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.
...
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.
"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.
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.
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.
i dunno it sounds like this guy got pretty screwed https://lemmy.world/comment/12967158
"...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.
There was a case Texas a few years back where the Dad of the kid took his gun to the hospital because they were going to pull the plug and harvest his organs. He thought that his kid wasn’t brain dead.
They were wondering what they would do with this nut job when the kid started moving.
He wasn’t brain dead and the Dad was right.
Wow, what a story 😬 I wonder how many of these there are? Of course they want to keep them out of the public, but damn. Even one is too much.
Without looking at the actual numbers, the likelihood of this is probably far less than waking up from any surgery in general.
Which is still less likely than actually dying during elective surgery.
Kinda get the feeling the for-profit medical system is deeply corrupt.
Capitalism is inherently corrupt
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.
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.
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.
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
That's so fucking dark
That is dark, but you should include that it's a different case. At least one person has already shared it as being this case.
If I'm at that point, and I breathe, just keep going. Full send it. Good luck finding a useful organ among the bunch, though.
Jesus Christ wtf?!?
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.
PUT
THEM
BACK!
"Well, okay. You can keep one of the kidneys. BUT I WANT THE REST BACK IN THERE, MISTER!"
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.
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 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.
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
That's a defining feature of brain dead. Otherwise, they're just dead.
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.
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.
IRL borrowing material from House M.D.
We want your liver.
Not mine
Coincidentally, shortly after the event, KFC announced a nuggets shortage.
DEAD
MAN
WALKING
New anxiety unlocked.
Right? Apparently we can't even die in hospitals anymore.
That costs extra.
It's the book/movie Coma all over again.
If Trump gets elected, I fully expect a House of the Scorpion type deal to keep the fossil alive
That explains why I'm so fucking bored today.
This is literally a Mars Volta album
Why are we harvesting organs from someone who OD’d to begin with? Wouldn’t that be problematic for the organ recipient?
Depends on the organs being harvested
Welp. I read this shit right before bed. Guess I know what I'll be dreaming about later tonight. New nightmare unlocked!