A special ambulance meant to preserve the deceased's organs for possible donation could be on New York City streets later this year. A pilot program for a "rapid organ-recovery ambulance" aims to increase the number of organs available for transplants. Likely donors would be people who die of heart attacks away from a hospital.
If successful, it could lead to wider adoption and many more organs donated for much-needed transplants. Based on similar programs that have operated in parts of Europe for years, it would be the first such ambulance in the United States.
Organ donations currently must come from live donors or people who die in hospitals, where systems are in place to quickly preserve organs and get family consent. About 15,000 Americans donate organs each year. Approximately two-thirds of them are deceased.
About 350,000 people in the United States die each year outside of hospitals. If even a small portion of those people could donate organs, the pool of available organs would grow considerably.
The pilot program is funded through a three-year, $1.5 million grant by the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services. The program would be run from New York City's Bellevue Hospital Center.
Before the ambulance is deployed, ethical issues are being studied. Some doctors, bioethicists and others oppose the idea. They say there could be conflicts of interest, either real or perceived. Are paramedics on the scene to save a life or gather organs? What about cases in which people are declared dead but later revived? Is it ethical to perform organ-preservation procedures on a body before getting family approval? And some people would object based on religious beliefs.
Addressing Concerns
Proponents say there would be a clear distinction between the crew that's attempting to save a victim's life and the one that arrives later to save the organs should the victim die.
Proponents also agree that discussion is a vital part of the process. Dr. Lewis R. Goldfrank, Bellevue's director of emergency medicine, is the program's principal investigator. "Sure there are things to debate," he said. "That's why we're spending most of our time in the discussion phase with communities, lawyers and with various nurses, paramedics and doctors -- so everyone understands what we're talking about."
In the pilot program, the rapid organ-recovery ambulance would arrive after the paramedics. If the patient dies, normal resuscitation efforts fail and there's no family member on the scene who objects, the organ-recovery crew would take over and begin preserving the organs.
The body would be placed in the ambulance, even if it's unknown whether the victim wished to donate organs. While driving to Bellevue, the crew would preserve the organs by doing chest compressions with an automated device and pumping oxygen into the lungs.
The procedures would give officials time to determine whether the victim is a suitable donor, has a donor card or is listed on an organ donor registry. It would also give time to locate family members who could give consent to organ donation.
Longer Life
There's a huge gap between the number of organs needed and the number available. Waiting lists are very long. According to the United Network for Organ Sharing, on average 18 people die each day waiting for organs.
The organ-recovery ambulance's proponents say these deaths could be avoided by finding more donors. There are usually around 100,000 people in the United States needing organ transplants at any given time, but fewer than 30,000 organ transplants are performed each year.
A 2005 Gallup survey found that more than 50 percent of Americans have agreed to donate organs or tissues on their driver's license or an organ donor card.
If a patient dies in a hospital, there's usually time to discuss the issue with family. It's also possible to take care of the organs in a timely manner. That's currently not the case when someone dies away from a hospital.
"The way things work in America, if one collapses in the street, there's no way for them to become an organ donor," said Goldfrank. "Most people who wish to be organ donors can't be, even if they're registered with an organ donor registry."
While those whose lives have been saved by organ transplants -- and their families and friends -- support finding more organs, many people are uncomfortable with the idea of sending an ambulance to the scene of an emergency for that purpose.
"We really would like the community to be involved," said Goldfrank. "In many ways, the community is the best resource and ally, as to whether they think people are suffering with the system we have now, with not having enough organs. If we believe people should have organ transplants, then we as a society should organize ourselves to make sure we can do it for people."
