The U.S. Department of Health and Human Services (HHS) initiated reforms of the country’s organ transplant system on Monday after a study of a major organ procurement organization revealed “disturbing practices” that the HHS characterized as a “systemic disregard for sanctity of life.”
HHS Secretary Robert F. Kennedy Jr. said in the press release that the department found that “hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying.” Kennedy added, “The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves.”
The review of one federally funded organ procurement organization (OPO), which serves Kentucky, southwest Ohio, and part of West Virginia, found “clear negligence” after examining 351 cases in which organ donation was authorized, but ultimately not completed.
According to the report, 103 cases (29 percent) were concerning, and 73 patients demonstrated
“neurological signs incompatible with organ donation,” meaning that they had high or improving levels of consciousness. At least 28 people “may not have been deceased” when organ procurement was initiated.
Although most of the patients eventually died, sometimes days later, some people who were greenlit for organ donation actually recovered and were able to leave the hospital. The HHS concluded that the results raised “serious ethical and legal questions” about the organization’s practices.
In response, the HHS announced that it instructed the Organ Procurement and Transplantation Network to make changes to safeguard potential organ donors nationally. The press release touted the safeguard updates as a vindication of President Donald Trump’s warnings that “entrenched bureaucracies, outdated systems, and reckless disregard for human life have failed to protect our most vulnerable citizens.”
Mounting Causes for Systemic-Level Concern
Despite new updates to the safeguards, questions about the ethics of the country’s current organ transplant system are increasingly coming to light. The HHS’s report was announced just one day after a New York Times report found that people across the nation “have endured rushed or premature attempts to remove their organs,” as some “were gasping, crying or showing other signs of life.”
According to the report, the organ transplant system’s push to harvest more organs has created “a pattern of rushed decision-making that has prioritized the need for more organs over the safety of potential donors.”
The report, along with a previous piece, documents a slew of horror stories that reflect the dangers of current practices. In one case, an unconscious man started to wake up as doctors were about to remove him from life support to take out his organs. Officials attempted to move forward even as the man was crying, curled into a ball, and started shaking his head.
One man cried and clenched down on his breathing tube, but doctors still withdrew him from life support. When another man who was paralyzed came off his sedatives and awoke in the organ transplant operating room, organ procurement coordinators simply asked him for consent to take his organs anyways — to the appallment of other doctors in the room. A different patient was subjected to preparations for donation even though her family pointed out that she appeared to be regaining consciousness, which she did.
In another case, a woman who was crying and looking around was sedated by doctors and then removed from a ventilator to start the process of organ donation. After being sedated and removed from support, she survived for hours until she finally died too late to donate organs. A surgical technician present during the affair said, “I felt like I was part of killing someone.” In her opinion, if the patient had “been given more time on the ventilator, she could have pulled through.”
Difficulties in Defining Death
A number of the recent shocking cases have involved the increasingly common practice of “donation after circulatory death,” in contrast to the practice of “donation after brain death.” Whereas donation after brain death is defined as when “the entire brain must cease to function, irreversibly,” those who undergo donation after circulatory death are selected for donation while they are definitively still alive with at least some brain activity.
However, doctors have determined they are not going to recover, and if relatives consent, the doctors remove life support but wait until the patient’s heart stops beating before transplanting their organs. As the New York Times reported, these prognoses are “more of a medical judgment call,” because they involve the intentional withdrawal of medical support while the patient is known not to be brain dead.
One reason this practice has caused hesitation is that a study has suggested that doctors are frequently wrong in their initial predictions that patients will not recover from traumatic brain injuries.
According to an article in Transplantation Reports, “organ scarceness” led to the idea of donation after circulatory death becoming more common, because transplanting organs in these cases can help to increase the supply of organs. Last year, 7,200 donations after circulatory death made up 43 percent of all deceased donors.
While circulatory death donation used to be largely avoided or prohibited, the pressure to acquire more organs heightened in 2020 when HHS released new policy guidelines that grade organ procurement organizations on the “number of organs” they procure “from eligible donors in its donation service area.” Those that underperform will potentially “be unable to renew their contracts.” Many of the organizations have responded to the new incentives by acquiring more circulatory death donors to improve their numbers.
However, medical professionals frequently raise questions as to whether circulatory death donors are actually dead at the time of donation.
In one medical journal article, the authors write that “there are compelling reasons for calling into question compliance of current practices of transplantation” with the rule that donors should be dead before doctors perform transplants (which is known as the dead-donor rule). For one thing, “donors under [circulatory death] protocols are not known to be dead at the time of organ procurement” (because there are several ways a lack of circulation can be reversed, such as CPR).
Is “Brain Death” Legitimate?
While numerous instances of donation after circulatory death have resulted in shocking disregard for the sanctity of life, difficulties in the concept of brain death pose “even more compelling reasons to argue that the [dead-donor rule] is routinely being violated in the case of ‘brain dead’ donors.”
Medical scholars have pointed out that “‘brain dead’ individuals maintain a wide array of biological functions, including circulation, respiration, wound healing, infection fighting, temperature regulation, secretion of neurohormones, and even gestation of a fetus for up to three months.” They added that “they are not dead according to the established biological conception of death.”
Earlier this month, for example, a woman in Georgia gave birth via emergency cesarean section to a baby boy after being declared brain dead for over four months.
The concept of brain death was first developed in 1968, several years after the first brain-dead organ donation, in order to “legitimate organ removal from bodies that continue to have circulation and respiration” with help from medical technologies like feeding tubes and ventilators. Another medical scholar writes that “the impetus for brain death understood as both a medical and legal definition of death was the substantial need for organs.”
Despite the widespread use of brain death laws to justify current medical practices, an astonishing number of journal articles among the medical and legal establishment are arguing that the concept of brain death is incoherent. According to one article, “The concept of brain death has long been recognized, however, to be plagued with serious inconsistencies and contradictions. Indeed, the concept fails to correspond to any coherent biological or philosophical understanding of death.”
That alone is cause for concern, but the typical response from medical scholars is perhaps more appalling. Many are actually pushing to get rid of the dead-donor rule and want to simply dispel “the fiction” that “organ donors are dead at the time of organ procurement.” They hope that abandoning the dead-donor rule altogether will allow for more organ transplants.
In other words, the medical profession has known for a long time that the current terms under which we have initiated organ harvesting are incoherent and morally dubious, but, as the shocking effects of that system are reaching the public’s attention, many in the medical profession want to establish a new ethical framework that blatantly harvests people’s organs while they are still alive.
Kennedy’s new reforms to provide safeguards present a solid first step, but the HHS can’t sit back and declare “mission accomplished.” The HHS’s distressing report should rather spark further investigation into the practices and principles of the country’s established medical class.