this post was submitted on 18 Oct 2024
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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.

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[–] [email protected] 80 points 4 weeks ago (3 children)

"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.

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[–] [email protected] 30 points 4 weeks ago
[–] [email protected] -1 points 4 weeks ago (1 children)

Why are we harvesting organs from someone who OD’d to begin with? Wouldn’t that be problematic for the organ recipient?

[–] [email protected] 14 points 4 weeks ago

Depends on the organs being harvested

[–] [email protected] 17 points 4 weeks ago (3 children)

IRL borrowing material from House M.D.

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[–] [email protected] 69 points 4 weeks ago* (last edited 4 weeks ago) (3 children)

"...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.

[–] [email protected] 11 points 4 weeks ago

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.

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[–] [email protected] 38 points 4 weeks ago (3 children)

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.

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[–] [email protected] 4 points 4 weeks ago (3 children)

Having read the article I’m not 100 percent certain if the patient is dead or being cared for at home.

Cases like this are why families keep people on life support.

[–] [email protected] 4 points 4 weeks ago

The patient is alive.

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[–] [email protected] 18 points 4 weeks ago (8 children)

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.

[–] [email protected] 3 points 4 weeks ago (2 children)

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?

[–] [email protected] 11 points 4 weeks ago

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.

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[–] [email protected] 1 points 4 weeks ago

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.

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[–] [email protected] 6 points 4 weeks ago* (last edited 4 weeks ago)

Coincidentally, shortly after the event, KFC announced a nuggets shortage.

[–] [email protected] 4 points 4 weeks ago (3 children)

It's the book/movie Coma all over again.

[–] [email protected] 1 points 4 weeks ago

This is literally a Mars Volta album

[–] [email protected] 0 points 4 weeks ago* (last edited 4 weeks ago)

That explains why I'm so fucking bored today.

[–] [email protected] 2 points 4 weeks ago

If Trump gets elected, I fully expect a House of the Scorpion type deal to keep the fossil alive

[–] [email protected] 37 points 4 weeks ago (1 children)

Kinda get the feeling the for-profit medical system is deeply corrupt.

[–] [email protected] 22 points 4 weeks ago

Capitalism is inherently corrupt

[–] [email protected] 8 points 4 weeks ago (1 children)
[–] [email protected] 4 points 4 weeks ago (1 children)

Right? Apparently we can't even die in hospitals anymore.

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[–] [email protected] 10 points 4 weeks ago (3 children)

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

[–] [email protected] 11 points 4 weeks ago

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.

[–] [email protected] 12 points 4 weeks ago* (last edited 4 weeks ago)

We are our brain activity and once that's gone for good all that's left is the biological machine that we live within.

A heart will beat as long as it doesn't die or otherwise suffer some other structural failure. They attach brain dead patients to a ventilator to continue respiration to keep the now-vacant body alive. It's a shame someone severely fucked up and compromised the safety and trust of the process in this case but don't let this confuse you into thinking there's no basis for the transplant to occur in the presence of a heartbeat.

[–] [email protected] 59 points 4 weeks ago (4 children)

That's a defining feature of brain dead. Otherwise, they're just dead.

[–] [email protected] 243 points 4 weeks ago (2 children)

Just to be clear, they had not actually started harvesting anything.

The nurses and doctors noticed as he was wheeled into the operating room and called it off, a bunch of them ended up in therapy over the situation.

Someone fucked up by declaring him brain dead clearly. He does however have significant brain damage from the drug overdose that initiated the whole situation.

[–] [email protected] 39 points 4 weeks ago (4 children)

This article says he was considered brain dead for three years. Where are you getting your extra info from?

This is scary either way.

[–] [email protected] 11 points 4 weeks ago (1 children)

If you think google his name you can see a picture of him riding in a car with his sister in 2023 so he's clearly not braindead.

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