Increased Demand for Organ Transplants Leads to Frightening Deathbed Scenes

A New York Times investigation into some organ donation practices has led to hearings in Congress.

The New York Times in July reported a rise in disturbing cases of organ donation after circulatory death, in which would-be organ donors were prepared for organ harvesting under questionable circumstances.

In addition to numerous harrowing stories detailed in the article, 55 medical workers in 19 states said they had witnessed at least one “disturbing case” of organ donation after circulatory death. Examples include tales of patients being inappropriately prepared for organ donation — a few even undergoing surgery before doctors realized that they were still alive.

The increase in these kinds of cases, the Times reports, is driven in part by federal pressure on organ procurement organizations to increase the number of organs available for those seeking organ transplants.

Why Donation After Circulatory Death Raises Issues

There are essentially two conditions in which a person can be declared legally dead: brain death, which is an irreversible state of permanent unconsciousness; and circulatory death, which is when the heart stops beating and cannot be restarted.

Currently, most donated organs in the United States come from people who are brain-dead and kept on machines to maintain their organs until harvesting is possible.

However, the number of those declared brain-dead is far lower compared with the number of people who undergo circulatory death. The problem with declaring “circulatory death” is that such a determination varies between states and even hospitals.

As the Times explains, patients being assessed for donation after circulatory death are on life support, and “their prognoses are more of a medical judgement call.”

What the Times found via interviews with medical workers across the country is that despite policies surrounding organ procurement procedures, some organ procurement organizations have been attempting to exert influence over physicians and hospital staff members making treatment decisions.

For example, a recent federal investigation looked into 350 cases in Kentucky over the past four years in which plans to remove organs were ultimately canceled. It found that in 73 instances, officials should have considered stopping sooner because the patients had high or improving levels of consciousness. (Most of the patients eventually died, but some recovered enough to leave the hospital.)

The case was spurred by what happened to Anthony Thomas Hoover II, who cried, shook his head, and drew his knees to his chest as doctors began to remove life support in preparation for organ harvesting.

Federal Policies Increase Pressure on Procurement Organizations

Organ transplants in the United States take place within an intricate system of hospitals, doctors, and nonprofit donation coordinators that carry out tens of thousands of lifesaving transplants each year.

However, the Times found that “some organ procurement organizations — the nonprofits in each state that have federal contracts to coordinate transplants — are aggressively pursuing circulatory death donors and pushing families and doctors toward surgery.”

Dozens of employees at such organizations told the Times it was largely because of government pressure.

In 2020, the Centers for Medicare & Medicaid Services said it would begin rating procurement organizations based on how many transplants they successfully arranged: “Underperforming [organ procurement organizations] will compete for their organizational contracts, and the worst performers will be unable to renew their contracts.”

The goal of the federal government was understandable: More than 100,000 people are currently waiting for an organ in the United States, and many people will die while waiting for a match. Demand far outweighs the supply, and many governmental and nongovernmental agencies have sought ways to close the gap in recent years. The theory is that competition would lead to more organ donations and organ transplants.

But the financial incentive apparently has led to efforts by procurement organizations to raise their numbers — and one way they’ve been able to do so is by pursuing more circulatory death organ donors, the Times reports.

Congressional Hearing Leads to Requests for More Oversight for Organ Transplants

The Times report suggests that many of these issues stem from the fact that the organizations involved in organ donation largely police themselves. The Organ Procurement Transplantation Network’s oversight committee “reviews complaints but has rarely acted against the hospitals and 55 procurement organizations that make up its membership,” the Times noted in an earlier article published in February. This lack of accountability results in issues like frequently violated protocols, and negligence.

In the days following the report, Newsweek noted that a number of states saw a dramatic decline in the number of people registered to be organ donors. The Association of Organ Procurement Organizations told that publication in a statement that the incidents “in no way represent the vast majority of experiences of the thousands who encounter organ donation and transplantation professionals each day.” 

And in response to the Times’ report, Maureen McBride, CEO of the United Network for Organ Sharing, said: “This falls far below the standard that the American organ donation and transplant system—the global gold standard—demands, and it cannot be tolerated. … This sharply underscores the need for a more unified and accountable structure for overseeing the nation’s organ donation and transplant system.”