NYC begins pilot program for organ preservation

Project initiated with HRSA funds

A pilot program between New York City's Bellevue Hospital and the city's police and fire departments is designed to allow the city to test the feasibility of recovering organs from the 400-plus eligible people who die of cardiac arrest outside of Manhattan hospitals each year, according to an announcement from the city.

Mayor Michael R. Bloomberg and the New York Organ Donation Network made the announcement about the pilot program on Dec. 1, when the pilot was initiated. The project is being funded with a $1.5 million grant from the U.S. Department of Health Resources and Services Administration (HRSA).

The city announcement said the pilot program will initially cover the borough of Manhattan. Once the 6-month pilot is completed, it will be evaluated to determine the program's potential to be expanded to other areas in New York City.

The pilot, which will run through May 2011, calls for Manhattan's Emergency Medical Services (EMS) calls to be monitored by a trained organ preservation team. This team consists of a family services specialist from the Organ Donation Network, a licensed emergency physician, and two who are trained as organ preservation specialists.

In instances where EMS goes out on a call, if resuscitation efforts fail, the organ preservation team will respond. If there is an organ donor card available — or if the deceased person was registered on the New York State Donor Registry, the Organ Preservation Team will "ask the family to honor those wishes by moving the deceased to the Organ Preservation Ambulance," according to the news release.

Patients will be taken to Bellevue Hospital, but organ donation "will not occur without written consent, or consent from the family or next-of-kin," the city's news release states.

Almost 8,000 people in New York City are on a waiting list for organ transplants.

"New York is currently ranked as one of the lowest organ donation rates in the [United States]," said Elaine Berg of the city's organ donation network, in the press release. "This program has the potential to begin to close the tremendous gap between the number of viable organs and the continuously increased need for life-saving transplants. We can prevent needless death on the waiting list by honoring the wishes of New Yorkers who want to be donors, but die outside the hospital."

The pilot program's genesis

According to Nancy Dubler, consultant for ethics to the New York City Health and Hospitals Corp. as well as a senior associate at Montefiore-Einstein Bioethics Center, the program had its beginnings with a conversation with Bellevue Hospital Center's Director of Emergency Services, Lewis Goldfrank, MD, at an Institute of Medicine committee meeting, where they discussed how to increase organ donation.

"We sat on this committee, and we became convinced that the real source of organs were people who died out of the hospital," Dubler tells Medical Ethics Advisor, adding that "the only other source of organs, except for those who die in the hospital, are live donations, and, in fact, live donation is very complicated."

"The closer the person donating, the more you worry about coercion, and the more distance the person, the more you worry about commodification," she says. "So, we were convinced. And Dr. Goldfrank had had many families in the emergency department say to him, 'Our loved has died; can't we donate organs?' And he had to say no."

The next committee meeting of the IOM also was attended by the New York City Fire Department, the Health and Hospitals Corp, the Organ Donor Network, and "all of the players in New York," she recalls.

That meeting was a vehicle not only for discussing the problem of organ donation, but also they set up a working committee, which then submitted an application to HRSA. HRSA then funded the project three years ago, according to Dubler.

The new team then began to work on several fronts, she says.

"One, in the hospital with the transplant surgeons, and the ER docs, and the perfusion specialists to see what a protocol would look like for when we had a patient who died in the field [and] who had organs perfused, [and] who then came to the hospital and was ready to donate," she says.

The team also worked with the New York State Department of Health, which oversees organ donation. Originally, the planning team had wanted to design a program similar to ones that have had success in Spain and France, where the program and the EMS teams could "approach people who died in their offices or on the street."

However, the New York State Department of Health would not agree to that.

"They were only comfortable with someone who died in their home, where that person had filled out a donor card or was on the New York State Registry, which means that there's first-person consent," Dubler explains.

The program only accepts donations from deceased patients between the ages of 18 and 60. The Dead Donor Rule, i.e., when a patient is determined to be brain dead, is honored, Dubler says.

"In our project, there is no question," she says. "The EMTs have been working on this person for half an hour or more, under the supervision of a physician" before death is declared.

"The aim of the project is to respect the family's position," she says. "So, we ask the family if the deceased had indicated the desire to donate; we ask the family to honor the deceased's wishes, but we don't ignore the family — even though under New York law, we could; but, this is such a radical project that we don't want to challenge any more than we have to."

Source

  • Nancy Dubler, Consultant for Ethics to the New York City Health and Hospitals Corp. and Senior Associate at Montefiore-Einstein Bioethics Center in New York.