The crime developed as a response to the Organ Bank Problem, a concept featured prominently in the early Known Space stories, particularly those set in the twenty first and twenty second century. The Organ Bank Problem is a central theme in the novel A Gift from Earth, as well as the Gil Hamilton detective stories. As speculative fiction, the concept is a prime example of a gedanken experiment. It is an examination of the consequences to society of a new technology (in this case, the perfection of organ transplants) and an existing problem (organ shortage), carried to a logical conclusion.
The effect of technology on society is a recurring theme in Niven's stories.
Compounding this problem, the high success rate of organ transplants tended to discourage research into other viable medical treatments. As a result, medical research was stagnated to a large extent, focusing primarily on improving transplants and little else. Repairing a failing organ (which could presumably fail again later) was considered secondary to the "complete" solution of replacing the failing organ.
An example in the Known Space universe was that anyone who wore eyeglasses was considered a reasonable candidate for an eye transplant (one or both); whereas in the real world, today's nearsighted population can solve the problem with laser surgery.
On Earth, the problem led to an repressive society almost unrecognizable by today's standards. Since the average citizens wished to extend their lives, the world government sought to increase the supply by using condemned criminals to supply the organ banks. When this failed to meet the demand, citizens would vote for the death penalty for more and more trivial crimes. First violent crimes, then theft, tax evasion, false advertising, and even traffic violations became punishable by the organ banks. This failed to solve the problem, as once the death penalty was passed for a crime, people stopped committing it. This resulted in nearly every crime meriting the death penalty. Further attempts to alleviate the problem by declaring certain groups of cryogenically frozen people to be dead in law (the so-called "Freezer Bills") and harvesting their organs also proved to be unsuccessful. The freezer vaults represented a finite supply and therefore were eventually exhausted.
The Belters took a different approach. They viewed survival as a virtue in and of itself, and were reluctant to turn otherwise healthy people into transplant stock. They preferred prosthetics to transplants wherever practical. Their solution to the problem was to keep transplant prices as high as the market would allow, thus dropping demand to meet the supply.
Colony worlds each took their own approaches. A notable example was the human colony of Plateau. Society was divided into a rigid caste system, with descendants of the Colony ship "Crew" holding absolute power over the descendants of the ship's passengers, or "Colonists". The Crew controlled the planet's entire industrial infrastructure, including all access to organs and transplants. They in effect controlled both supply and demand by their absolute rule.
Organlegging can be considered a crime that evolved to meet the demand. Since the supply of organs could never match the demand, there would be those desperate enough seek them at any cost. Many of those people would be of sufficient wealth as to provide a strong financial incentive for a black market.
The crime of organlegging involves several aspects: abduction of unsupecting persons, the harvesting of their organs, and finding customers to purchase the organs once they were acquired. Thus a successful organlegging gang required three groups of people, one to handle each aspect of the operation.
The first group (the "snatch men") usually consisted of young, tough, uneducated males, with just enough intelligence to capture a prospect, and get him or her to the harvesting facility alive without getting caught.
The second group were the "doctors", the ones who harvested the organs and kept them ready for transport to a customer at a moments notice. This was usually the safest aspect of the operation as the harvesting facility could be hidden in a remote location, and the doctors had little or no public contact.
The third group (usually referred to as "organleggers" proper) were the ones who found potential customers, and delivered the organs to them. They were salespeople and field surgeons at the same time. The advent of automated precision surgical equipment allowed them to transplant the organs on the spot and required minimal training to operate. This was by far the most dangerous aspect of the operation. Some customers would attempt to turn in the organleggers in a fit of conscience after receiving their transplant. At least one pair of organleggers were killed by a customer attempting to cover his tracks for another crime. For this reason, they changed their identities, faces, and other physical characteristics frequently—a simple process given that they can use their own stockpiles for cosmetic grafts.
The only way to end the organlegging problem was to reduce the demand for human organs. Given the desire of humans to extend their lives, the only way to reduce the demand was to find a substitute for transplant stock. However, the draconian anti-technology laws of the ARM hindered all developments. It was not until the mid-twenty-fourth century that alloplasty, improved prosthetics, and most importantly, the ability to grow the needed organs by manipulating one's own DNA, ultimately made the organ banks obsolete.