Natasha Miller says she was getting ready to do her job preserving donated organs for transplantation when the nurses wheeled the donor into the operating room.
She quickly realized something wasn鈥檛 right. Though the donor had been declared dead, he seemed to her very much alive.
鈥淗e was moving around 鈥� kind of thrashing. Like, moving, thrashing around on the bed,鈥� Miller told NPR in an interview. 鈥淎nd then when we went over there, you could see he had tears coming down. He was crying visibly.鈥�
The donor鈥檚 condition alarmed everyone in the operating room at Baptist Health hospital in Richmond, Ky., including the two doctors, who refused to participate in the organ retrieval, she says.
鈥淭he procuring surgeon, he was like, 鈥業鈥檓 out of it. I don鈥檛 want to have anything to do with it,鈥� 鈥� Miller says. 鈥淚t was very chaotic. Everyone was just very upset.鈥�
Miller says she overheard the case coordinator at the hospital for her employer, (KODA), call her supervisor for advice.
鈥淪o the coordinator calls the supervisor at the time. And she was saying that he was telling her that she needed to 鈥榝ind another doctor to do it鈥� 鈥� that, 鈥榃e were going to do this case. She needs to find someone else,鈥� 鈥� Miller says. 鈥淎nd she鈥檚 like, 鈥楾here is no one else.鈥� She鈥檚 crying 鈥� the coordinator 鈥� because she鈥檚 getting yelled at.鈥�
"Everybody's worst nightmare"
The organ retrieval was canceled. But some KODA workers say they later quit over the October 2021 incident, including another organ preservationist, Nyckoletta Martin.
鈥淚鈥檝e dedicated my entire life to organ donation and transplant. It鈥檚 very scary to me now that these things are allowed to happen and there鈥檚 not more in place to protect donors,鈥� says Martin.
Martin was not assigned to the operating room that day, but she says she thought she might get drafted. So she started to review case notes from earlier in the day. She became alarmed when she read that the donor showed signs of life when doctors tried to examine his heart, she says.
鈥淭he donor had woken up during his procedure that morning for a cardiac catheterization. And he was thrashing around on the table,鈥� Martin says.
Cardiac catheterization is performed on potential organ donors to evaluate whether the heart is healthy enough to go to a person in need of a new heart.
Martin says doctors sedated the patient when he woke up and plans to recover his organs proceeded.
KODA officials downplayed the incident afterwards, according to Martin. She was dismayed at that, she says.
鈥淭hat鈥檚 everybody鈥檚 worst nightmare, right? Being alive during surgery and knowing that someone is going to cut you open and take your body parts out?鈥� Martin says. 鈥淭hat鈥檚 horrifying.鈥�
The patient
Donna Rhorer of Richmond, Kentucky, told NPR that her 36-year-old brother, Anthony Thomas 鈥淭J鈥� Hoover II, was the patient involved in the case. He was rushed to the hospital because of a drug overdose, she says.
Rhorer was at the hospital that day. She says she became concerned something wasn鈥檛 right when TJ appeared to open his eyes and look around as he was being wheeled from intensive care to the operating room.
鈥淚t was like it was his way of letting us know, you know, 鈥楬ey, I鈥檓 still here,鈥� 鈥� Rhorer told NPR in an interview.
But Rhorer says she and other family members were told what they saw was just a common reflex. TJ Hoover now lives with Rhorer, and she serves as his legal guardian.
The general outline of the incident was disclosed in September by a letter Nyckoletta Martin wrote to the House Energy and Commerce Committee, which held a . She later provided additional details about the case to NPR.
鈥淪everal of us that were employees needed to go to therapy. It took its toll on a lot of people, especially me,鈥� Martin told NPR.
Investigations underway
The Kentucky state attorney general鈥檚 office wrote in a statement to NPR that investigators are 鈥渞eviewing鈥� the allegations.
The federal Health Resources and Services Administration (HRSA), which helps oversee organ procurement, said in a statement to NPR that the agency is 鈥渋nvestigating these allegations.鈥� And some people involved in the case told NPR they have answered questions from the Office of the Inspector General of the federal Department of Health and Human Services, though no federal official from that office has commented on the case.
Baptist Health Richmond, where that incident allegedly occurred, told NPR in a statement:
鈥淭he safety of our patients is always our highest priority. We work closely with our patients and their families to ensure our patients鈥� wishes for organ donation are followed.鈥�
"Not been accurately represented"
KODA, the organ procurement organization, confirmed that Miller was assigned to the operating room for the case. But the organization told NPR in a statement that 鈥渢his case has not been accurately represented.
