During a House Energy Committee hearing before the Congressional Recess, Rep. Kim Schrier (D-WA) asked Chief, Organ Transplant Branch at the U.S. Department of Health and Human Services Dr. Raymond Lynch about standard procedures to ensure safe organ procurement.
00:00The gentleman yields. The chair recognizes the general lady from Washington, Dr. Schreier, for her five minutes of questioning.
00:08Thank you, Mr. Chairman. Thank you, Ranking Member Clark. Thank you, Dr. Lynch, for being here today.
00:13And let me just say, it is such a pleasure to see my friend, John Joyce, with gavel in hand.
00:20And I want to say congratulations and thank you to you.
00:22I would like to start today just by pointing out how incredible and what a blessing organ donation is.
00:31I don't want to lose sight of that in all of this discussion.
00:36A single donor can save, by my count, up to eight lives, can bring sight to the blind, can help burn victims, and so much more.
00:45And the families and individuals who make this noble decision to donate their organs to save others should be thanked and honored.
00:56And that's why it's so important to address the recent widely publicized donor safety concerns.
01:02And I just want to be really clear that what's been documented by the HRSA report and the New York Times investigation is egregious.
01:11And no patient or their family should ever have to worry about carelessness or recklessness or harm after making this very noble, selfless decision to help others.
01:22And that's why it's so important that we get these questions right today.
01:27The process of organ procurement and donation involves multiple parties.
01:32It's a pretty complex and integrated system.
01:34Health care providers, hospitals, organ procurement and transplantation networks, and HRSA, the Health Resources and Services Administration,
01:45all working together with this common goal of saving lives.
01:48And as we see the fast growth in organ donations country and the relatively new focus on donation after circulatory death,
01:57I'm concerned that medical training and education may not be keeping pace with the often medically complex decisions and requirements for declaring circulatory death.
02:10And so, Dr. Lynch, I just first wanted to touch on, in really following up on Representative Mullen's question,
02:16what gaps are there in the training for providers involved in procurement procedures and those responsible for declaring death?
02:25Particularly, if you could point out, what could be done better to avoid errors?
02:30So, an individual provider's familiarity with organ donation and procurement in general may vary, and with DCD, it may vary considerably.
02:42The fail-safe here is that the OPO is the expert.
02:45The coordinators who go on site and the individuals to whom they report are the experts.
02:51They do this every day, all year long, and they have an established area in which they do it.
02:56So, they should know the hospitals where they need to work to provide extra support.
03:00One of the concerning aspects that HRSA found in its review was that these events appeared to be more frequent relative to the number of attempted donor recoveries in small hospitals.
03:12And that speaks to the quality of the education and support that was being provided.
03:18Support can be a good thing, but it should never be mistaken for bullying or for telling somebody that this is just how it is.
03:25And the instances that we documented are concerning that those things may have been confused.
03:32I think it's a very interesting point to point out that it's in smaller community hospitals, not the trauma centers where you would get massive volumes and have a lot of experience with this.
03:41I just wanted to point out that in other areas of medicine, when I was practicing, you know, a woman comes in, pregnant woman for delivery, there's a standard order sheet.
03:52You check boxes and make sure you haven't forgotten anything.
03:55When you do hospital orders, we had a mnemonic that helped us remember not to forget fluids or not to forget checking blood pressures, those kinds of things.
04:03And so I'm wondering if anybody's considering a, just a procedural standard, even the procedural pause that we take before operations happen because of some tragedies there and is used to prevent that.
04:18Is anybody working on a standard checklist?
04:21You know, check this many minutes later, check that many minutes later, make sure they're not on opioids, whatever it is.
04:26So I would agree with you.
04:29Many of my friends are in areas of medicine other than transplant, and this is perplexing to them because we appear to have skipped a generation relative to when I was in medical school, the Institute of Medicine, now what's called the National Academy of Science, Engineering and Medicine, issued to err as human, showing that, you know, the preventable medical errors were causing unnecessary death.
04:49That led to a revolution in acknowledging error in preventing it through increased data reporting, increased general and up-to-the-minute education, and things like the timeout.
05:01These things are knowable and fixable.
05:04This is care.
05:05This is safe if it is practiced well.
05:07It is being practiced well in many areas of the country.
05:10HRSA's corrective action plan and directive to the OPTN are to make sure that it is consistently safe across the country.
05:17Thank you very much, and thank you for your contribution to hundreds of patients who are now alive because of your transplantations.
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