Since it has come up in the comments on my review of Kazuo Ishiguro's novel Never Let Me Go, I'm going to go ahead and discuss some of the issues around cutting-edge biomedical technologies in the book that might, or might not, be plausible when pondered. (As Bill points out, the scientific details in the novel itself are pretty minimal -- the focus is squarely on the interactions between characters -- so plausibility is only an issue if you're not good at suspending disbelief.)
WARNING: This post will be packed with spoilers!
Unless you've already read the book, or you have sworn a blood-oath never to read the book, you really should skip this post.
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Purpose-bred cloned humans as ready sources of vital organs for donations:
It's plausible enough that eventually, the technical challenges to successfully cloning humans will be worked out. So that part didn't bug me.
The part I worried about a little had to do with the feasibility of organ transplantation from the clones. First off, from what I know about cloned livestock (like Dolly the sheep), they haven't always been the healthiest; it seemed to me that might be as much a worry with the cloned humans, too. Also, there was an issue of compatibility between organ donor and recipient. So for a good part of the novel, I was guessing that Kathy and Ruth and Tommy and the other Hailsham kids had been created as sources of "back-up organs" for particular people from whom they'd been cloned. You'd think that would take care of many, if not all, of the rejection issues. Except, when you think about that way of doing things, it means you have the costs of supporting a whole extra human (although the society in the novel wasn't actually seeing the clones as humans) just in case affluent person needs a new kidney or liver or heart. That wouldn't be terribly cost effective.
As it turns out, the Hailsham kids were cloned as general-purpose organ donors, a sort of shared resource for all the people in society. So, there would still be the issues of finding the donor who best matches the recipient. However, in the world Ishiguro creates in the novel, the people needing organs don't need to wait around until a potential donor is in a motorcycle accident -- the clones' organs are always there ready to be harvested.
Providing the genetic material for clones as an activity roughly equivalent to selling blood:
Near the middle of the book, as Kathy and Ruth and Tommy are talking about the possibility that friends of theirs have seen the woman from whom Ruth could have been cloned, it comes out that these "donors" of materials are most likely down-and-out members of society who are short on cash -- junkies, pornographic models, and the like. It's not totally implausible that young and poverty-stricken folks might have the right genetic endowment to produce excellent candidates for organ donation. However, the part I didn't entirely believe was that there would be a serious pay-out for the required genetic material. Wouldn't we be talking something more along the lines of a cheek swab than an egg donation? (I suppose there might be a lot of preliminary labwork before the cheek swab to make sure the donor would produce suitable clones, but still.)
You've got to gestate those clones somewhere, don't you?
There's not even a passing discussion of the women who have to have been part of the clone-production scheme, and where they fit in with the dregs of society. (I'd imagine that gestating a clone would be where the big compensation would be available, but there's a pretty significant time commitment, not to mention the imposition on one's dietary and other lifestyle choices.) No word, either, on the source of the enucleated ova.
But possibly we don't hear about this part of the process because it's just not on the Hailsham kids' radar.
Why are the cloned humans sterile?
Kathy and her friends seem always to have been aware that they can't have kids. We're never given an explanation for why. Some people might read Ishiguro as suggesting that this is a built in side-effect of being a clone. I'm inclined to think, however, that the kids were surgically sterilized at a young age.
Serial organ donation versus wholesale harvest:
Some readers may worry about the plausibility of having the cloned humans donate an organ, then go through a long recovery before donating the next organ, with some clones making it to a fourth donation before they "complete" (i.e., end up with too few organs of their own to keep living and thus, one assumes, have the rest of what's useful harvested). How efficient is that? My guess is that this is a matter of trying to balance supply with demand. Until there's a definite recipient for a particular organ, it's better to keep that organ in play in a (reasonably) healthy body, harvesting it "fresh" when it's needed.
Another plausibility issue, for me, was why society at large would assume the clones had no souls and were less than fully human, but I take it that's not really a question of scientific plausibility.
So, if you have any biomedical nitpicks with Never Let Me Go that you'd like to add to the pile, leave them in the comments.
Janet: I think that you're way over-analyzing the scientific basis of the story. It is science fiction. The basic premise is that the technology exists to do what the story reveals that they do. You must suspend disbelief of that premise. The interest in the story is all those things that you mentioned previously - how that science affects those individuals and their society. In this era, when science is learning to create clones, this is a parable on the potential dangers of that technology.
