RICHMOND, Ky. — A Kentucky organ donation case that has garnered national attention is at the center of a fight for organ donation and organ procurement organization reform in Washington.

The case sounds like a plot for a movie: a man still alive about to get his organs harvested. But that was reality for TJ Hoover, a Richmond man who woke up in the operating room as the procedure was about to begin. It’s a case too real for former organ preservationists who were there that day and felt compelled to fight for change.

Natasha Miller used to work as an organ preservationist with Network for Hope, formerly known as Kentucky Organ Donor Affiliates (KODA). She left KODA in 2023.

“We flush the organs," Miller said. "We preserve them, essentially, and then we package them and send them out to where they’re going." 

But an incident in Oct. 2021 at Baptist Health Richmond has stuck with Miller ever since. A donor was alive on the operating room table as preservation was about to begin.

“I walked over, and you could definitely see that he was crying," Miller said. "He was looking around, obviously moving, fighting the staff ... not like actual fighting, but just moving around." 

Miller said both the declaring physician and recovering physician became alarmed with what was happening.

“The recovering physician was, like, 'I don’t want any part of it; I'm going to go to the lounge and sit. You all let me know what you're doing,'" Miller said.

The retrieval was canceled.

Nyckoletta Martin also worked for KODA during that time. She was not assigned to the room that day but thought she might have, so she began reviewing case notes. Martin left KODA one month after the incident in 2021.

“Prior during that day, TJ went to the cardiac catheterization lab, and he woke up for the first time during his admission there," Martin said. "KODA did not stop the case. The hospital staff was alarmed they were calling it euthanasia, and it was explained to them that they planned to give more palliative medications in the OR." 

Martin and Miller alleged KODA higher-ups seemed to pressure for the organ retrieval to continue.

“There was just a lot of opportunities for KODA to do the right thing, and they failed," Martin said. "They failed the donor, they failed the family and they failed the system for those of us who dedicate our lives to organ donation." 

Martin said she has heard from others in Kentucky and the U.S. with similar stories. While she still believes in lifesaving abilities of organ donation, she said it has to be safer.

“There needs to be someone there who is solely dedicated to the donor that has a good medical background that can look at the chart and say 'X,Y, Z,'  was done properly," Martin said. "Just somebody who is not affiliated. The No. 1 complaint I’ve received are families feel like they’re pressured and don’t have time to make decisions." 

In response to Martin and Miller's claims

Nonprofit Network for Hope said it is an “inaccurate portrayal” of events and the donation process worked as it should have. The donor network sent Spectrum News 1 the following statement: 

"The recent news coverage about Network for Hope (NFH and f/k/a Kentucky Organ Donor Affiliates (KODA)) and a case involving a potential organ donor from October 2021 greatly misrepresents an organ procurement organization’s (OPO) role in organ recovery and the organ donation process. Public trust is vital to our efforts in providing lifesaving organ transplants to others, and we are deeply concerned that these misrepresentations have eroded the public trust in NFH and in the organ donation system. We want to reassure you of NFH’s commitment to transparency, compassion, ethical practices and the highest standards in organ donation.

Therefore, we want to make the following abundantly clear:

1. Organ donation only occurs after either brain death or cardiac death has been declared by the patient’s health care provider. Importantly, this case was referred to KODA as a potential Donation after Cardiac Death (DCD) case, not a potential Brain Death (BD) case. As with all DCD cases, in this case, the patient’s family was informed about the organ recovery process for potential DCD donors. The family acknowledged that their decision to withdraw life support was made prior to and independent of any discussion or consideration of organ and tissue donation. The family also acknowledged their understanding that only after the provider discontinues life support and only after the patient has progressed to cardiac arrest, would the patient’s physician declare death. Importantly, the family acknowledged that if the patient did not experience cardiac death within a certain time frame, the patient would remain in the care of the provider and be transferred back to an appropriate area of the hospital. In this case, before life support was withdrawn, the patient’s condition improved, and the organ recovery was cancelled.

2. OPOs do not provide patient care or declare death. We are only authorized to proceed with organ recovery after a patient’s independent health care provider has declared death.

3. OPOs are nonprofit organizations, and they are reimbursed by the transplant centers that accept organs on behalf of transplant patients. OPOs may only bill for costs incurred in facilitating the organ donation process, and the reimbursement process is overseen by the Centers for Medicare and Medicaid Services (CMS)."

Baptist Health Richmond sent Spectrum News 1 a statement that reads, “The safety of our patients is always our highest priority. We work closely with our patients and their families to ensure our patients’ wishes for organ donation are followed.”

Attorney General Russell Coleman, R-Ky., said his office has been in contact with Kentucky’s federal delegation and is “in collaboration with our Kentucky law enforcement and prosecutorial partners, we will continue reviewing the facts to identify an appropriate response.”

The need for reform  

Despite the experience, both Miller and Martin said they still believe organ donation is essential.

“I still believe in organ donation, just when it’s done correctly and in the right manner," Miller said.

Both women believe more information should be given to people agreeing to be organ donors at the DMV as well.

Greg Segal shared this case with Congress members in Oct. 2024 at the House Energy and Commerce investigations subcommittee. He founded Organize, which fights to reform organ donation in America.

Segal said the system currently lacks accountability and is monopolized by one organization: the United Network for Organ Sharing.

“They have all the wrong financial incentives and no accountability, and a few things need to happen," Segal said. "The federal government needs to set standards and enforce those standards to make sure that behaviors like this don’t continue unabated." 

Segal said nationally, organ procurement organizations like Network for Hope should be headed by people with medical backgrounds. He also said patient care is unsafe, OPOs have kickback schemes and the process preferences white, wealthy patients.

Segal's full testimony is available online.