# City to Deploy Ambulances to Save Organs



## MMiz (Dec 4, 2010)

*City to Deploy Ambulances to Save Organs
*

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. 

*Read more!
*


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## Shishkabob (Dec 4, 2010)

Hmmm....

Don't quite know what to think yet.


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## Amycus (Dec 4, 2010)

I don't quite understand how/why that'd actually preserve organs and such. I really don't get it.


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## reaper (Dec 4, 2010)

Save tax money. Train the EMTs to remove the organs!


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## Amber2313 (Dec 4, 2010)

Lol@training us to take organs. 
I get that they're trying to do a good thing, but why do we need two trucks for it? Maybe I'm missing something, but what does the first truck do that the second can't?
If the first does save the pt, the second wasted.
If the first doesn't manage to save them, why can't they load and go rather than sending a second?


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## abckidsmom (Dec 4, 2010)

I'm sitting here watching a National Geographic doc, "Inside the Body Trade."  

In China, they pick up bodies off the street, harvest their kidneys, and put the body back out for the coroner.  The international organ trade is shocking.

This idea sounds neat, but I'd be really surprised if they succeeded in harvesting any kidneys during the study period.


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## Cameron (Dec 5, 2010)

What happens when someone is in deep hypothermia or in something else, that makes them appear dead, but they are alive and their vitals are not showing?


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## emtpche (Dec 5, 2010)

How do they explain it to the family. Folks sorry about your  loss the next crew here would like take some parts. It sounds like a Monty Phyton skit...We come for your liver.


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## JJR512 (Dec 5, 2010)

Cameron said:


> What happens when someone is in deep hypothermia or in something else, that makes them appear dead, but they are alive and their vitals are not showing?



The protocol for organ removal should include language that excludes hypothermic patients.


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## firecoins (Dec 5, 2010)

JJR512 said:


> The protocol for organ removal should include language that excludes hypothermic patients.



hypothermic patients get transported to the hospital in NYC. Hence you don't need a truck for them. Hospital staff will ask family for the organs.  This truck has been talked about for years.


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## JJR512 (Dec 5, 2010)

firecoins said:


> hypothermic patients get transported to the hospital in NYC. Hence you don't need a truck for them. Hospital staff will ask family for the organs.  This truck has been talked about for years.



Exactly.


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## Veneficus (Dec 5, 2010)

Only in America.

Maybe next the city can outsource it to a for profit company?

They could then bill medicare, medicade, the recipient's insurance or even pay cash.

Who comes up with this foolishness? 

Of course if you are going to do it, it should be done with style. The rig should be white with a reaper and black vultures all over it and the crew should have t-shirts that say something like: "farming theirs to save yours" or some other incredibly whacker slogan.

Seriously though, I think it is incredibly overzealous and in extremely poor taste.


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## firecoins (Dec 5, 2010)

Veneficus said:


> Seriously though, I think it is incredibly overzealous and in extremely poor taste.



So we should let perfectly good organs go along with the people that need them because it may offend the family of the potential donor? Or is it okay to do it in the hospital but distastful when it occurs at home?

If I die at home, it is okay for them to do this to my family.


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## Veneficus (Dec 5, 2010)

firecoins said:


> So we should let perfectly good organs go along with the people that need them because it may offend the family of the potential donor? Or is it okay to do it in the hospital but distastful when it occurs at home?
> 
> If I die at home, it is okay for them to do this to my family.





"It sounded like you weren't going to make it, so we have this truck in the wings just in case." 

What happens when the locals start figuring out that this truck miraculously happens to be in the nieghborhood everytime somebody dies? 

Especially in the more socio-economically challenged areas there are going to be disproportionately lower save rates. What about the perception those "rich folk" let the poor die so they can save more of themselves?

What about the issue it causes when the donor truck gets there first and is just "hanging out" simply because of the location of units on a given day?

At what point does it become organ farming?

From the hospital perspective, when a patient is brought there, there is at least the illusion that all that could be done has been. I know it is no different than a good ALS squad, you know that, but the regular people in the world don't. They can't even figure out what the difference between medics and EMTs are. 

The best organ donors are from accidents, not from illness. Most arrests at home are from illness, not from accidents. 

At what point does this cease to be organ collection and become organ farming?

From a scientific standpoint it sounds great, more organs means more potential transplants. I get it. But at what cost? 

Medicine is already in danger of being a strictly factory endevor that has no concern other than the Frankenstein science of it. Think about this on a massive scale, a bunch of trucks around the nation showing up right after a death everytime and hacking out some useful parts. 

Might as well have the funeral homes do it, that way they can provide ALS service, organ donation, and funeral service all at one low cost. No redundant vehicles or persons.

Why we are at it, since we know that accidents resulting in unisystem brain death are the best donors, the next time a jet flies into a bilding we can dispatch the truck and start harvesting off the expectant and deceased bodies right then and there. Black tag now gets you triaged to organ donation.

