Kentucky man declared brain dead wakes up during organ harvesting
Kentucky man declared brain dead wakes up during organ harvesting
Case of Anthony Thomas ‘TJ’ Hoover II is under investigation by state and federal government officials
Case of Anthony Thomas ‘TJ’ Hoover II is under investigation by state and federal government officials
A man who had gone into cardiac arrest and been declared brain dead woke up as surgeons in his home state of Kentucky were in the middle of harvesting his organs for donation, his family has told media outlets.
As reported Thursday by both National Public Radio and the Kentucky news station WKYT, the case of Anthony Thomas "TJ" Hoover II is under investigation by state and federal government officials. Officials within the US's organ-procurement system insist there are safeguards in place to prevent such episodes, though his family told the outlets their experience highlights a need for at least some reform.
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WKYT reported that Rhorer only learned the full details of her brother's surgery at the hands of Baptist and the Kentucky Organ Donor Affiliates (Koda) in January. That's when a former employee of Koda contacted her before sending a letter to a congressional committee that in September held a hearing scrutinizing organ-procurement organizations, NPR reported.
The letter's author said she saw Hoover begin "thrashing" around on the operating table as well as start "crying visibly", according to NPR.
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About an hour after Hoover had been brought into surgery for his organs to be retrieved, a doctor came out and explained that Hoover “wasn’t ready”. “He woke up,” Rhorer said.
I wonder how far into the surgery they got. I'm assuming either not at all, or like only the initial cut, which may have been what gave the stimulation to knock him out of whatever coma state he was in.
If he was in the actual operating room for a full hour, that's a LONG time for nothing to have happened; but the hospitals I've worked at, there's a holding area where family is allowed to be at the patient's side, then shortly before surgery they get moved to pre-op (no family) for final prep before finally being pushed to the OR, so I suspect a lot of that hour was in pre-op.
...assuming organ harvest cases even go to pre-op - tbh I'm not sure if they do.
I've assisted in a few organ harvest cases, and the surgery itself is absolute madness - each organ system being harvested has its own team who specializes in that system, and they need to be extracted and preserved quickly to ensure they stay viable. So the second the docs get the green light to cut, it's like a pack of lions going to town on a gazelle. The time between initial cut and the donor being an empty carcass is like minutes. As soon as a team gets the organ they're after, they break scrub and leave, so the chaos transitions pretty quickly to this eerie quiet OR with a now not-just-brain-dead but dead dead patient flayed open on the table, blood all over the place since they don't really care about controlling bleeding, supplies all over the floor...
It's literally 6 high speed surgeries at the same time.
Point being - if someone woke up in the middle of that, they're already well passed the point of being completely fucked. You couldn't just call a stop and put it all back together. For real the best thing they could do in that scenario would be to push some general anesthetic to knock the patient back out, then continue the harvest (assuming general anesthetic wouldn't ruin the organs) and try to figure out what the actual fuck happened later.
NPR made it a point to say that some observers worry that the media attention Hoover’s case has drawn could undermine an organ-transplant system with a waiting list of more than 100,000 people. A professor of medical ethics with whom NPR spoke said all indications are that cases like Hoover’s are generally “one-offs that hopefully we’ll be able to get to the bottom of and prevent from ever happening again”.
That was my first thought too. This sounds like a super weird scenario, and while we should definitely dig, I'm a little uneasy about it circulating the web.
But Rhorer defended her decision to go public with Hoover’s story, saying it would be worth sharing if it could “give one other family the courage to speak up or if it could save one other life”.
...and that's the thing - that one life being 'saved' (or more likely: death delayed a bit, beyond the point of being a harvest candidate) is going to doom multiple others to death and prolonged agony. Going public was not a responsible choice. Where they should have gone was to a conference room in that hospital with a bunch docs from that hospitall and from KODA, their ethics board, and their patient advocacy staff, where they could have had every one of their concerns and grievances addressed in extreme detail, and provided to those docs extreme detail on every little gut feeling they had that was putting up red flags that something wasn't right, and possibly identify some potential system improvements - that's the data that could have saved other families from going through this again.
Going public is pretty much always the correct decision.
I don't want a healthcare system where fuck-ups are covered up in order to influence decisions of the patients.
That's not a slippery slope, that's a greased fireman's pole to corruption.I agree. I also think the media plays a large role in the equation.
I would assume they'd sedate the person, even if brain dead, to guard against this exact scenario (which means they'd be harvesting a not-actually-braindead person, but that's a separate issue). Do they not do this? Or did they just not sedate enough or something? I don't know how sedation is measured, does being braindead make it harder to measure because some metric already looks like it does while sedated?
