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Hospital Hopes to Assemble Traveling Organ Transplant Team

Posted on: Friday, 6 June 2008, 11:10 CDT

A group of paramedics are considering forming a special ambulance crew designed specifically to rush to the scene of a recent death in order to collect the body and its organs to that they could be used for transplant.

In the U.S., organs are harvested from those who die at hospitals because doctors are on hand with the proper equipment needed to preserve the organs and remove them before they spoil. The proposed system would allow hospital workers to collect organs from others as well.

The so-called "rapid-organ-recovery ambulance," is already raising ethical questions, but top medical officials in the Fire Department and Bellevue Hospital say it could save many lives.

Dr. Lewis Goldfrank, the director of emergency medicine at Bellevue, said the project could produce an “amazing transformation” by 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 arrive on the scene shortly after paramedics had ceased efforts to resuscitate a patient .

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

This could lead to problems, some experts of medical and legal ethics said.

"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.

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.'"

But Nancy Dubler, the ethics consultant of the project, said there would be an "absolute barrier" between the medical personnel involved in the lifesaving effort and those working on the organ recovery team.

Furthermore, paramedics working to save the person’s life would not be informed of awaiting transplant crew. 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.

A counselor would also go along with the transplant team in order to try to get family 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.

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

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.

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

Source: redOrbit Staff and Wire Reports

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