City Tries Ambulances to Save Organs

City Tries Ambulances to Save Organs
By ANEMONA HARTOCOLLIS
Published: December 1, 2010
NY Times

Some 911 calls in Manhattan will now bring out two ambulances, one hurrying to the scene and one lagging slightly behind.

The first one will try to save the patient’s life. The second one will try to save the patient’s kidneys, in case the first ambulance fails.

After months of grappling with the ethical and legal implications, New York City medical officials are beginning to test a system that they hope will one day greatly increase the number of organs collected for transplant.

For five months starting Wednesday, the city will deploy a specially trained team that will monitor 911 calls for people who may be in danger of dying, like those having a heart attack. If efforts to resuscitate the patient fail, the team will quickly move in and try to save the kidneys; normally, patients who die outside hospitals cannot be donors because if too much time passes after the heart stops beating, the organs are unusable.

City officials said the project would be the first of its kind in the United States, though similar operations have been carried out in Europe. They said that they believed they had solved any ethical problems by adopting what they called very conservative standards for who would qualify as a donor.

To overcome fears that patients would be allowed to die for the sake of their organs, officials said that doctors and paramedics trying to resuscitate a patient would not be told whether the preservation unit was waiting in the wings until a supervisor had given the order to stop rescue efforts. The organ team, which will travel in a bright red and white ambulance marked “Organ Preservation Unit,” is supposed to remain out of sight.

The dead person would have to have registered as a donor through a card, driver’s license or online registry, and the family would also have to give consent.

The trial, which is being financed with a $1.5 million federal grant, is limited: to most areas of Manhattan, to the hours of 4 p.m. to midnight, to adults between 18 and 60, and to people who die of cardiac arrest at home or another residence.

To satisfy concerns that evidence of a crime could be destroyed in the harvesting process, a police detective sergeant would go to the home to be sure that there had been no foul play.

Officials said they would not harvest organs from anybody who had been involved in a crime scene, whether a poisoning or stabbing or shooting. Dr. Lewis Goldfrank, director of emergency services at Bellevue Hospital Center, a city hospital, said that in a case of foul play, he thought it “highly unlikely there will be a loved one or authorized person in the room calling in to 911 and still staying there” when the police and organ preservation team arrived.

Dr. Goldfrank said that he would like to see the program expanded to other types of deaths, perhaps even from car crashes or homicides, but that at this point, government agencies were reluctant to allow that. “If we prove that you can take the body and successfully do this, that will be the next step,” he said.

Dr. Goldfrank said that he hoped there would be at least one case during the December-to-May trial period that would end with a transplant. But he and other officials said that even if no organs were transplanted, what they really wanted to test was the protocol, which required a delicate balance of treatment and consent.

In 2009, about 7,600 people were waiting for an organ transplant in the greater New York City area, but there were only 285 deceased organ donors that year, according to the New York Organ Donor Network.

http://www.nytimes.com/2010/12/01/nyregion/01organ.html?hp