Brett Guthrie Asks HHS Official Point-Blank If Organ Procurement Policies Are Out-Of-Date

5 months ago

During a House Energy Committee hearing before the Congressional Recess, Rep. Brett Guthrie (R-KY) asked Chief of the Organ Transplant Branch at the U.S. Department of Health and Human Services Dr. Raymond Lynch about guidelines for organ procurement.

Transcript

00:00Guthrie for his five minutes of questioning.

00:02Thanks, and thanks, Dr. Lynch.

00:03Thanks for being here, and thanks for your report.

00:05As I said, I'm opening, saying this is personal to me,

00:07and I want people to be organ donors,

00:09and I want people to have the ability to have a full life

00:13if they have the access to organs,

00:15but we want to make sure everything is right and done correctly.

00:19And one of the things I think you said,

00:21you weren't here at the beginning of this,

00:23but you didn't say, hey, I wasn't here,

00:24so it's not my responsibility at the time.

00:27Also, when we had our meeting,

00:31you didn't say, well, it's somebody else's issue, not mine.

00:33You said, HRSA has a role in this,

00:34and you just got started with Ms. Clark.

00:38So what does HRSA need to do different

00:41to make more confidence in the system?

00:44So I'd like to begin by expressing my apologies

00:47for the care that was delivered to your constituents,

00:50to the people of Kentucky.

00:51It's unacceptable, and it's not something

00:53that HRSA is going to let stand.

00:54This was the impetus for our corrective action plan

00:57to make sure that this did not continue in Kentucky

00:59and that other OPOs could learn by example.

01:02This is HRSA's responsibility.

01:05HRSA has this authority delegated by the secretary,

01:08and we intend to make sure that the OPTN

01:10and its contractors are able to fulfill this role.

01:14Okay, so thank you.

01:15So from your perspective, or from HRSA's perspective,

01:17what more needs to be done by others,

01:19including the hospitals, the OPOs, OPT,

01:22and all the different groups?

01:24What needs to be done differently?

01:25There's room for improvement by all parties,

01:28but the central figure here is the OPO.

01:31So nobody proceeds to organ procurement

01:33without an OPO's involvement.

01:36The OPO is the subject matter expert in this,

01:38and they are the ones who drive the process.

01:40They conduct the evaluation to identify

01:42and manage the donors,

01:44and they are responsible for the identification

01:47of transplantable organs that will be offered out for matching.

01:50So what do they need to do different

01:52to give more confidence to the system?

01:53So to, we need better policy within the OPTN

01:57to make sure that these lapses in care are preventable.

02:01We don't need to...

02:01So what updated policies, what would you...

02:03So right now there is, as specified in the regulation,

02:07there is attending to public health and patient safety.

02:11I think that we can speak definitively

02:13to improving DCD policy.

02:15This has been something that the OPTN board has discussed

02:18and other entities have discussed for years,

02:20but no action has been taken.

02:23So those who are listening,

02:25means it's circulatory.

02:27There's two types of...

02:28Could you explain the difference

02:29in brain debt and circulatory death?

02:32So the manner of organ donation and procurement

02:35that most people are familiar with is brain death.

02:38That is where somebody is legally deceased,

02:40their brain is not functioning,

02:42but their body is being maintained on ventilator

02:45and with medical support.

02:46And that group, which is a big group...

02:49Well, there's a bigger...

02:49Unfortunately, because of drug overdose,

02:51it's a bigger group of the second.

02:52But that group, we're really not questioning today

02:55what's being done with them, are we?

02:58HRSA has ongoing work to make sure

03:00that all forms of organ donation and procurement are safe.

03:03But brain debt is not...

03:05This is a different category.

03:06The case in Kentucky was donation

03:08after circulatory death or DCD.

03:10Historically, that was a less common pathway.

03:14In the United States right now,

03:16it's about 50% of the organ donors.

03:18In our case, it's because of, unfortunately,

03:20drug overdoses.

03:22So I'm going to answer a lot of my questions.

03:26Do you believe that...

03:27So policies and procedures need to be updated.

03:32And we need to follow them, obviously.

03:34So what specifically do you think

03:36in the Kentucky case would have...

03:37What was their OPO's responsibility

03:39in the Kentucky case,

03:40and where do you think it failed?

03:42So some of this could have been corrected locally.

03:44So under CMS regulations, which guide an OPO,

03:47they're required to have a quality department.

03:49Every OPO also has a medical director.

03:52Appropriate identification of the donors,

03:55appropriate re-evaluation of their neurologic status

03:58would have prevented many of these errors.

04:00Training and good hospital development,

04:02meaning building that collaborative relationship,

04:05and listening to the medical teams

04:06and the families would have prevented many of these.

04:09Okay.

04:11So will you commit to ensuring

04:12that there will be increased transparency from HRSA

04:15if and when it identifies other issues

04:17with organ procurement?

04:19And so those who are responsible for implementation,

04:22overseeing organ donations,

04:23procurement, and transplants

04:24can address these problems?

04:25Yes.

04:25Commit to working together?

04:26Well, I think it's important that as people are listening to this,

04:30there is a distinct difference in the two.

04:33I know we need to make sure everything works,

04:35but someone who's brain dead versus circulatory death,

04:38and we need to,

04:40and unfortunately the cases are rising

04:42with circulatory death,

04:43so we need to make sure we have the procedures in place

04:45to make sure someone is ready to donate

04:50before the process moves forward.

04:53But you have to prepare for it

04:55because you know they're going to die.

04:56That's the issue, isn't it,

04:58is that if there's circulatory death,

05:00you remove the,

05:01it's not brain dead,

05:02once you remove the treatment,

05:04they're passed.

05:05But circulatory death,

05:06when you remove the treatment,

05:07because they're going to die anyway,

05:09then it takes a little while.

05:11That's kind of the space we're worried about, right?

05:14There is ongoing work.

05:15There has been work for many years

05:16to try and get better at predicting

05:18who will pass and in what time frame.

05:20It remains inexact,

05:22but however you're planning on predicting that,

05:24you need accurate information,

05:25and that gets down to conducting

05:27a good neurologic exam

05:28and a good history

05:30on what is wrong with the patient.

05:32I yield back.

Brett Guthrie Asks HHS Official Point-Blank If Organ Procurement Policies Are Out-Of-Date

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