Organ harvesting gone wrong: Patient wakes up on the table
Industry Buzz
“Drug overdose alone is very capable of mimicking this [brain death] if you don't perform neuroimaging and allow time for drug washout... As someone who not infrequently has to declare brain death, it's one in the most serious and solemn tasks I feel I do. There can be no doubt that the person is dead and part of the criteria require a injury causing irreversible cessation of function of the whole brain, including the brain stem.” — @_qua, MD, anesthesiology
Last month, a federal investigation revealed that a Kentucky organ donation organization (now called Network for Hope) pushed hospitals to proceed with organ donation surgeries even when patients showed signs of life or recovery.[]
The investigation focused on "donation after circulatory death," a circumstance where patients aren’t brain dead but are removed from life support with the expectation they won’t survive.
However, in at least 73 cases in Kentucky, signs of consciousness or distress were ignored, and in some cases, patients woke up or showed clear reflexes or pain before the surgery was stopped.
The ongoing inquiry began following congressional testimony about Anthony Thomas Hoover II, a 33-year-old man admitted after an overdose in 2021.
The shocking case
Despite being unconscious for 2 days, Hoover exhibited increasing levels of awareness leading up to the planned procurement. During pre-retrieval procedures, he showed signs of crying, withdrawing his legs up to his chest, and moving his head.
According to a report from The New York Times, one physician present refused to withdraw life support, citing excessive neurological activity. Case notes documented that hospital staff “was extremely uncomfortable with the amount of reflexes patient is exhibiting,” and that “hospital staff kept stating that this was euthanasia.”[]
Hoover survived the episode and later spoke with his family, though he sustained neurological sequelae.
Natasha Miller, a former employee of the procurement organization, stated, “If it had not been for that physician, we absolutely 1,000 percent would have moved forward.”[]
The investigation concluded that the nonprofit pressured staff, ignored warning signs, and failed to recognize that sedatives or drugs might have masked a patient’s real condition. As a result of the investigation, federal regulators have demanded urgent reforms.
Understanding DCD vs brain death
One of the issues in the Hoover case was that he was considered to have been in a state of circulatory death.
Donation after circulatory death (DCD) differs significantly from donation after brain death (DBD), particularly in terms of how death is determined.
Under the typical DCD process for an eligible case, after a family consents to donation, an organ procurement organization (OPO) assesses organ viability and arranges transplant logistics. Each state has at least one OPO, often with staff based in hospitals.
The patient is moved to the OR, where life support is withdrawn. If death occurs within 1-2 hours, the team waits an additional 5 minutes before organ recovery begins. Strict protocols ensure organs are not removed before or causing death.
In a post on the r/medicine subreddit, doctors emphasize the amount of caution necessary:
“Drug overdose alone is very capable of mimicking this [brain death] if you don't perform neuroimaging and allow time for drug washout... As someone who not infrequently has to declare brain death, it's one in the most serious and solemn tasks I feel I do. There can be no doubt that the person is dead and part of the criteria require a injury causing irreversible cessation of function of the whole brain including the brain stem.” — @_qua, MD, anesthesiology
“Cases like this are exactly why brain death has to be taken as the most serious test we do as physicians.” —@bonushand, DO, neurology & neurocritical care
However, the DCD process assumes irreversible loss of circulatory and respiratory function, but does not require brain death.
Jenny Daigle, Director of Communications for the Association of Organ Procurement Organizations (AOPO), spoke about the Hoover case on behalf of the AOPO. “I want to clarify an important factual detail regarding the 2021 incident you are reporting on. The case in question was not a “donation after brain death (DBD)” scenario—it was a “donation after circulatory death (DCD)” case. In DCD, organ procurement can only begin after a patient’s heart has stopped and death has been declared based on circulatory criteria, not neurological (brain death) criteria.” She further added, “This distinction is critical, as the clinical protocols, safeguards, and determination of death processes differ significantly between brain death and circulatory death pathways.”
HHS Secretary Robert F. Kennedy Jr. has warned that if Network for Hope fails to implement mandatory corrective actions, the organization risks decertification.[]
The American Society of Transplant Surgeons (ASTS) expressed support for federal oversight following the Kentucky donor case, emphasizing the need for “multidisciplinary peer review” and “vetted investigation” when standards are not met. ASTS reaffirmed, “We are ready to share our expertise and experience to partner with the federal government and its agencies to further improve transplantation for the American public.”[]
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