AOC Asks Doctor About Organ Procurement Organizations Advocating For Premature Removals

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During a House Energy and Commerce Committee hearing on Tuesday, Rep. Alexandria Ocasio-Cortez (D-NY) spoke about organ procurement organizations advocating for premature removal surgeries.

Transcript

00:00woman from New York, Ms. Alexandra Cortez. Thank you so much, Mr. Chairman. The ability

00:06to transplant an organ from one person to another is one of the great successes of modern medicine,

00:14and the United States' organ transplant system is responsible for saving so many lives,

00:21and also for the loved ones of those who have lost family members and friends to actually

00:29see their gifts live on in others. And because organ transplants do save lives, the system we have in

00:39the United States needs to work well, and there are so many people responsible for ensuring that it

00:44does. Dr. Lynch, can you briefly describe the circumstances in which most organ donations occur?

00:54So I agree with your sentiments completely. This is a public good. This is something that

00:59restores hope to individuals who have suffered loss in the case of the donor families, and it

01:04literally restores life to people on the wait list. The way that this process works is that the OPO is

01:10the central figure in it. The OPO staff are supposed to show up to a hospital, identify individuals who

01:16are neurologically injured, either if they're already brain dead or if they're progressing in

01:20that fashion, or if they're not brain dead or not believed to be progressing that way if they have a

01:25poor prognosis in the family is considering moving towards end-of-life care. The OPO then facilitates

01:31getting adequate information about the donor, which means blood work, history and physical,

01:35and in some cases invasive tests. And then they facilitate the operation where other parties,

01:41usually staff from transplant centers, come to that donor hospital and recover the organ.

01:46Thank you. And it is often a patient's loved ones and their family or friends that often have to

01:53make this difficult decision. And as you mentioned, the individuals who often help them make those

01:58decisions are from OPOs or organ procurement organizations. Dr. Lynch, can you explain a little

02:06bit further about what an organ procurement organization is for people who are learning how this system works?

02:14Sure. OPOs are an almost unique element of the American healthcare landscape. They serve two

02:21different populations. They serve those patients who are the potential donors and they serve the

02:25potential recipients with the organs that they recover. They also have a unique situation in that

02:30they are made whole on their costs completely by the federal government. They also have a situation where

02:36the patients with whom they interact are at their most vulnerable. They're neurologically injured or

02:40deceased. So they're not going to speak up about the care that they receive. Thank you. And in the way

02:47that this system is set up, there is currently only one organ procurement organization in any given reason

02:54and in any given region, which sometimes means that individuals may have little choice between OPOs.

03:02Dr. Lynch, I have a report issued by your agency, HRSA, in March of this year.

03:07Dr. Lynch, the report found cases where the organ procurement system has at times not worked properly

03:15and patient safety was jeopardized. Now, I think it's very important that in order to protect

03:22individuals and not to raise too much of an alarm, by and large, our organ procurement system works well,

03:27but we also want to protect the integrity of that system and ensure that we investigate

03:33any situations where a question may be raised. The report found cases where the organ procurement

03:40system has not worked properly. And some of these do not appear to be isolated incidents. We do have a

03:47case of a woman in her 30s, which was reported just two days ago in the New York Times. In 2022,

03:54Danela Gallegos was hospitalized and went into a coma. Doctors thought that she would not survive,

04:00and her family agreed to donate her organs. However, it seemed that Danela started to improve responding

04:08to touch and trying to move. Yet, the organ procurement organization serving her area

04:16pushed towards surgery for organ removal and donation anyway. However, and the system did work.

04:23Thankfully, hospital staff refused to move forward with the procedure. And Ms. Gallegos has actually made

04:31a full recovery. I would like to submit her statement to the record. Without objection, so ordered.

04:38According to your to HRSA's report, there have been about 100 unique cases that had quote unquote

04:48concerning features. Now, that does not mean that they were all like Danela Gallegos's case. But Dr. Lynch,

04:56HRSA has investigated additional cases. And the OPO was found to have

05:06pressured the medical team to move forward with this. Is that accurate? And if so,

05:13how many organs, what would be the standards for an organ procurement organization to be on a path to

05:19decertification? And what would the line be for that? So I'll start with the decertification decision

05:24would not rest with HRSA. That would be within CMS. I won't speak to Ms. Gallegos case. There are numerous

05:33cases that have been reported to HRSA. We have ongoing reviews and we have made referrals to partner

05:39agencies. The corrective action plan that we have for Kentucky, as we were hearing about these other

05:45cases in other areas, also includes a plan to make the OPTN make this safe nationwide. And we believe

05:51that that will address the type of area that you're describing. Great. Thank you very much.

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