The facts
It is indeed “worthy of a horror film”, this story reported this fall by CNN and which made the rounds on social networks. On October 25, 2021, a 33-year-old man, Anthony Hoover, overdosed in Richmond, Kentucky. He was no longer breathing and his heart had stopped beating when emergency services arrived, but they were able to revive him.
Except that his brain had suffered severe damage, according to a scan taken in the emergency room. Anthony Hoover showed no reflexes in his hands or eyes, and another imaging test reportedly found no signs of brain activity. He was declared “cerebral dead,” according to his medical records cited by CNN.
Then, four days after his overdose, still showing no signs of improvement, he was taken to the operating room to have his organs harvested — he was a registered donor.
The problem is that Mr. Hoover regained consciousness while he was being transported there. According to a caregiver interviewed by CNN and who was to participate in the surgery, he “followed objects with his eyes,” “pushed our hands away,” and said “no.” “When the doctor [chargée de prélever ses organes] arrived, she immediately said: I’m not doing that,” testified the caregiver.
There was then (alleged) pressure from the organization responsible for organ donations in Kentucky, Kentucky Organ Donation Affiliates (KODA), to find another doctor who would agree to pronounce Hoover dead and to take his organs despite everything. KODA also denied everything and said the facts had been distorted by people who had not worked on the case.
A few weeks later, Mr. Hoover was released from the hospital. He has serious after-effects from his overdose, but he is still very much alive.
«Impossible»
The story does not say whether or not other doctors were available at the time the doctor in charge of the sample withdrew. We must keep in mind, however, that even assuming that another doctor had agreed to replace her, it is completely implausible that he would have agreed to pronounce death and remove the organs – this would have implied murder, or at least In short, an absolutely ridiculous level of incompetence and clearly punishable by prison.
Errors, and even serious errors, are obviously always possible, but all this makes it practically unthinkable to harvest organs from someone who is not completely dead. (Mark Humphrey/Archives The Associated Press)
In this sense, Mr. Hoover’s story is above all that of a system of safeguards that ended up working. Some of these barriers clearly should have been activated before, and Mr. Hoover undoubtedly came unnecessarily close to death, of course. But he is not dead, precisely because of these safeguards.
Because in general, comments Dr. Pierre Marsolais, an internist and intensivist who has worked for a long time to improve organ donation in Quebec, “if things are done correctly, it is impossible for a case like this to occur, whether here or in the United States.
There are essentially two kinds of candidates for organ donations, he explains: people who have died of cardiorespiratory arrest and whose heart cannot be taken (except in very rare cases), since it was damaged by lack of oxygen; and people who are in a state of “brain death” but whose heart still functions and could be transplanted to someone else.
In this last case, which seems to have been that of Mr. Hoover, the protocols to be respected before being able to harvest organs are extremely strict, insists Dr. Marsolais. A series of tests must be carried out to eliminate any possibility that the patient’s brain is not truly dead.
“It takes imaging which shows that the brain is destroyed, it takes a neurological examination which shows that there is no longer any sign of activity in the brain, we must ensure that there is no There are no confounding factors, such as certain medications, that would make the neurological test less reliable. And if there is a test that we cannot do, we must replace it with another.
“For example, if the patient is wearing a prosthetic eye, I can’t do the eye reflex test, so I have to do another test instead, which would show that there is no more blood circulation to the eye. brain,” illustrates Dr. Marsolais.
Errors, and even serious errors, are obviously always possible, but all this makes it practically unthinkable to harvest organs from someone who is not completely dead.
Confusion
It’s difficult to know exactly what went wrong in Mr. Hoover’s case, since Dr. Marsolais obviously did not have access to his medical records. But “the only way I can imagine something like that happening is if there was a doctor somewhere who didn’t do his job. Because otherwise, if things are done correctly, it’s impossible,” he says.
If Mr. Hoover was indeed declared brain deadas they say in the United States, there was obviously a mistake made somewhere, because “you simply don’t come back from brain death,” says Dr. Marsolais.
However, there appears to have been some confusion over Mr. Hoover’s status since CNN reports that the doctor who was to harvest his organs was preparing to perform a “cardiac catheterization”, a procedure which aims to ensure that the arteries of the heart are not obstructed — it would make no sense to transplant a poorly functioning heart.
This suggests that Mr. Hoover would have been declared brain dead, as his file indicated, but in other passages of the CNN article, he seemed instead to be considered a deceased donor after cardiopulmonary arrest. KONA, at least, claims that he was listed as such in its files – except that at that time, his heart could not have been transplanted and cardiac catheterization would have been of no use…
Was Mr. Hoover’s family, which provided much of the information to CNN, given the correct information? Had she misunderstood it? Did CNN report it correctly? A bit of everything? Impossible to say without having access to his file.
One thing is unfortunately certain, laments Dr Marsolais: “It’s the kind of thing that provokes a reaction and that some people will interpret in all sorts of ways. And there are more people who will be wary of organ donations. It’s very damaging, a story like that.”
Verdict
No, you can’t really be “killed” by organ donation. Healthcare workers apply a whole series of “safeguards” to ensure that organs are not taken from people who may “wake up”. Mr. Hoover’s case is troubling because it appears that many of these barriers failed, but some worked. And this is an absolutely rare case.
