Ethicists Debate Ambulance for Organs

"Unless there is a plethora of EMS vehicles available where this ambulance serves, which is not the case in many areas, they still should concentrate on treating and transporting patients who have a chance at survival first."

Mehlman adds that some may worry whether the responders on such an ambulance would be under any pressure to stop trying to revive a patient in order to begin saving his or her organs. And at a time when the growing need for transplant organs is met by public concern over how these organs are obtained, such considerations become especially crucial, Allen says.

"One reason some people are unwilling to sign living wills is that they are afraid that will make physicians give up on them sooner than they should in order to get their organs," he said. "Such fears are overwrought in general, but understandable and real."

And high-profile incidents -- such as a recent case in California in which a transplant surgeon was accused of hastening the removal of organs from a donor who did not yet meet appropriate criteria for brain death -- add to such fears.

Division of Responsibility May Be Needed

The key to avoiding potential problems may lie in preserving a singular role for emergency medical responders. This would mean that those arriving at the scene would ideally focus on saving the patient, or saving the organs -- but never both.

"EMTs generally attempt resuscitation and continue that effort until an emergency department physician they are talking to tells them to stop," Allen said. "In such a scenario, the two roles of the rescuer and the retriever -- rather than harvester of a human as a source of organs -- reside in the same person.

"Once this process begins and it is widely known, there will be instances where the EMTs are suspected or accused of giving up resuscitation attempts too soon in order to get a corpse still warm enough to do the procedures for organ harvest."

Despite these concerns, Caplan says groups in Philadelphia may soon follow New York's lead. Other cities may follow.

But even as the popularity of these services rises, Allen says, the implementation of these plans will be far from simple.

"The kinds of issues and the details to implement a program like this successfully may not be insurmountable, but they are considerable," he said. "Doing this is not a no-brainer."

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