WASHINGTON (AP) — Transplant experts are seeing a spike in people revoking organ donor registrations, their confidence shaken by reports that organs were nearly retrieved from a Kentucky man mistakenly declared dead.
It happened in 2021 and while details are murky surgery was avoided and the man is still alive. But donor registries in the U.S. and even across the Atlantic are being impacted after the case was publicized recently. A drop in donations could cost the lives of people awaiting a transplant.
“Organ donation is based on public trust,” said Dorrie Dils, president of the Association of Organ Procurement Organizations, or OPOs. When eroded, “it takes years to regain.”
Only doctors caring for patients can determine if they're dead -- the law blocks anyone involved with organ donation or transplant. The allegations raise questions about how doctors make that determination and what’s supposed to happen if anyone sees a reason for doubt.
Key is ensuring “all doctors are doing the right tests and doing them well,” said Dr. Daniel Sulmasy, a Georgetown University bioethicist.
The 2021 case first came to light in a congressional hearing last month, with unconfirmed details in later media reports – allegations that a man who’d been declared dead days earlier woke up on the way to the operating room for organ-donation surgery and that there was initial reluctance to realize it.
The federal agency that regulates the U.S. transplant system is investigating, and the Kentucky attorney general’s office said it is “reviewing the facts to identify an appropriate response.” A coalition of OPOs and other donation groups is urging that findings be made public quickly and the public withhold judgment until then, saying any deviation from the industry's strict standards would be “entirely unacceptable.”
Donate Life America found an average of 170 people a day removed themselves from the national donor registry in the week following media coverage of the allegations – 10 times more than the same week in 2023. That doesn’t include emailed removal requests or state registries, another way people can volunteer to become a donor when they eventually die.
Dils' own organ agency, Gift of Life Michigan, usually gets five to 10 calls a week from people asking how to remove themselves from that state’s list. In the last week, her staff handled 57 such calls, many mentioning the Kentucky case.
Unlike the voluntary U.S. donation system, French law presumes all citizens and residents will be organ and tissue donors upon death unless they clearly opt out.
After the reports from Kentucky reached France, the number joining that nation’s donation refusal registry jumped from about 100 people a day to 1,000 a day in the past week, according to the French Biomedicine Agency.
Dr. Régis Bronchard, an agency deputy director, said the spike “reflects anxiety, incomprehension among the general public” that could have “catastrophic consequences.”
Doctors can declare two types of death. What’s called cardiac death occurs when the heart stops beating and breathing stops, and they can’t be restored.
Brain death is declared when the entire brain permanently ceases functioning, usually after a major traumatic injury or stroke. Ventilators and other machines keep the heart beating during special testing to tell.
Only about 1% of deaths occur in a way that allow someone to become an organ donor – most people declared dead in a hospital will quickly be transferred to a funeral home or morgue.
But most organ donations are from brain-dead donors. Only after that declaration does the donor agency assume responsibility for the deceased, looking for potential recipients and scheduling retrieval surgery — while typically nurses at the hospital where the person died continue care to ensure equipment properly maintains their organs until they're collected.
The donor agency and transplant surgeons arriving to retrieve organs must check records of how death was determined. Anyone – donor hospital employees, donor agency staff or surgeons – who sees anything concerning is supposed to speak up immediately.
“This is extremely rare,” Dr. Ginny Bumgardner, an Ohio State University transplant surgeon who also leads the American Society of Transplant Surgeons, said of the Kentucky case.
In operating rooms “the whole process stops” if someone sees a hint of trouble, and independent doctors are called to doublecheck the person really is dead, Bumgardner said. In her 30-year career, “I’ve never had a case where the original declaration was wrong.”
Georgetown’s Sulmasy agreed problems are infrequent. But he said there’s wide variation in what tests different hospitals perform to determine if someone’s brain-dead, whether they’re a potential organ donor or not. Doctors are debating whether to add additional test requirements.
Stricter criteria could “assure the public that we have done enormous due diligence before we determine that somebody’s dead,” he said. It could help “to get people to stop ripping up their organ donor cards.”
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John Leicester, the AP's chief correspondent in Paris, contributed to this report.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
The organ donor entry on the back of a driver license is photographed in New York on Friday, Oct. 25, 2024. (AP Photo/Patrick Sison)
Manchester United finally ran out of patience and fired manager Erik ten Hag on Monday after a troubled start to the season which has left the 20-time English champions languishing in the Premier League amid a period of major upheaval at the club.
The Dutch coach won two domestic cups in his 2 1/2 years in charge but has paid the price for leading United to its worst start to a season, with the team in 14th place and having lost four of its opening nine league games.
Heavy home losses to fierce rival Liverpool and Tottenham left Ten Hag under severe pressure and seemingly changed the mood among United fans who previously were prepared to give him more time. A 2-1 loss at West Ham on Sunday proved to be his last game in charge.
United has won just one of its last eight games in all competitions.
“Erik ten Hag has left his role as Manchester United men’s first-team manager,” United said, adding that Ruud van Nistelrooy, one of Ten Hag’s assistants and a former striker at the club, would be taking over as interim head coach while a permanent head coach is recruited.
“We are grateful to Erik for everything he has done during his time with us and wish him well for the future.”
