Kentucky man declared brain dead ‘woke up’ during organ harvesting
www.theguardian.com
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.

…

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.

  • BlameThePeacock@lemmy.caEnglish
    2464·
    1 month ago

    Just to be clear, they had not actually started harvesting anything.

    The nurses and doctors noticed as he was wheeled into the operating room and called it off, a bunch of them ended up in therapy over the situation.

    Someone fucked up by declaring him brain dead clearly. He does however have significant brain damage from the drug overdose that initiated the whole situation.

    • TachyonTele@lemm.ee
      424·
      30 days ago

      This article says he was considered brain dead for three years. Where are you getting your extra info from?

      This is scary either way.

      • FlowVoid@lemmy.worldEnglish
        353·
        30 days ago

        She was caring for him for three years.

        You cannot be brain dead for three years. Brain death is legal death. Once you are declared brain dead, you are officially a cadaver and won’t be going home. You are going to the morgue that day, with possibly a brief initial stop in the operating room if you’re an organ donor.

        • Lichtblitz@discuss.tchncs.de
          172·
          30 days ago

          That’s not the case (at least in Germany). Being brain dead does not replace the conscious decision on when to disable life support.

        • bradorsomething@ttrpg.network
          4·
          28 days ago

          That’s not correct. When a person is declared dead but is maintained for organ harvesting, a tech is brought in to keep the body stable to best preserve all organs being taken. Think ICU, but focused on saving the organs with not much concern for the brain. Breathing, BP, and heart rate are optimized for organ survival until a surgical team can be set up for harvesting. A colleague did it for a while, and said it was depressing and a lot of sitting around watching the monitor and tweaking drips until they could arrange surgery. When my brother died, we donated what we could, but a lot of his organs were non-viable due to his illness… still, every little bit helps.

          I’d like to lighten up the mood by commenting the guy is lucky this happened in Kentucky… everyone knows the standard for being brain dead is much lower there. :)

      • BlameThePeacock@lemmy.caEnglish
        12·
        30 days ago

        If you think google his name you can see a picture of him riding in a car with his sister in 2023 so he’s clearly not braindead.

    • Rookwood@lemmy.world
      940·
      1 month ago

      Seems like they must have fucked up multiple times. I’m thinking it was probably the nurses that blew the whistle on this and stopped the whole thing.

      • BlameThePeacock@lemmy.caEnglish
        633·
        1 month ago

        The articles about this specify that it was the doctors that refused to perform the operation.

        • Apytele@sh.itjust.works
          8·
          30 days ago

          It’s usually a team effort. Usually when we’re disagreeing it’s some tiny little thing like how much sedation or pain or anxiety medication is needed, or which specific modality of treatment is indicated for something. The pain and anxiety thing can also go either way, sometimes it’s the nurses wanting more meds for the patient and sometimes they’re thinking less should be used and same for the doctors. And the other common disagreement is usually a disagreement of statistics vs lived experience, so the doctors are looking at the big picture of how things play out across large populations in places across the country or even world, vs nurses are thinking more in terms of their specific population and environment and what their specific team is trained and experienced at pulling off. Big picture vs individualized. There’s also some overlap though, they’re pushing more nurses especially in higher ed to learn more about stats and they’re pushing doctors to individualize things to their patients and teams.

          This is all to say that there are a lot of extreme moments where we’ll both just look at each other like what in the actual fuck is happening. We don’t always agree on the exact solution but we can usually at least come to a rapid consensus that what is currently happening is unacceptable.

  • peopleproblems@lemmy.world
    879·
    30 days ago

    “Were in the middle of harvesting his organs…” He’d be dead by that point.

    They can probably remove the corneas before incisions are made for the major organs, but once they make that first incision, those organs come out in a matter of minutes to be placed in sterile containers.

    “Had gone into cardiac arrest” meaning his heart stopped. From a drug overdose. Anyone here wanna guess what that means? You got it - CPR. Anyone who knows how to actually do CPR knows that if you do it correctly you are breaking ribs. That’s going to hurt like fuck when you wake back up.

    When they harvest organs, they aren’t just specialized butchers in there. These are surgeons, specifically specializing in organ transplant. The room for error in this specialty is 0. Every modern surgery, regardless of it is organ harvesting or not, will ultimately have a “pause” where everyone goes down the list to make sure everything that needs to be checked is checked.

    He likely didn’t get to the pause, he probably woke up before that. He was probably being evaluated by the team, and one individual caught something that had been overlooked. The rest of the team spent time to verify, then determined they could actually revive him. This is not a pleasant experience. He would not have been given pain medication beforehand, as he was in for a drug overdose, I could predict it probably wouldn’t work anyway.

    Whoever went public with this will cause many deaths because of the increase in fear of organ donation.

    • Maggoty@lemmy.world
      451·
      30 days ago

      It depends on how you define, “in the middle”. According to NPR he had woken up during his heart catheter to check it’s health for donation and they just sedated him back down. It was when he went into the final operating room that they refused to do the organ removal. That’s past all the checks that are supposed to be done. If he wasn’t visibly writhing on the table and crying he’d be dead.

    • Sunoiki@lemmy.worldEnglish
      40·
      30 days ago

      Your mixing organ procurement after cardiac death with brain death. It’s the cardiac death donations where they have to move very fast to reduce the warm ischemia time.

      For brain death they can be systematic, corneas sure, but for major organs usually kidneys first, bowel, liver, pancreas if usable (usually with bickering about which team gets more vena cava and aorta). Heart and lungs are functioning throughout the abdominal portion to keep them well perfused, then each is flushed and chilled as it’s passed off. So there is a period of time of ongoing surgery for this to occur.

