X-Message-Number: 30813
Date: Thu, 12 Jun 2008 18:43:25 -0700
From: "Charles Platt" <>
Subject: Organ Recovery

Now all we need to do is persuade them to recover ALL the organs, at
which point cryonics goes mainstream.


NY considers creating 'organ-removal' ambulance
By DAVID B. CARUSO, Associated Press Writer
Thu Jun 5, 3:14 PM ET

NEW YORK - Saving the living has always been the No. 1 priority for a
New York City ambulance crew. But a select group of paramedics may
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 early planning
stages, could raise a host of ethical questions and strike some
families as ghoulish. 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. Surgeons have only a few critical hours before kidneys, livers
and other body parts suffer damage that renders them unusable.

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 express consent.

But 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.

Distraught relatives could be unnerved by the site of a transplant
team arriving so soon after a death. Some might have a religious
objection to organ donation, and be enraged to learn that a body had
been moved and injected with fluids.

Other families might also   rightly or wrongly   question whether the
paramedics curtailed their lifesaving efforts because a patient had
valuable organs.

"A lot of people don't trust the medical system to begin with, and in
the city, you have additional class and race issues to deal with,"
said Arthur Caplan, a professor of bioethics at the University of
Pennsylvania. "I could very easily see a family saying, 'If it was a
white, rich person, that person would have been saved. But instead
you've sent the meat wagon.'"

Doctors working on developing a pilot program say they realize the
sensitivity of the issue and are building precautions into the system,
which would start with just one ambulance.

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 would have nothing to
do with that process.

A separate supervisor would make the call on whether to dispatch the
organ-recovery ambulance, and that team would be barred from arriving
until five minutes after a formal declaration of death.

Only cardiac arrest patients who die of natural causes would be
considered candidates for the program.

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

"That's a tricky conversation," acknowledged Dr. David Prezant, the
Fire Department's chief medical officer. He said grieving relatives
might expect to be asked about organ donation at a hospital, but are
certain to be caught off guard if the topic is broached in the field.

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.

Researchers say their next step is to consult with lots of New
Yorkers, including religious leaders and members of the Manhattan
neighborhood around Bellevue where the ambulance would operate.

"If everyone isn't comfortable with the answers, we won't be moving
forward to a pilot phase," Dubler said.

Goldfrank estimated that 22,000 people die at home each year in the
U.S. who might be able to donate organs through such a program,
although he added that it would probably only be workable in big,
dense cities.

Opinion surveys in the U.S. routinely find that a majority of
Americans are willing to donate their organs. In New York, more than
1.4 million people have signed an organ donor registry maintained by
the state.

"Several hundred people die every month waiting for organs," said Dr.
Richard O'Brien, an emergency physician at Moses Taylor Hospital in
Scranton, Pa., and a spokesman for the American College of Emergency
Physicians. "This could be a way to make organs more reliably
available to people who desperately need them."

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