By the time the Peloran showed up, organ banks were the way to live.  Even the middle class could by them.  And government banks granted access to those that couldn’t afford them in the politicians’ undying effort to buy more votes in the next election.  And since they reserved the best of the organ banks for themselves, I really do mean undying.  People don’t call them bloodsucking vampires for nothing after all.  The politicians that is.