Four years ago, an unconscious Kentucky man began to awaken as he was about to be removed from life support so his organs could be donated. Even though the man cried, pulled his legs to his chest and shook his head, officials still tried to move forward.

Now, a federal investigation has found that officials at the nonprofit in charge of coordinating organ donations in Kentucky ignored signs of growing alertness not only in that patient but also in dozens of other potential donors.

The investigation examined about 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.

Although the surgeries didn’t happen, the investigation said multiple patients showed signs of pain or distress while being readied for the procedure.

Most of the patients eventually died, hours or days later. But some recovered enough to leave the hospital, according to an investigation by the federal Health Resources and Services Administration, whose findings were shared with The New York Times.

The investigation centered on an increasingly common practice called “donation after circulatory death.” Unlike most organ donors, who are brain-dead, patients in these cases have some brain function but are on life support and not expected to recover. Often, they are in a coma.