After Kelly Hugo flew through a snowstorm to reach the bedside of her mortally wounded son at a U.S. Army hospital in Germany, where he had just been brought from Afghanistan, she didn't hesitate when asked about organ donation.
"I said, 'Oh, yes,' " the junior high school counselor recalls, memories still fresh of that December in 2010 when she last saw her son, Marine Cpl. Sean Osterman, 21, of Princeton, Minn., "because something good has to come out of something bad."
Since 2006, about 140 European lives have been saved because organs - hearts, lungs, livers, kidneys and pancreases - were harvested from 36 U.S. servicemembers determined to be brain dead from wounds suffered in Iraq or Afghanistan, according to statistics from the German foundation that oversees organ removal and implantation.
All casualties from combat funnel through the U.S. Army's Landstuhl Regional Medical Center in Germany for care before being flown to the USA.
The window for removing, transporting and transplanting organs is narrow given the viability of organs, making it difficult for them to be used in the USA, says Insel Angus, a Landstuhl intensive care nurse involved in these cases.
Troops who are brain dead from head wounds arrive on a ventilator. Even with ventilator support, key organs last for only 24 to 36 hours, says Joel Newman, a spokesman for the German foundation's USA counterpart, the United Network for Organ Sharing.
The U.S. military flies family members to Germany for a final reunion and, when appropriate time has passed, asks about organ donation, says Angus, trained to handle the discussions.
"It is very emotional. It is very difficult," she says, "because we feel the pain of losing one of our servicemembers. ... We feel the grief of the family."
The rate of organ donation from patients at Landstuhl is relatively high compared with other hospitals in Germany, according to data from the German foundation.
Recipients are mostly German but also from The Netherlands, Belgium, Luxembourg, Austria, Croatia and Slovenia, according to the foundation.
"Many (families of U.S. servicemembers) believe the donation carries on the legacy of their loved one," says Ami Neiberger-Miller, a spokeswoman for TAPS, a U.S. group that supports grieving military families.
Osterman suffered massive brain damage from shots to the face during combat in Helmand province. Three organs, including his heart, were harvested.
Hugo says her son was a big, generous man who wouldn't have flinched at the question of organ donation. "If you would have asked Sean at that point, he would have said, 'Hell, yes.' "