鈥淣o one at KODA has ever been pressured to collect organs from any living patient,鈥� according to the statement from Julie Bergin, president and chief operating officer for Network for Hope, which was formed when KODA merged with the LifeCenter Organ Donor Network. 鈥淜ODA does not recover organs from living patients. KODA has never pressured its team members to do so.鈥�
Organ procurement system officials, transplant surgeons and others said that there are strict protocols in place to prevent unsafe organ retrieval from happening.
鈥淚ncidents like this are alarming. And we would want them to be properly reported and evaluated,鈥� , president of the , told NPR in an interview. 鈥淎nd obviously we want to ensure that individuals are, in fact, dead when organ donation is proceeding. And we want the public to trust that that is indeed happening. The process is sacred.鈥�
The accusations that emerged at the congressional hearing in September undermine trust in the organ donation system and have led to a drop in people signing up to be donors, .
鈥淔or over five years, our nation鈥檚 organ procurement organizations (OPOs) 鈥� the non-profit, community-based organizations that work with grieving families every day to save lives through transplantation 鈥� have been subject to malicious misinformation and defamatory attacks based on hearsay, creating a false narrative that donation and transplant in the U.S. is untrustworthy and broken,鈥� the letter reads.
Others also fear such unnerving reports could undermine the organ transplant system.
鈥淭hese are horrifying stories. I think they need to be followed up carefully,鈥� says Dr. , a professor of medical ethics, anesthesia and pediatrics at Harvard Medical School who works as a critical care physician at Boston Children鈥檚 Hospital.
鈥淏ut I really would not want the public to believe that this is a serious problem. I believe that these are really one-offs that hopefully we鈥檒l be able to get to the bottom of and prevent from ever happening again,鈥� Truog says.
103,000 people waiting for transplants
Some critics of the organ procurement system say they weren鈥檛 entirely surprised by the allegations. With more than 103,000 people on the for a transplant, organ procurement organizations are under enormous pressure to increase the number of organs obtained to save more lives. In addition, there is an ongoing .
鈥淚 hope that a case like this really is extreme, but it does reveal some of those underlying issues that can arise when there are disagreements about the determination of death,鈥� says Dr. , an associate professor of Medicine and bioethicist at the University of Colorado.
But some wonder how rarely this happens.
鈥淭his doesn鈥檛 seem to be a one-off, a bad apple,鈥� says Greg Segal, who runs , an organ transplant system watchdog group. 鈥淚 receive allegations like that with alarming regularity.鈥�
Likewise, , a bioethicist and lawyer at the Mitchell Hamline School of Law in Saint Paul who studies organ donation, cites reported .
鈥淭his is not a one-off,鈥� Pope says. 鈥淚t has been alleged to happen before.鈥�
Another near miss described
Dr. , a transplant surgeon at the University of Alabama at Birmingham, described a similar incident during the congressional hearing where Martin鈥檚 letter was disclosed. It happened at a hospital outside of Alabama.
鈥淲e actually were in the operating room. We had actually opened the patient and were in the process of sort of preparing their organs, at which point the ventilator triggered and so the anesthesiologist at the head of the table spoke up and said, 鈥楬ey, I think this patient might have just breathed,鈥欌�� Cannon later told NPR in an interview. 鈥淚f the patient breathes, that means they鈥檙e not brain dead.鈥�
Nevertheless, a representative from the OPO wanted to proceed anyway, Cannon says. He refused.
鈥淲e were kind of shocked that an OPO person would have so little knowledge about what brain death means that they would say, 鈥極h, you should just go ahead.鈥� And we thought, 鈥楴o. We鈥檙e not going to take any risk that we murder a patient.鈥� Because that鈥檚 what it would be if that patient was alive.鈥�
"Why me?"
Since TJ鈥檚 release from the hospital, his sister, Donna Rhorer, says her brother has problems remembering, walking and talking.
When she asks TJ about what happened, she says he says: 鈥淲hy me?鈥�
鈥淚 do feel angry,鈥� says Rhorer.
鈥淚 feel betrayed by the fact that the people that were telling us he was brain dead and then he wakes up,鈥� Rhorer says. 鈥淭hey are trying to play God. They鈥檙e almost, you know, picking and choosing 鈥� they鈥檙e going to take this person to save these people. And you kind of lose your faith in humanity a little bit.鈥�
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