WASHINGTON (AP) — Transplant experts are seeing a rise in people revoking organ donor registrations, and their confidence is shaken by reports that organs were nearly recovered from a Kentucky man wrongly declared dead .

It happened in 2021 and although the details are murky, surgery was avoided and the man is still alive. But donor registries in the United States and even across the Atlantic are being affected after the case recently became public. A drop in donations could cost the lives of people waiting for a transplant.

“Organ donation is based on public trust,” said Dorrie Dils, president of the Association of Organ Procurement Organizations (OPO). When it erodes, “it takes years to recover.”

Only doctors caring for patients can determine if they are dead; The law prohibits anyone from engaging in organ donation or transplantation. The allegations raise questions about how doctors make that determination and what is supposed to happen if someone sees cause for doubt.

The key is to ensure that “all doctors are doing the right tests and doing them well,” said Dr. Daniel Sulmasy, a bioethicist at Georgetown University.

An alleged near accident in Kentucky

The 2021 case first came to light in a congressional hearing last month, with details not confirmed in subsequent media reports: allegations that a man who had been declared dead days earlier woke up on the way to the operating room to an organ donation surgery and that There was initial reluctance to realize.

The federal agency that regulates the U.S. transplant system is investigating, and the Kentucky attorney general’s office said it is “reviewing the facts to identify an appropriate response.” A coalition of OPO and other donation groups is urging that the findings be made public quickly and that the public not weigh in until then, saying any deviation from the industry’s strict standards would be “completely unacceptable.”

The number of people choosing not to donate organs has skyrocketed

Donate Life America found that an average of 170 people per day removed themselves from the national donor registry in the week following media coverage of the allegations, 10 times more than the same week in 2023. That doesn’t include removal requests submitted by email or state records. another way people can volunteer to become donors when they eventually die.

Dils’ own organ agency, Gift of Life Michigan, typically receives five to 10 calls a week from people asking how to get off that state’s list. In the last week, its staff handled 57 such calls, many of which mentioned the Kentucky case.

The Kentucky accusations reverberated in France

Unlike the American voluntary donation system, French law assumes that all citizens and residents will be organ and tissue donors in the event of death, unless they clearly choose not to.

After the Kentucky reports reached France, the number of people joining that country’s donation rejection registry jumped from about 100 people a day to 1,000 a day last week, according to the French Biomedicine Agency.

Dr. Régis Bronchard, deputy director of the agency, said the increase “reflects anxiety and misunderstanding among the general public” that could have “catastrophic consequences.”

What should happen after death and before organ donation?

Doctors can declare two types of death. What is called cardiac death occurs when the heart stops beating and breathing stops and cannot be restored.

Brain death occurs when the entire brain permanently stops functioning, usually after a major traumatic injury or stroke. Ventilators and other machines keep the heart beating during special tests to find out.

Only about 1% of deaths occur in a way that allows someone to become an organ donor; Most people declared dead in a hospital will be quickly transferred to a funeral home or morgue.

But most organ donations come from brain-dead donors. Only after that declaration does the donor agency assume responsibility for the deceased, search for potential recipients and schedule retrieval surgery, while typically the nurses at the hospital where the person died continue to care to ensure that the team adequately maintains their organs until they are ready. collected.

What happens if something goes wrong?

The donor agency and transplant surgeons who arrive to retrieve the organs must check the records of how death was determined. Anyone (donor hospital employees, donor agency staff, or surgeons) who sees something concerning should speak up immediately.

“This is extremely rare,” Dr. Ginny Bumgardner, a transplant surgeon at Ohio State University who also heads the American Society of Transplant Surgeons, said of the Kentucky case.

In operating rooms “the whole process stops” if someone sees a hint of trouble, and independent doctors are called in to verify that the person is really dead, Bumgardner said. In his 30-year career, “I have never had a case where the original statement was incorrect.”

Georgetown’s Sulmasy agreed that problems are rare. But he said there is a wide variation in the tests different hospitals perform to determine whether someone is brain dead, whether they are a potential organ donor or not. Doctors are debating whether to add additional testing requirements.

Stricter criteria could “assure the public that we’ve done a tremendous amount of due diligence before determining that someone is dead,” he said. It could help “get people to stop tearing up their organ donor cards.”

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AP Chief Paris Correspondent John Leicester contributed to this report.

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