How the Plan Would Work

Saturday, May 24, 2008

In New York's pilot program, a rapid-organ-recovery ambulance would stand by, either at Bellevue or at the scene of an emergency call. The organ team would wait five minutes after EMTs give up on resuscitation, to create a clear demarcation between efforts to save lives and those to preserve organs.

"The process of resuscitation would be very distinct from the process of organ recovery so that we would be sure that, ethically, there's no potential for an overlap or misconstruing of what's going on," said Bradley Kaufman, a top medical director for the New York City Fire Department, which operates ambulances.

Once all hope for resuscitation was gone, and as long as no family members objected, the victims' bodies would be transferred to the organ ambulance team, even if the victims' willingness to be organ donors was unclear. The crew could then perform measures on the body to prevent the organs from deteriorating, including chest compressions with an automated device and pumping oxygen into the lungs through a tracheal tube to keep blood and oxygen flowing. The crew might also administer the blood-thinning drug heparin to prevent clots while speeding to Bellevue.

At the hospital, doctors could take additional steps, such as inserting a plastic tube known as a cannula into an artery, usually in the groin, to infuse the body with fluids to cool and preserve the organs. Organ bank workers would then assess whether the person was a suitable donor, determine whether they had an organ donor card or were listed on an organ donor registry, and try to locate a family member to give consent.

Certain patients could be routinely exempted, such as possible crime victims who need to be seen by a medical examiner, and possibly members of religious groups that may object, such as Orthodox Jews.

-- Rob Stein

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