- The Washington Times - Monday, June 9, 2008

Saving the living has always been the Number 1 priority for a New York City ambulance crew. But a select group of paramedics might soon have a different task altogether - saving the dead.

The city is considering creating a special ambulance whose crew would rush to collect the newly deceased and preserve the body so that the organs might be taken for transplant.

The “rapid-organ-recovery ambulance,” still in the planning stages, could raise a host of ethical questions.

But top medical officials in the Fire Department and Bellevue Hospital say it has the potential to save hundreds of lives.

Generally in the U.S., only people who die at hospitals are used as organ donors, because doctors are on hand with life-support machinery and other equipment to preserve the organs and remove them before they spoil.

Dr. Lewis Goldfrank, the director of emergency medicine at Bellevue, said the ambulance project could spark an “amazing transformation” by substantially increasing the pool of donors.

The system would be one of the first of its kind in the U.S., although similar ambulances have operated successfully in parts of Europe, he said.

The transplant ambulance would turn up at the scene of a death mere minutes after regular paramedics ceased efforts to resuscitate a patient. The team would begin work almost immediately, administering drugs and performing chest compressions intended to keep the organs viable.

Sometimes, those steps would be taken before getting approval from a relative and without knowledge of the departed’s wishes regarding organ donation.

Any organ removals would be done at the hospital only, and no organs would be removed without getting the family’s expressed consent.

Experts in medical and legal ethics said they still see potential for trouble.

“Starting this process without knowing whether the decedent wanted to be a donor could be a problem,” said Maxwell Mehlman, director of the Law-Medicine Center at Case Western Reserve University in Cleveland.

The project’s ethics consultant, Nancy Dubler, director of the division of bioethics at Montefiore Medical Center, said there would be an “absolute barrier” between the medical personnel involved in the lifesaving effort and those working on the organ-recovery team.

Paramedics responding to an emergency would not be told whether there was a transplant crew waiting in the wings, and they would have nothing to do with that process.

A separate supervisor would make the decision about whether to dispatch the organ-recovery ambulance. Only cardiac-arrest patients who die of natural causes would be considered candidates for the program.

The organ-recovery team also would travel with a counselor who would make every effort to get a family’s consent before the body was moved or touched.

The city has received a $1.5 million, three-year grant from the federal government, but there is no set date yet for when the ambulance might begin operating.



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