New York City officials plan within months to dispatch the nation's first ambulance equipped to preserve bodies of the newly dead so that families have time to consider organ donation.
The controversial twist: Crews would swoop in and perform procedures on a corpse without consent in order to preserve the organs until the family had time to give consent for organ donation. No organs would be taken without consent.
The proposal for the Rapid Organ Recovery Ambulance followed complaints from families who were told their loved one, who had wanted to be an organ donor, could not donate because the person died outside a hospital.
Bradley Kaufman, medical director for quality assurance at the New York City Fire Department, says, "We've had families say, 'He wanted to be an organ donor. How can we make that happen?' " But because his crews were not transporting the patient, he says, they couldn't help them donate.
The goal of the program, which has federal funding and is being watched closely by the nation's other emergency medicine and transplant teams, is to buy time.
Most organs today come from either living donors who give a kidney or part of their healthy liver or from people pronounced brain dead in the hospital while their hearts are still beating. Both scenarios give time to obtain family consent.
About half of the 12,000 people nationally who are eligible to donate organs after brain death become organ donors. But a much larger pool of potential donors who die from cardiac arrest outside the hospital -- an estimated 22,000 people a year -- don't get considered for organ donation.
One reason is that once crews declare a death in the field, they avoid unnecessary medical costs and reduce risks by eliminating the lights-and-siren run to the hospital.
But some doctors and families are expected to dislike the idea of performing procedures without consent.
"It is very difficult to try to do what is right without doing harm," says Nancy Dubler, director of bioethics at Montefiore Medical Center in New York. Dubler heads the ethics group considering the plan.
If the idea flies, the ambulance could be on the streets as early as next month.
"We're moving slowly," says Lewis Goldfrank, professor and chairman of emergency medicine at Bellevue Hospital, who heads the team. "There is immense potential, but the No. 1 topic is the ethics."