There’s been a story in both the media (NY Daily News, NY Times, Fox 5 NY, CNN) and those reports were syndicated on all the mainstream EMS News sites (JEMS, EMS1, EMS World) about the New York City Organ Harvest pilot program that began December 1st. Not surprisingly, there seems to be a lot of confusion as to what the program actually entails because no one actually reported it from an EMS Systems perspective. so I’d like to clear up a few of the common misconceptions I’ve seen around right off the bat before even getting into the issue…
- The deceased does have to already be an organ donor – the team will not know if the deceased is an organ donor for sure until they get there. This restriction will probably change in the future
- The harvest team should not enter the home until the medics onscene terminate the resuscitation effort – at that point the harvest team then has 50 minutes to get the deceased into the ambulance and hooked up to what is believed to be a
bypass machineLUCAS Chest Compression System
- The harvest team should not enter the home until an NYPD Detective clears the scene as non-suspicious
- It is a four person team–
- A Physician – determines if the deceased is an eligible candidate for being a donor and hooks up what is believed to be a bypass machine in the ambulance
- An Organ Donor Family Specialist – deals with the grieving family and obtains the necessary consent
- Two EMTs – for all intents and purposes they are relegated to the duties of chauffeur and physically removing the deceased
- Harvesting of the organ will occur at the hospital, not on the scene or in the back of the ambulance
So what is the City of New York saying with this pilot program?
There are alot of good reasons to be an organ donor and even more reasons why we should look to increase the number of organ donations, but I don’t think this is the appropriate way to do so. Even if you were going to run this type of program, I really don’t think organ harvesting is appropriate for a 911 System to be doing. When you get down to the nuts and bolts of it, that’s what is REALLY going on here.
Undoubtedly this puts EMS providers in a rough situation for a couple of reasons. First, even though the providers may legitimately not know their patient is a candidate for the team, the truly grief stricken family will assume otherwise simply because of the appearance of the truck. That one up there is the actual unit that’s going to respond to harvest organs and TOTWTYTR has a photo of a FDNY EMS ambulance on his blog. They look ALOT alike, right? Probably because the one above used to do what the one over there still does… responds to emergency calls in an attempt to preserve life. The mere accusation of not doing everything within our power to resuscitate a patient will damage the reputation of the EMS provider (whoever that is because contrary to popular belief FDNY only provides around 65% of the 911 ambulances) and the importance of dialing 911 when there is an emergency.
Another reason that sort of accusation is damaging is because of the affect it will have on the actual provider’s morale. There you are, working a code as if it was your own mother, and no matter what you do nothing helps. You make the call to terminate, get it, provide some compassion and care to the grieving family while finishing up your paperwork and your partner cleans the scene… and in walks the harvest team. The grief stricken family refuses to consent for their deceased non-organ donor relative, throws the accusation at the EMS providers as they leave, and what do you think that’s going to feel like? Shitty, that’s how. Now that provider is going to be hurt and angry and starts down the path of burnout before it was their time.
Finally this damages us because of all the places it sets us back from. Our profession continues to be a dangerous one and while we have fought long and hard to try and make it safer ending futile transports through field terminations, well here we are again transporting the deceased lights and sirens. We continue to fight to be recognized as a profession and here we are once again relegated to the familiar roles of moving men and chauffeurs. It’s professional discrimination if ever there was a case for that.
For years we’ve drilled into the heads of children and adults that if there is an emergency you call 911. That public education campaign has been very successful and some would argue that more often than not people call 911 too much, and depending on the day I may be one of those people!
This changes the dynamic because now that 911 system has the potential to profit whether you live or die. Of course the question is, how much does a kidney transplant actually cost? According to Kidney In The News the average cost is $54,875 not including your hospital room or post transplant care. To cover the 1.5 million cost of the pilot program it would take the full revenue from 28 transplants, which over 5 months equates to roughly 6 donors a month. Of course, that’s assuming they can find someone on the organ donor lists that will match. Now spread that cost over all the transplants performed and the number they need to harvest suddenly becomes much less and the program becomes more profitable.
I know some of you are shaking your heads and rightfully so, but that’s really what it is boiling down to. The fire department is looking to subsidize their budget cuts and trying to save the living through EMS isn’t paying the bills anymore.
This post was updated after personally visiting with the Organ Preservation Unit on December 8th