When Brain Dead Isn't

One fully recovered organ donor is one too many

Due to multiple instances of gross negligence and misconduct, the department of Health and Human Services (HHS) is decertifying the organ donor organization Network of Hope that served Kentucky, Indiana, Ohio, and West Virginia.

At a press conference with RFK Jr announcing the move, Donna Rhorer described what she witnessed when her brother was declared brain dead and was being prepped for organ harvesting:

“His eyes were open, he was tracking me, and they told me it was just reflexes— then during the heart cath, he was thrashing and crying and grabbing the doctor’s hands to stop him. Even after those signs the organ procurement process continued until the physician refused to proceed. One of the organizations own coordinators called the home office after the doctor refused. She was told: ‘find another surgeon, or you’ll lose your job, because we’re finishing this case.”

Thankfully that didn’t happen and her brother was in the audience reportedly weeping openly as she described those events.

Any reasonable person would agree that this organization should be decertified, but the explicit framing of the situation by HHS is that safe organ donation is possible, which itself presumes that brain death is a valid diagnosis.

Until medical school and particularly my medical residency, I would have agreed. But every physician learns the list of common conditions and biochemical abnormalities that can, and more often than not, do temporarily interfere with measurable brain function and make it essentially impossible to ever practically be absolutely certain that someone is irrevocably brain dead.

These most commonly include: electrolyte abnormalities, sepsis, organ dysfunction, shock, and the adminstration of narcotics and benzodiazepines that suppress neural function.

Every single patient I ever saw in a hospital that looked like they were brain dead or was assessed for brain death had more than one of these extremely common confounding factors present at the time of the neurology consult for brain death (usually called when the family was trying to decide to pull the plug on a ventilator and let their relative die a natural death - I was thankfully never involved in an organ donation case).

What would often happen after the first consult would be a note from the neurologist listing all the reasons why a diagnosis of brain death would be impossible to make, and advising that the medical team correct the electrolytes, treat the septic shock, stop the confounding medications, rule out other factors, ie get brain imaging for a stroke, a spinal tap for brain infection, etc.

However, despite our best efforts there was often no way to entirely eliminate every confounder. The ultimate diagnosis of brain death was like so many diagnoses just an educated guess.

Now, regardless of whether or not anyone agrees with the principle of harvesting organs in someone declared brain dead while they are literally still physically alive (as they must be to donate organs), we should be able to agree that if there is even an outside chance that they could recover bodily and brain function eventually then we should never, not even once, risk killing such a person by taking their organs and giving them to someone else.

That would clearly be a case of some kind of murder.

Regardless of how needy or deserving the recipient is, it is simply wrong by every religious and secular convention modern civilisation was built upon.

And yet the case of Donna Rhorer’s brother is not the lone exception of someone who was declared brain dead and later recovered.

To state it clearly: there is no way to be absolutely certain organ donors are irrevocably “brain dead” before their organs are harvested.

While organ donation is clinically “effective”, it cannot be made “safe”.

I would check those driver’s licenses and make extra certain that neither you nor a loved one checked the organ donor box.