WEDNESDAY, Aug. 3 (HealthDay News) — When a 31-year-old public relations executive suddenly fell ill last month in need of a complete liver transplant, well-meaning colleagues issued a press release drawing attention to her plight.

But did their plea on behalf of co-worker Shari Kurzrok, who remains hospitalized at New York University Medical Center, violate ethical boundaries or spur others to cross the line?

“I think it’s fair to say that there were some activities undertaken that went a little too far,” conceded Kym White, managing director of Ogilvy Public Relations Worldwide in New York, which issued the press release and helped arrange a small print advertisement seeking a liver donor with Type A or Type O blood.

White said some of the activities in which people have engaged were inappropriate, although she insists the campaign was borne of good intentions.

As the demand for donor organs in the United States continues to outstrip supply, more people are using the Internet and advertising to find donor organs. And as the safety of transplantation surgery improves, more living donors are coming forward to offer one of their kidneys or a lobe of a liver or lung.

All of this raises new ethical quandaries, according to the writers of three companion articles in the Aug. 4 issue of the New England Journal of Medicine. Who decides, for example, whether a living donor is psychologically and physically fit to donate a kidney? And how will the nation’s organ transplant system ensure the fair distribution of organs to those most in need — not simply the most vocal?

In seo services a prepared statement, the United Network for Organ Sharing (UNOS), a private group that contracts with the federal government to administer the nation’s Organ Procurement and Transplantation Network (OPTN), said it is committed to providing comprehensive information about the risks and benefits of being a living donor. In addition, it said, the OPTN has established criteria for living donor transplant programs.

Meanwhile, a proposal regarding deceased donor solicitations will go before the OPTN/UNOS board of directors this November, UNOS said in the statement.

Kurzrok’s case exemplifies a practice known as “direct donation.” Instead of waiting for the nation’s organ transplant system to identify and procure a liver, family and friends of the Great Neck, N.Y., native took it upon themselves to help find a donor.

“Direct donation of organs from deceased donors is very problematic,” said Dr. Robert Steinbrook, national correspondent for the New England Journal of Medicine.

The reason? He quoted Dr. Francis L. Delmonico, a Boston transplantation surgeon who serves as president of UNOS’s executive committee: Such solicitations “can undermine the allocation system and prevent the best medical use of the organ.”

Steinbrook’s commentary recalls the case of a 32-year-old Houston man with liver cancer who received a directed liver last year after advertising in newspapers, on a Web site and on two highway billboards but who died eight months after the transplant.

“His controversial campaign might have encouraged a donation that would not have occurred otherwise, or diverted a liver from someone with a greater chance for long-term survival,” Steinbrook recounted.

At the same time, direct donations from living donors, especially kidney donors, will continue to be an important source of organs, he said.

Across the nation, about 89,000 people were on waiting lists to receive an organ transplant as of last month and, of that group, 62,500 patients were awaiting kidney transplants, Steinbrook said. Yet only a quarter of them are expected to receive a transplant with the next year.

Living donation is helping to fill the gap between supply and demand. In 2004, just over 27,000 organ transplantation