If you are not going to target the most likely because of protocol, all you are doing is abusing a bunch of corpses and wasting a lot of money for some rather long odds.

Of course if any of the survivors are related, it will increase the odds of a match. 

Don't forget, the poorer the people generally the more close their attachment to family. Mutual survival depends on it. If you upset that or take it away, it really is a disservice to those people.

As my Basic teacher once said: "How is this going to look on the 6 o'clock news."

I think Dr. Josef Mengele would be most proud of this experiment to see if the protocol works.


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## Hockey (Dec 6, 2010)

How much would one kidney go for? I do have one that I would like gone...


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## MS Medic (Dec 6, 2010)

firecoins said:


> So we should let perfectly good organs go along with the people that need them because it may offend the family of the potential donor? Or is it okay to do it in the hospital but distastful when it occurs at home?
> 
> If I die at home, it is okay for them to do this to my family.


I have to agree with firecoins. I've loaded pts knowing I was only taking them to the hospital to die, so I don't see the problem with this as long as the safeguards mentioned above are in play. I am just curious how the logistics of keeping the organ removal sterile happens in the back of an ambulance, but I guess that is the reason for a second truck.


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## firecoins (Dec 6, 2010)

The survival rate for prehospital codes is pretty low.  Not everyone who codes would necessarily be a donor.  

I will see if I can find protocols for it.


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## zmedic (Dec 7, 2010)

I can't believe that you are comparing this to the Nazis. The basic facts are if you are transported to the hospital in cardiac arrest, they terminate the arrest in the hospital, the MDs there is legally required to ask the family about organ donation. Now if that same person is pronounced in the field, even if though they were an organ donor, those organs couldn't be used because of the legal issues with transporting a dead body to the hospital. That's all this really is, a mechanism to transport someone who has already said they want to donate their organs and has died to the hospital where their wish can be carried out. 

The two trucks things is pretty straight forward, you are separating those who worked the initial cardiac arrest from those who will deal with getting the families permission.


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## jjesusfreak01 (Dec 7, 2010)

Cameron said:


> What happens when someone is in deep hypothermia or in something else, that makes them appear dead, but they are alive and their vitals are not showing?



Standard medical principle: 

"You're not dead until your warm and dead"

EMS should never discontinue efforts on a hypothermic patient until they have a warm dead body.


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## Veneficus (Dec 7, 2010)

zmedic said:


> I can't believe that you are comparing this to the Nazis. The basic facts are if you are transported to the hospital in cardiac arrest, they terminate the arrest in the hospital, the MDs there is legally required to ask the family about organ donation.



I am not comparing it to nazis.

I am comparing it to a physician who demonstrates quite effectively how the pursuit of scientific knowledge or advancement can be utterly inhumane. There really are not a lot of real life examples to compare that to.

In my opinion, the pursuit of "potentially saving lives" driving a mobile butcher shop with lights and a cross on it, compared to the odds and reality of finding suitable donors and organs is overzealous to the point of inhumane.

The stated purpose of "finding out if the protocol can work" and what that means is the pursuit of science without compassion for "we can do it and what if..."


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## Sasha (Dec 7, 2010)

I can see this discouraging people from becoming organ donors. There's already the myth that EMS/ER staff wont save you if they see your an organ donor. Let's add more fuel to the fire by sending the trucks.


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## firecoins (Dec 7, 2010)

I don't know if anyone I have "worked" was an organ donor.  Nor would it have made a difference in the outcome.

I have known about this truck since 2008 but it has not gone into operation until now. I am not sure if it is because there is no update on protocols in reguards to calling for it.  

We already are cooling people down for codes.


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## TransportJockey (Dec 7, 2010)

This is a decent read that kinda ties in with this topic:
http://gomerville.com/2010/12/07/cl...sored:-or-why-we-need-death-panels-on-wheels/


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## Sasha (Dec 7, 2010)

> I don't know if anyone I have "worked" was an organ donor. Nor would it have made a difference in the outcome.



Of course not but thats not what some in the general public think.


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## zmedic (Dec 7, 2010)

Not sure why you are calling it a moblie butcher shop. It's an ambulance that transports the donor to the hospital where the organs are harvested just like any other donor.


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## Veneficus (Dec 7, 2010)

zmedic said:


> Not sure why you are calling it a moblie butcher shop. It's an ambulance that transports the donor to the hospital where the organs are harvested just like any other donor.



I thought it was a bit more poetic than "meat wagon."

The popular term for an ambulance that was usually run by a funeral home when all they had to do was convert the yellow light to a red one and back to designate the function.

Honestly, how many viable donors do you really think this is going to produce?

Let's analyze this a bit?


*"specially trained team that will monitor 911 calls for people who may be in danger of dying, like those having a heart attack"*

When grandpa dies at home, in the hood, from renal failure secondary to cardiac insufficency from uncontrolled HTN, and prior MI with fatty liver change, and blindness from diabetes, you really think that this justifies the complications and cost this can create?