      But you’re right, the process to declare brain death is lengthy and very formalized. Then while someone from anesthesia is in the room to maintain the body, they are not giving anesthesia. And definitely right about the last point, but it’s a big fuck up.

  • Melatonin@lemmy.dbzer0.com
    68·
    30 days ago

    “…cases like Hoovers are one-offs…”

    Ummm, CASES LIKE THIS??? THERE’S MORE???

    The letter’s author said she saw Hoover begin “thrashing” around on the operating table as well as start “crying visibly”, according to NPR.

    Fucking horror show.

  • Ranvier@sopuli.xyz
    38·
    30 days ago

    Really want to know exactly who declared brain death? For instance in the article the family talks about seeing eye movements and being told they’re "just reflexes."Yeah that may be, but reflexes involving the eyes are cranial nerve reflexes, they go through the brain. There can’t be brain death if they are there. That’s a brain function. Testing to make sure all cranial nerve reflexes are absent (gag, apnea, vestibular, etc) is one of the basic pieces of brain death testing.

    There’s a lot of confusion in popular media between brain death and persistent vegetative state. In a persistent vegetative state there’s still many brain functions going, but troubles maintaining consciousness. Brain death testing when properly done there is extensive testing done by a neurologist or someone with a similar background to show no brain function at all remains before it can be declared brain death, no matter how basic, even the simplest of brain reflexes. It’s not just one test but a whole series of testing with different modalities.

    Would really like to know what happened here to cause such a colossal mess. Or nearly did, the doctors stopped before doing anything at least.

    • peopleproblems@lemmy.world
      15·
      30 days ago

      I suspect that when they declared him brain dead, it was too early in recovering from the overdose that his reflexes weren’t normal yet.

      Drug interactions and drug metabolism are complete unknowns, as I strongly suspect this guy did not have genomic testing done before they administered narcan or whatever antidotes they needed to push.

      • Ranvier@sopuli.xyz
        8·
        30 days ago

        This isn’t something that gets done like after a few hours or a day or something. It takes quite some time to get through cooling protocols, warming again, complete all the testing, geting everything stable. Talking like a week plus at the quickest. And cranial nerve reflexes are just one thing of many different tests done. And to boot, it sounds like from the article they knew he had cranial nerve reflexes, which anyone halfway competent should know, means there is certainly not brain death. Really want to know what this hospital was doing that they messed up so badly.

    • nutsack@lemmy.world
      49·
      30 days ago

      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, ‘Hey, I think this patient might have just breathed,’” Cannon later told NPR in an interview. “If the patient breathes, that means they’re not brain dead.”

      Nevertheless, a representative from the OPO wanted to proceed anyway, Cannon says.

      interesting

    • FundMECFSResearch@lemmy.blahaj.zone
      11·
      30 days ago

      What a shitshow.

      This kind of shit is going to hurt people needing organs a lot. We need better organ donor safeguards so these kind of scandals dont happen.

      Though honestly, it sounds more like some of the speciliasts fucked up than the procedure being bad.

  • Sterile_Technique@lemmy.worldEnglish
    235·
    1 month ago

    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.

    • superkret@feddit.org
      132·
      30 days ago

      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.

    • catloaf@lemm.eeEnglish
      3·
      30 days ago

      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?

      • Sterile_Technique@lemmy.worldEnglish
        11·
        30 days ago

        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.

      • ArmyTiger@lemmy.world
        8·
        30 days ago

        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.

    • thesohoriots@lemmy.worldEnglish
      32·
      1 month ago

      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.

    • MataVatnik@lemmy.world
      76·
      30 days ago

      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)

      • TheRealKuni@lemmy.worldEnglish
        72·
        30 days ago

        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.

        • MataVatnik@lemmy.world
          11·
          29 days ago

          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.

          • TheRealKuni@lemmy.worldEnglish
            1·
            29 days ago

            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.

  • IMALlama@lemmy.world
    155·
    1 month ago

    This whole thing is nuts to me. From the way the article reads, the patient was likely still breathing and had a heartbeat. I get wanting to keep organs fresh, but this seems… non ideal

      • LadyAutumn@lemmy.blahaj.zoneEnglish
        3·
        30 days ago

        True, but for an organ harvest… would you not want the cadaver to be, well, dead dead? Like, would you start taking organs out while the cadaver still has a beating heart?

        • FlowVoid@lemmy.worldEnglish
          6·
          30 days ago

          Once the heart stops beating, the organs fail. Including the heart itself.

          That’s kind of the point of defining brain death. Normally death is declared after the heart stops beating. In brain death, the heart is beating but the brain is not receiving any blood.

      • rhombus@sh.itjust.works
        2·
        29 days ago

        Heartbeat, yes. Breathing, no. Once the brain is completely dead the body can’t breathe on its own, it has to be kept on a ventilator to keep the organs alive.

    • deur@feddit.nl
      12·
      1 month ago

      We are our brain activity and once that’s gone for good all that’s left is the biological machine that we live within.

      A heart will beat as long as it doesn’t die or otherwise suffer some other structural failure. They attach brain dead patients to a ventilator to continue respiration to keep the now-vacant body alive. It’s a shame someone severely fucked up and compromised the safety and trust of the process in this case but don’t let this confuse you into thinking there’s no basis for the transplant to occur in the presence of a heartbeat.

    • bdonvr@thelemmy.club
      11·
      30 days ago

      Nah that’s not unusual. Brain trauma or degradation can and often does leave someone with a beating heart but little to no hope of ever being conscious again - hence the term brain death.