But if you start thinking about the intermediate option of preservation, then you don’t have to be in that setting. So by putting this paper out, we’re saying that it’s perfectly fine with us if you want to try and ask for organ preservation in order to think about organ donation later. That would be okay. … People keep asking, what are we going to do about transplants? Well, this is the option that would get you into a much bigger set of potential people.

Romm: So how would your proposal work?

Caplan: So let’s say an average person, a 49-year-old man, is just sitting at home and he has a massive stroke or a massive heart attack. And his relatives call the EMTs and they get there within 10 minutes, if we’re lucky. And they try to resuscitate this person and they look at all his vitals. They pronounce him, and they say, “We’re so sorry, he’s died from a heart attack right here. But we want to ask you something, and we know it’s tough, but it will create some options for you: Would you consider allowing us to try and preserve his organs so that you can consider organ donation later? We have some equipment that would maybe allow us to preserve his organs until we get him back to the hospital, and when there, you could talk about organ donation with us when you’ve had a chance to accept this terrible thing that’s happened.” So they’re saying, “We know you’re vulnerable, we know this is probably the worst moment of your life, we don’t want to get into organ donation but we want to save that as an option here.” And the people in the house could say, “No way, forget it,” or they could say, “Okay, we’ll come to the hospital a little later and talk to you about this, but right now we’re just going to cry.”

Romm: What would be the process of preserving the organs?

Caplan: Basically you have to make sure the organs don’t get oxygen-deprived. What you’re trying to do is use artificial technology—the whole trick is circulating blood through the organs. It depends where you are and what kind of preservation intervention you can do. Sometimes you can just put somebody on a drug that will keep the organs okay for another hour, or sometimes you can put them on a mini heart pump. Some places have that in a special ambulance to take them back. It all depends on where they’re going and what’s around. If you’re in rural Oklahoma, you might not get much—it could be a three-hour drive to a community hospital and they’re not really set up to manage it.

Romm: At what point would the second step kick in?

Caplan: That’s when the organ-procurement people would come in. The family would come in, and they’d talk to them and say, “We want to talk to you about organ donation. Did this person have an organ-donor card? Do you know if they wanted to do this? Is there any reason you have to think that they don’t want to do this?” It would be the usual discussion that takes place now when somebody’s brain-dead.