Because when he codes at 58 it was from a freak MI with no other comorbidities?

If they were hunting down potential viable donors, like 22 y/o ejected from a car, or crashing his motorcycle (donorcycle) I could agree that the benefits might be worth the downfalls. As is, I stand by my original comments comparing this to inhuman experimentation.

*"If efforts to resuscitate the patient fail, the team will quickly move in and try to save the kidneys"*

I am not a trnsplant expert, but from what I have learned and witnessed, maybe the liver would be a better choice. You know not as precise matching required as for a kidney.

But I also have serious reservations about how this actually is going to look and work logistically. I wonder if sensitivity training is part of it? When it comes to manners and sensitivity, no offense, New Yorkers, especially "blue collar ones," doesn't exactly inspire confidence. 

*"The organ team, which will travel in a bright red and white ambulance marked “Organ Preservation Unit,” is supposed to remain out of sight"*

yea, real inconspicuous. I guess we should be thankful it wasn't red and  safety orange.

*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. *

You don't see a major problem there? In order to stop the family from reversing the wish to be a donor in grief, I think you might have to enact some law to give the victims desire to donate at least the level of living will, or maybe offer the family some cash or other compensation like total funeral expenses.

*"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."*

And who finances it if this trial is adopted?

It's not like there is a whole lot of money laying around to add some more expenses. Why should only New York benefit from this? Why should the rest of the country pay for yet another program to support New York city? Maybe if the locals want this they should pay for it?

(I admit, I am socially liberal and fiscally conservative) 

*"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."* 

Half assed experiment on the recently deceased. If we prove we can take mostly unviable organs from unlikely candidates, maybe we can expand to likely ones?

*"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."*

Lol. Gotta say something right? 

*"if no organs were transplanted, what they really wanted to test was the protocol, which required a delicate balance of treatment and consent." *

Experimenting on a corpse that was aquired from a family during a time of emotional stress that is not even likely to result in a transplant. I hope they are all proud of themselves.

*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.* 

Hmmm... Perhaps a public education campaign encouraging donors would be money better spent?

Afterall, they are more likely to be successful scooping trauma arrests off the pavement with BLS and lights and sirening them over to the hospital.

I wonder if they do that now? :unsure:

Instead let's try to devise a plan to farm them from families last minute?

A good idea? Really?

*"New York City medical officials..."*

I am so glad they didn't use the word "doctors."

But this almost has a death panel, government taking away the corpse of a loved one for some poorly thought out purpose flare. 

Maybe they could even make sure that the transplants happen over at Dr. Goldfrank's hospital? Because we all know that organ transplantation and follow up care is a total economic loss.


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## firemedic07 (Dec 9, 2010)

they should only have one truck. and that truck should try to save them then transport to the hospital no matter what. in non refusal situations. and arent citys *****ing about the budget, now they have to hire more medics or reapers to fill the spots on the other trucks. when they could just hire more medics and put more trucks in service.


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## zmedic (Dec 9, 2010)

It's a lot less ethical to transport a cardiac arrest patient lights and siren, doing CPR down the stairs, telling the family they have a chance just to harvest their organs than the current protocol. Here they are doing what they normally do in the case of a futile cardiac arrest, call it in the field. Then another team is coming in with more training and equipment and going from there.


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## jjesusfreak01 (Dec 9, 2010)

Veneficus said:


> *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. *
> 
> You don't see a major problem there? In order to stop the family from reversing the wish to be a donor in grief, I think you might have to enact some law to give the victims desire to donate at least the level of living will, or maybe offer the family some cash or other compensation like total funeral expenses.



Actually, we passed a law like this last year. Totally stupid though, since the first time the heart appeared on my license it was without my consent. If they want to pass a law to make it opt out, then whatever, but letting the DMV determine whether I want to donate or not is possibly the stupidest idea ever.


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## Veneficus (Dec 9, 2010)

zmedic said:


> It's a lot less ethical to transport a cardiac arrest patient lights and siren, doing CPR down the stairs, telling the family they have a chance just to harvest their organs than the current protocol. Here they are doing what they normally do in the case of a futile cardiac arrest, call it in the field. Then another team is coming in with more training and equipment and going from there.



I never advocated that.

I did point out that the traumatic arrests or other accidental injuries would more likely produce viable organs than medical arrests at home. 

In major trauma, the world over is to transport to a trauma center. If the person is dead the original unit doesn't have to work them, just load them up and drive with the normal flow of traffic. 

I think the reaper mobile is a public relations disaster waiting to happen.

My main ethical concern is the fact they set up a program with a very unrealistic goal that is going to impact people. (though not the dead person) 

But I also have serious reservations about "talking people" into organ donation by people who are actually sitting around listening to radio traffic looking for an ambulance to chase.


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