All hospitals are required to participate in a chain of procedures involving potential organ donors — from getting permission, to notifying a local organ procurement organization when opportunities arise.

"We deal with the donor and the family, and the process of making a decision to donate," said Jean Walsh, a trauma coordinator at Saint Francis Hospital in Poughkeepsie, a level 2 trauma center.

"Preparing the patient to donate is very emotionally exhausting, but gratifying at the same time. If you think about it, it's such a tragic thing that's occurred , but on the other hand, it's one of the most generous and gracious things a family can do is to take a tragedy and turn around and make a gift of life to other people, and to make other people's lives better because of it."

There is no one person designated to start the chain. Doctors and nurses recognize potential donors who will soon face brain or cardiac death.

Before approaching the family, there are several criteria a patient must be determined to meet. The hospital then calls the New York Organ Donor Network.

"You can never be wronged or criticized in making that call, because sometimes people look like they're moving in that direction," Walsh said.

Most donors are young adults who wind up in the intensive care unit, often as a result of car crashes or other incidents that caused brain trauma. Many patients have already made the decision to donate, whether it be a signature on their driver's license or through the Donate Life Registry.