But he can't take the bus, because he has no idea how to get change for a $100 bill. He eventually makes his way over, checks in and decides he's hungry. He orders three pizzas.
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A few days later, Corey is back with Mary, still in Houston, and on the street. After the hotel and the pizzas, $30 or so for Mary and Burger King for Gilbert, Corey spent the rest of his money at GameStop on a Nintendo DS and some new RPGs. He's already finished more than 60 percent of Final Fantasy XII.
After Kalas is contacted by the Press, Corey says he has been fired. He and Mary await her next disability check. The night before it arrives, Corey and Mary stay in a tent near the George R. Brown Convention Center with some other homeless people. Corey takes a sleeping pill. He wakes up to learn that Mary had sex with two of the men while he slept. When she cashes her check, he steals the money and holes up for a week in a roach motel near the North Loop. Someone takes his Nintendo.
Once the money runs out, Corey heads back to the library. On the patio outside, he is attacked by two of Mary's friends. They pull his hair and punch his face. Then they grab the game cartridges from his pocket, rip his wallet off its chain and run away.