Among those linked with taking over at United are former England coach Gareth Southgate, former Chelsea manager Graham Potter and former Barcelona coach Xavi Hernandez. Brentford manager Thomas Frank was asked about his interest in the vacancy and replied: “I’ve said many, many times, I’m very happy here. I think it’s one of the best clubs in the world. What happens in the future, who knows? But I’m very, very happy here."
Ten Hag joined from Dutch giant Ajax in 2022 and was tasked with the responsibility of bringing the good times back to a club that has been in decline since former manager Alex Ferguson retired in 2013.
Despite winning the League Cup in 2023 and the FA Cup this year, United was showing no sign of improving on its worst league campaign in 34 years, having finished in eighth place last season.
Already 12 points behind first-place Manchester City in the Premier League, United — which never had a distinguishable style of play under Ten Hag and often conceded late goals — appears to have little hope of challenging for the title and is in danger of missing out on qualification for the lucrative Champions League once again.
Ten Hag only held on to his job following an unexpected victory over fierce rival Man City in the FA Cup final in May and an extensive end-of-year review by United. He was then handed a one-year extension to his contract to 2026.
However, the club’s new soccer leadership — fronted by new minority owner Jim Ratcliffe — was unimpressed with the pace of change and the recent results under Ten Hag, who has overseen the spending of about 615 million pounds ($800 million) on new players since his arrival. In the Premier League, only Chelsea has spent more in that time.
Ratcliffe, the British billionaire, has taken over control of United’s soccer operations, with a new CEO, sporting director and technical director all installed in recent months. They now have to appoint a sixth permanent manager since Ferguson’s departure, following David Moyes, Louis van Gaal, Jose Mourinho, Ole Gunnar Solskjaer and Ten Hag.
"I don't think anybody will be truly shocked after what happened yesterday," former United defender Gary Neville said of the latest loss to West Ham.
“The fact they are in 14th is just unacceptable. You can't be 14th after nine games with the level of spending that has occurred, without being under significant pressure.”
Bruno Fernandes, United's current captain, posted on Instagram his best wishes to Ten Hag.
“Thanks for everything boss!” Fernandes wrote, alongside pictures of him and Ten Hag holding the FA Cup trophy. “I appreciate the trust and the moments we share together, I wish you all the best in the future.
Fernandes added: “Even knowing the last period hasn’t been great from all of us I hope you fans can keep with you the good things the manager has done for our club!”
United winger Alejandro Garnacho also took to Instagram, saying: “It hasn’t gone as well as we wanted, but I will remember the good times we had together and I wish you all the best in the future. Thank you very much Erik.”
United's next game is at home to Leicester in the English League Cup on Wednesday.
FILE - Manchester United manager Erik ten Hag gestures during the English Premier League soccer match between West Ham United and Manchester United at the London Stadium in London, Sunday, Oct. 27, 2024. (John Walton/PA via AP, File)
FILE - Manchester United's head coach Erik ten Hag celebrates with Manchester United's goalkeeper Andre Onana after winning the English FA Cup final soccer match between Manchester City and Manchester United at Wembley Stadium in London, Saturday, May 25, 2024. (AP Photo/Ian Walton, File)
FILE - Manchester United's head coach Erik ten Hag watches the play during an English Premier League soccer match between Manchester City and Manchester United at the Etihad Stadium in Manchester, England, Sunday, March 3, 2024. (AP Photo/Dave Thompson, File)
FILE - Manchester United's head coach Erik ten Hag, left, celebrates after Manchester United's Rasmus Hojlund scoring his side's second goal during the English Premier League soccer match between Manchester United and Brentford at Old Trafford stadium in Manchester, England, Saturday, Oct. 19, 2024. (AP Photo/Dave Thompson, File)
FILE - Manchester United's head coach Erik ten Hag shouts out from the touchline during the English Premier League soccer match between Manchester United and Fulham at Old Trafford, Friday, Aug. 16, 2024, in Manchester, England. (AP Photo/Dave Thompson, File)
FILE - Manchester United's Lisandro Martinez lifts Manchester United's head coach Erik ten Hag while celebrating victory in the English FA Cup final soccer match between Manchester City and Manchester United at Wembley Stadium in London, Saturday, May 25, 2024. (AP Photo/Ian Walton, File)
FILE - Manchester United's head coach Erik ten Hag sits on the bench during a Europa League opening phase soccer match between FC Porto and Manchester United at the Dragao stadium in Porto, Portugal, Thursday, Oct. 3, 2024. (AP Photo/Luis Vieira, File)
FILE - Manchester United's head coach Erik ten Hag and Manchester United's Bruno Fernandes pose with the trophy after winning the English FA Cup final soccer match between Manchester City and Manchester United at Wembley Stadium in London, Saturday, May 25, 2024. (AP Photo/Ian Walton, File)
Manchester United manager Erik ten Hag reacts on the touchline during the English Premier League soccer match between West Ham United and Manchester United at the London Stadium in London, Sunday, Oct. 27, 2024. (John Walton/PA via AP)
Manchester United manager Erik ten Hag on the touchline during the English Premier League soccer match between West Ham United and Manchester United at the London Stadium in London, Sunday, Oct. 27, 2024. (John Walton/PA via AP)
