A former employee of an organ recovery group said in a letter to a congressional committee that in 2021 the Kentucky organization tried to harvest organs for transplant from a patient who was still alive.
Nyckoletta Martin said a man who was incorrectly listed as brain dead woke up in a Kentucky hospital. But the group charged with recovering the organs, the , wanted to proceed with the operation anyway, Martin said. Martin called it an alarming case of patient abuse.
Organ transplantation in the United States is overseen by a Richmond, Virginia-based contractor, the United Network for Organ Sharing, or . Anne Paschke, a spokesperson for the contractor, said UNOS was unaware of the allegation until it was referenced at a congressional hearing Wednesday by the House Committee on Energy and Commerce. Had it been reported to the transplant network, the claim would have been investigated by a peer review process.
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Paschke called the remarks serious and unfounded, saying they “have the potential to jeopardize confidence our country’s donation and transplantation system.â€
After Virginia Rep. Morgan Griffith, R-9th, amplified the allegation Wednesday, it drew responses of disbelief.
“It’s like a bad Netflix movie,†said Rep. Kelly Armstrong, R-N.D. “Is it possible this stuff is actually happening?â€
Griffith
UNOS has held the organ transplantation contract since its inception in 1986. It oversees the Organ Procurement and Transplant Network, which includes 56 organ procurement organizations and about 250 transplant hospitals.
A nonprofit, UNOS has faced years of problems. It has been accused of operating old technology, failing to get organs delivered on time and an inability to discipline underperforming members of the network.
Repairing the country’s system for organ transplantation is one of the rare places where Republicans and Democrats agree, Rep. Kathy Castor, D-Fla., said Wednesday.
A law passed in 2023 breaks up its monopoly. The Health Resources and Services Administration has solicited bids for contractors to take on various pieces of UNOS’ work. UNOS agreed to a contract that expires at the end of the year. The government can extend the contract up to another year.
UNOS said it supports the government’s plan to divide up the contracts. UNOS believes it has the experience and expertise to remain a part of the national system.
‘Crying and thrashing’
Martin said she had been working for Kentucky Organ Donor Affiliates for a year when she was called to the hospital in 2021. A young man had overdosed and was declared brain dead. It was Martin’s job to recover the organs for transplantation, she wrote in a letter to Congress obtained by the Richmond Times-Dispatch.
Martin said that her colleagues notified her that the man awoke during a cardiac catheterization procedure in preparation for organ donation.
“He was crying and thrashing around,†Martin wrote in her letter.
Medical staff gave him a sedative and a paralytic and returned him to the intensive-care unit. Later, he woke again. The determination that the man was brain dead was an error. Such errors are “shockingly common,†Martin wrote.
But a senior official for Kentucky Organ Donor Affiliates, the organ recovery group, directed that the organ recovery proceed, Martin said. The man’s movements were written off as reflexes. Staff wheeled the patient toward the operating room, a process known as an “honor walk,†where employees stand and honor the organ donor. The man woke a third time, Martin said.
On the operating table and fully conscious, the man cried, shook his head and pulled at his breathing tube. The surgeon canceled the procedure, and the patient was taken back to the ICU. The senior organ procurement official looked for another surgeon to take the organs, but none would do it.
Two weeks later, the man was discharged from the hospital, and several organ procurement employees quit the company, including Martin.
“It was horrifying to see so many opportunities for KODA leadership to do the right thing and not to do them,†Martin wrote.
Paschke, the UNOS spokesperson, said the allegations should be reported to law enforcement for further investigation. She said the safety of patients is UNOS’ top priority.
UNOS has a phone number for reporting safety events, and reports can be made confidentially. The network’s bylaws prohibit retaliation against whistleblowers. But Greg Segal, who started a reform group called Organize, testified Wednesday that UNOS ignores calls for improvement and sometimes attempts to quiet those who speak out.
In 2022, UNOS’s then-CEO, Brian Shepard, of the Health Resources and Services Administration to discipline or remove failing organ collection groups – not UNOS’s.
A new CEO, Maureen McBride, took over last year and is steering the nonprofit toward “a future defined by innovation and improvement,†Paschke said.
Dr. Seth Karp, a transplant surgeon at Vanderbilt University Medical Center, said organ transplant teams have poor training and standard of practice.
On Capitol Hill on Wednesday, other transplant experts explained that a patient might show signs of life after he or she has been declared dead. Dr. Robert Cannon, a transplant surgeon at the University of Alabama at Birmingham, said he once experienced a similar situation. During the procedure to remove the organs, the anesthetist said it appeared the patient breathed.
No one knew what to do, Cannon said, so someone called the organ procurement organization to ask for help. The organization recommended the hospital staff continue collecting the organs “which would have been murder had we proceeded,†Cannon said.
Instead, Cannon stopped the procedure, and the patient died at a later point. Every transplant surgeon has a story like this, he added.
Dr. Seth Karp, a transplant surgeon at Vanderbilt University Medical Center, said that from time to time, after a patient has arrived for organ removal, the question arises of whether the patient is actually dead. Transplant teams have poor training and a poor standard of practice, Karp said.
“People don’t know what to do in that situation,†Karp said.
Another who testified Wednesday, Segal, said he has heard similar allegations with regularity. Some employees of organ procurement organizations decline to be organ donors because of the company’s practices.
Paschke, a spokesperson for UNOS, said those who testified spread “untruths and misunderstandings†about the transplant network.
Organ groups don’t collect enough
These allegations of overzealous pursuit of organs contrast the most common criticism of organ procurement organizations — that they do not collect enough organs, disregarding patients who don’t speak English or those who died in Veterans Affairs hospitals, critics said. After organs are collected, too many of them are discarded or lost before they can be transplanted into a needy patient, Karp said.
There isn’t a uniform policy across all states to determine if a dead patient is ready to become an organ donor, Cannon said. Often, two doctors will affirm that the patient has experienced brain death. They might check for breathing and whether blood is flowing to the brain. The transplant surgeon who removes the organs is not part of the determination – and should not be, Cannon added.
After the patient is declared dead, the organ procurement organization steps in and begins making arrangements, including speaking to family members.
If the transplant surgeon or another staffer notices something to suggest the patient is alive, the operation stops immediately. Such instances are rare, Karp said.
Allegations such as these are troubling, said Rep. Debbie Lesko, R-Ariz., because they go beyond hurting a patient. If word spreads that organs are harvested before a patient dies, fewer people will volunteer to be organ donors.
“This is a problem,†she said.
