John Joyce Grills HHS Official When Organ Procurement Should Be Immediately Stopped

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During a House Energy Committee hearing before the Congressional Recess, Rep. John Joyce (R-PA) asked Chief of the Organ Transplant Branch at the U.S. Department of Health and Human Services Dr. Raymond Lynch about when organ procurement processes should be immediately stopped in a hospital.

Transcript

00:00I thank you for your testimony, and we will now move to questioning.

00:04I will begin and recognize myself for five minutes.

00:09Dr. Lynch, to better understand what occurred with the index case

00:13and how a DCD, or donation after cardiac or circulatory death,

00:18how a case like that works,

00:20is it fair to say that it is not a failure in a DCD case

00:25if the patient doesn't end up dying in the allotted time

00:28and the process is during the procuring of the organs if it is stopped?

00:36It's fair to say that the OPO has a duty to look for donors.

00:41The prognosis, meaning planning whether or not an individual will expire within a time period

00:48that would allow for the recovery of their organs, is imprecise.

00:52So in good faith cases, there will be instances where a patient has a withdrawal of care,

00:57is allowed to progress to a natural death,

00:59but that occurs over too long of a timeline to make the organs usable.

01:02And you wouldn't consider that a failure, would you?

01:04I would not.

01:06However, it is a failure.

01:07If at any point in the process leading up to the removal of the patient from life support

01:12and declaring that patient is deceased,

01:16that the patient shows signs of improvement, neurologic function,

01:19such as signs of pain or fear,

01:23if you see a patient crying,

01:25if you see these kind of neurologic responses,

01:29the process should be immediately stopped.

01:31Do you agree?

01:33I agree.

01:33Or in another case, when a patient was awake and following commands,

01:38yet the OPO did not terminate the organ procurement process

01:43at the moment the patient exhibited that behavior.

01:46Is this how a DCD case should work?

01:49No, it is not.

01:50Why is that?

01:52So in DCD, the appropriate initial and then the subsequent evaluation is key.

01:57Identifying those individuals where the injury to the brain is sufficient

02:01that they will not recover and allowing them to progress to a natural death.

02:05If over the course of the days between the OPO's initial assessment

02:08and when they ultimately go to the operating room,

02:11if they're improving,

02:11then it is unlikely that they're going to pass in that time frame

02:15and they're being exposed unnecessarily to harm.

02:18So continued reevaluation as the process continues

02:21has to be part of the process, correct?

02:23Correct.

02:25We have seen continued reports of these concerning instances.

02:29In an instance, at times, by both OPO's and the OPTN board

02:34and its investigative arm that these cases do not represent a failure in the system.

02:40Based on your opinion as a transplant surgeon

02:44and now in your role as the chief of organ transplant brands of HRSA,

02:49can DCD continue to be done in a way that protects patient safety

02:53and honors the sacrifice of what these patients are doing?

02:57Absolutely. So this is critical to ensuring patients' ability

03:02to have their wishes fulfilled.

03:03So if you make that brave decision to be an organ donor

03:06and you can pass in a manner that you can be recovered safely as a DCD donor,

03:10you should be afforded that right.

03:12We're also relying on these organs to save the lives of other Americans.

03:15This is complex care.

03:17It's technically demanding, but it's knowable and fixable.

03:20This is something that can be done safely.

03:22As part of the investigation, HRSA analyzed information from over 350 unique cases

03:29of A&R patients or authorized not recovered.

03:33This means that the patients were considered for DCD recovery,

03:37but no organs were transplanted.

03:39The report continues that 103 of these cases, or nearly 30%, had concerning features.

03:46Could you explain what some of those features are and what the common themes are in these cases?

03:52So HRSA's report and what we documented in our corrective action plan

03:56essentially identified four problems.

03:59There was the inability to perform a good initial or subsequent neurologic exam

04:03and identify those individuals who were likely to progress.

04:07There was a poor pattern of collaboration and respect for the input from the primary medical team,

04:13the hospital providers, there was poor communication and treatment of families,

04:17and then there was poor documentation of what was actually occurring with these patients

04:21in the OPOs records.

04:24Would you say that the issues occurring in these cases are more related to policies

04:29on how the situations are handled, or personal errors, or a lack of communication from team?

04:35Because there are multiple teams that are involved as this entire process continues.

04:38So this is, as I said, this is a technically demanding form of care.

04:43It involves good collaboration between the OPO and the hospital,

04:47but every area in the country has exactly one OPO.

04:50They are the only ones who can provide this care.

04:52It is within their scope to make those relationships, do the education for the hospital,

04:57and provide that expertise and support to help them.

05:01I thank you for the clarity of your answers.

05:04I think it is important for this discussion.

05:06I now yield five minutes.

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