NEW YORK - Saving the living has always been the No. 1 priority for a New York City ambulance crew. But a select group of paramedics may soon have a different task altogether - saving the dead.
The city is considering creating a special ambulance whose crew would rush to collect the newly deceased and preserve the bodies so the organs might be taken for transplant.
The "rapid-organ-recovery ambulance," still in the early planning stages, could raise a host of ethical questions and strike some families as ghoulish. But top medical officials in the Fire Department and at Bellevue Hospital say it has the potential to save hundreds of lives.
In this country, only people who die at hospitals generally serve as organ donors, because doctors are on hand with life-support machinery and other equipment to preserve the organs and remove them before they spoil. Surgeons have only a few hours before kidneys, livers, and other body parts suffer damage that renders them unusable.
Lewis Goldfrank, Bellevue's director of emergency medicine, said the ambulance project could spark an "amazing transformation" by substantially increasing the pool of donors. Similar ambulances have operated successfully in parts of Europe, he said.
Only cardiac-arrest patients who died of natural causes would be considered candidates for the program. The transplant ambulance would turn up at the scene minutes after regular paramedics had ceased efforts to resuscitate a patient. The team would begin work almost immediately, administering drugs and performing chest compressions intended to keep the organs viable.
Sometimes, those steps would be taken before getting approval from a relative and without knowledge of the departed's wishes.
Actual organ removals would be done at the hospital only. And no organs would be removed without getting the family's express consent.
Still, experts in medical and legal ethics said they saw potential for trouble.
"Starting this process without knowing whether the decedent wanted to be a donor could be a problem," said Maxwell Mehlman, director of the Law-Medicine Center at Case Western Reserve University in Cleveland.
Distraught relatives could be unnerved by the site of a transplant team arriving so soon after a death. Some might have a religious objection to organ donation and be enraged to learn that a body had been moved and injected with fluids.
Others might also - rightly or wrongly - question whether the paramedics had curtailed lifesaving efforts because a patient had valuable organs.
"A lot of people don't trust the medical system to begin with, and in the city you have additional class and race issues to deal with," said Arthur Caplan, a professor of bioethics at the University of Pennsylvania. "I could very easily see a family saying: 'If it was a white, rich person, that person would have been saved. But instead you've sent the meat wagon.' "
Doctors working on developing a pilot program say they realize the sensitivity of the issue and are building precautions into the system, which would start with just one ambulance.