If the technology existed now to do those things, this would be science not science-fiction.
If you read Buck Rogers, do you argue that we don't know how to make ray-guns? If Star Trek, that we don't know to make matter transmitters? etc.
Karl, I agree with you that suspension of disbelief is the right stance while reading the novel.
However, that doesn't keep me from evaluating plausibility afterwards, as a separate exercise. (And here, I'm less worried about what we don't yet know how to do than with issues that maybe fly in the face of knowledge we already have. On the whole, I don't think Ishiguro's left us in too implausible a place, but it's interesting to try to fill in the details.)
In short, suspending disbelief and then unsuspending it can be a both/and kind of thing.
I thought the implication was that they had been engineered to the point where they contained more than one of each organ- four kidneys, or extra livery bits, things like that. While they were undergoing the operations, they were slowly losing one or two of these semi-essential things, and getting weaker and weaker. I considered the possibility that when working organs were removed, vestigal organs were connected so that they would grow and become more functional. Otherwise, suddenly dying after the second operation would happen in the majority of cases instead of being an occasional but infrequent occurance. Also, I imagine that very few standard people would be capable of day trips after two operations which removed several organs.
I haven't read this novel (so basically I'm just talking out of my posterior region here), but based on your description of it I would suspect that the science is not the aspect of the story that requires the suspension of disbelief.
I recall a review of this book that raised the question of what kind of society would be able to afford such a medical system.
One of the things I liked about this book was that it didn't get too deeply into the science of what was happening as I thought that would have ruined it with improbabilities clogging up my thoughts while I was reading. I agree with you that the time for thinking about the ideas is after reading.
I wondered about the sterility/gestation issues too. I had visions of them having been entirely gestated in the lab (was that what happened in Brave New World? I seem to remember it was.) I thought that the obvious thing would have been using the cloned humans to gestate more cloned humans. I hadn't thought of them being organ donors for specific people though, or of them having multiple copies of organs. Nice ideas.
It is so easy to get wrapped up in the gee-wiz aspects of science that we overlook some of the more prosaic but fundamental challenges involved in the introduction of radical new technology such as the development of purpose bred clones. Ishiguro, in his non-scientific treatment of the topic, alludes to the question of how one would keep purpose-bred clones from expressing the wants, desires, and yearnings that come naturally to humans. Love, freedom of choice, the pursuit of happiness are all emotion driven behaviors that are difficult to suppress for any meaningful length of time. In the world of Kathy and Tommy, either the clones were drugged, behaviorally programmed, or genetically modified in some way that allowed them to minimally question authority. This behavioral control not only contributes to the 'ick factor' of Ishiguro's story, but is also one of the most difficult objectives to achieve in the real world. Thankfully.
I've worked in the field of transplantation, so I can tell you there's a very good reason for keeping the kids alive to donate organs. Almost instantly at death organ deterioration starts. After about 48 hours the organ is completely useless. You just can't harvest the organs and store them somewhere - they need to be used immediately. The less transport time the better - so if you have the donor walk into a room, and simply move the organ 10 feet into the recipient, taking only a few minutes, you dramatically increase the chance of survival of the recipient.
"As it turns out, the Hailsham kids were cloned as general-purpose organ donors, a sort of shared resource for all the people in society. So, there would still be the issues of finding the donor who best matches the recipient."
Right. While donation from an identical twin is best, you can get almost as effective results just by matching a reasonable number of immunological/genetic markers. I assumed all the kids were probably blood type O and basically filled almost every combination of the important markers for donation.
"First off, from what I know about cloned livestock (like Dolly the sheep), they haven't always been the healthiest; it seemed to me that might be as much a worry with the cloned humans, too."
OK, but don't you think they'd be using more advanced cloning techniques if they're doing this on a massive scale? This is like saying all cars should be unreliable because the very first horseless carriages weren't very reliable.
Another plausibility issue, for me, was why society at large would assume the clones had no souls and were less than fully human, but I take it that's not really a question of scientific plausibility.
This doesn't seem at all like a plausibility issue for me. Many societies, including the U.S. during slavery, have already demonstrated the ability to view certain populations of humans as lacking souls and being less than fully human. Sadly, I can't see any obstacle to a group of humans arguing themselves into believing that cloned humans would have no souls and are less than fully human. Some of the opposition to stem cell research derives from the fear of this kind of disrespect for human life resulting.