A Push for More Organ Transplants Is Putting Donors at Risk

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People across the United States have endured rushed or premature attempts to remove their organs. Some were gasping, crying or showing other signs of life.

Last spring at a small Alabama hospital, a team of transplant surgeons prepared to cut into Misty Hawkins. The clock was ticking. Her organs wouldn’t be usable for much longer.

Days earlier, she had been a vibrant 42-year-old with a playful sense of humor and a love for the Thunder Beach Motorcycle Rally. But after Ms. Hawkins choked while eating and fell into a coma, her mother decided to take her off life support and donate her organs. She was removed from a ventilator and, after 103 minutes, declared dead.

A surgeon made an incision in her chest and sawed through her breastbone.

That’s when the doctors discovered her heart was beating. She appeared to be breathing. They were slicing into Ms. Hawkins while she was alive.

Across the United States, an intricate system of hospitals, doctors and nonprofit donation coordinators carries out tens of thousands of lifesaving transplants each year. At every step, it relies on carefully calibrated protocols to protect both donors and recipients.

But in recent years, as the system has pushed to increase transplants, a growing number of patients have endured premature or bungled attempts to retrieve their organs. Though Ms. Hawkins’s case is an extreme example of what can go wrong, a New York Times examination revealed a pattern of rushed decision-making that has prioritized the need for more organs over the safety of potential donors.

In New Mexico, a woman was subjected to days of preparation for donation, even after her family said that she seemed to be regaining consciousness, which she eventually did. In Florida, a man cried and bit on his breathing tube but was still withdrawn from life support. In West Virginia, doctors were appalled when coordinators asked a paralyzed man coming off sedatives in an operating room for consent to remove his organs.

Stories like these have emerged as the transplant system has increasingly turned to a type of organ removal called donation after circulatory death. It accounted for a third of all donations last year: about 20,000 organs, triple the number from five years earlier.

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Fifty-five medical workers in 19 states told The Times they had witnessed at least one disturbing case of donation after circulatory death.

Workers in several states said they had seen coordinators persuading hospital clinicians to administer morphine, propofol and other drugs to hasten the death of potential donors.
“I think these types of problems are happening much more than we know,” said Dr. Wade Smith, a longtime neurologist at the University of California, San Francisco, who frequently evaluates potential donors and has studied donation after circulatory death.

A recent federal investigation — prompted by the case of a Kentucky man whose organs were pursued even as he shook his head and drew his knees to his chest — found that the state’s procurement organization had ignored signs of increasing consciousness in 73 potential donors.

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