No idea. I've only done a few of these, and again they're absolute madness. I'm a surgical tech, so getting the sterile field and instruments set up is my first responsibility; then it's getting those instruments into the hands of the surgeons so they're not wasting ANY time; then it's packing up the mess afterward. In slower cases I can kinda check out what the anesthesia folks are doing, and sometimes even help out with super basic shit like holding an O2 mask on the patient's face before they're intubated to free up their hands for actual patient care, but that's all extra, time-permitting stuff that isn't a normal part of my job.
For organ harvests specifically, I don't even recall if an anesthesiologist or CRNA was present or not - these cases require 100% of my focus to stay honed in on my own job, otherwise I'll fall behind, which slows the surgeons down, which compromises the organs being harvested and used.
It makes intuitive sense to give a little sedation to prevent the scenario from the article, but I could see that being problematic for a harvest: sedation or general anesthesia are systemic, so any of that they administer is going to make its way into the organs being harvested. Whether or not that's an issue for those organs or the next patient receiving them... no idea. Could actually be beneficial and already standard practice. Or anywhere in between. That'd be a question for an organ harvest doc - it's over my head.
No, if a patient is declared brain dead, there is usually no sedation given. It shouldn't be necessary, as the neurons responsible for sensing pain aren't alive and processing signals, and extra medication like sedation comes with the risk of hemodynamic instability, which is already kind of a headache in brain dead patients as the brain is no longer meditating that (extremely oversimplified). Yes, sedation can be measured (sorta) with a BIS probe, a spectral imaging probe on the forehead that acts like an EEG with fewer probes, but it's not very useful in brain death as it's ultimately looking at blood flow, and in brain death, we don't expect to see blood flow to the brain.
All of this, of course, assumes that he was declared brain dead, which is a very specific legal term with very specific parameters that vary slightly state by state, which seems unlikely in this situation. He may have been deemed to have a severe neurologic injury with an unlikely prognosis of meaningful recovery, and thus be a planned DCD (declared cardiac death) donation, meaning placed on a minimally assistive ventilatory support and allowed to die once his respiratory drive was so low he died of hypoxic respiratory failure. But the article is long on anecdotes and short on the technical terms physicians would use, so it's hard to say.
Maybe I’m an optimist, but perhaps this will simultaneously scare off the conspiracy paranoids/lead paint crowd and ensure quality organs go to deserving and rational patients.
I opted out as an organ donor a few years ago and it was after reading comments like yours where people described the process of organ harvesting. I find it to be pretty dehumanizing. I think there is a lot of pressure to do it without much education on the subject. Additionally I wish I could control where my organs went, I wish I could consent right before I died and I wish there wasn't a giant Rube Goldberg machine of financial incentives (that can be cheated to benefit the wealthy) driving the entire enterprise, but we don't live in a perfect world. I hope if I'm ever I situation where I would need a transplant I will not be a hypocrite and let myself die or just survive on life support. This article is just a drop in the bucket, and to me, your comment and this case only highlight sentiments that were already there. We are not animals we can't put blinders on people in the hopes that more of them sign up to have their organs harvested after death using a system that is arguably kinda fucked up. There is this attitude and arrogance that come from the medical profession where people think because they know best and want to keep patients in the dark in matters of life and death (CDC lying about masks, to absolute catastrophes like the case of Memorial Medical Center after hurricane Katrina)
I opted out as an organ donor a few years ago and it was after reading comments like yours where people described the process of organ harvesting. I find it to be pretty dehumanizing.
You opted out of potentially saving lives because you feel like the necessary process of rapidly removing and preserving quickly decaying organs doesn’t treat the cadaver with proper respect?
That’s a really strange stance.
Additionally I wish I could control where my organs went
I’m glad you can’t. I realize the system isn’t perfect, but it’s better than the absurd complexity of letting the flawed and uneducated person dying decide who gets them. Imagine, for example, bigots demanding no black person or gay person gets their organs. Screw that. Continue to improve the system, but a system needs to be in place.
See, this is what I mean 👆 "iT sAvEs liVess, wHat arE yOu a PieCe of ShiT?" Using social pressure to shame others into a system, which if they were educated on it, they probably wouldn't agree to it.
More than 60% of the people that receive organ transplants are 50 or older. To tell you the truth, no I don't care about being their hero. And as I mentioned there is a for profit incentive system in place which I'm not comfortable with (in the US at least) And just as a bigot wouldn't want their organ going to a certain portion of the population, I wouldn't want my organs going to a bigot or some wealthy asshole that can afford the procedure while others die. Also I wouldn't want to find myself at deaths door surrounded by a transplant team circling my dying body like vultures treating my body like a commodity.
See, this is what I mean 👆 "iT sAvEs liVess, wHat arE yOu a PieCe of ShiT?"
Those were not my words.
I think it’s wild that you care about what happens to your organs after you die. I do think it’s a selfish position, personally, but you do you. I just doubt you’ll feel as strongly opposed to organ donation if you ever find yourself needing one.