U.S. Organ Donation System Faces Scrutiny

Its saving lives

Lets start with the truth: organ donation gives people a second chance. A real one. Not in the movieson operating tables, in hospitals, every single day across the country. One persons decision to say "yes" can save as many as eight lives. Thats eight families getting more time. More birthdays, more dinners, more "I love yous."

And for the most part, the U.S. organ donation system works. Quietly, efficiently, and with incredible care, thousands of transplants happen each year. But lately, somethings shaken that trust.

What if I told you there were casesactual, documented caseswhere people showed signs of life while being prepped for organ donation? Chests shaved, bodies sterilized, about to go under the knife and then, movement. Moaning. Awakening.

It sounds like a horror story. But it happened. And now, everyones asking: How does this system really work? And how do we make sure it never happens again?

Im not here to scare you. Im here to tell you whats realwhat went wrong, how we fix it, and why, despite everything, saying "yes" to donation might still be one of the most powerful choices youll ever make.

Something went wrong

Back in 2021, a man named TJ Hoover was in a Kentucky hospital after a drug overdose. Doctors declared him brain-dead. His organs were listed for donation. The preparation startedchest shaved, body cleaned, ready for surgery.

Thenmovement.

TJ began moaning. He moved his arms. He wasnt brain-dead. The procedure was canceled. He survived. And today, hes sharing his story online, warning others.

That by itself was alarming. But heres whats worse: this wasnt an isolated case.

A federal investigation by the Health Resources & Services Administration (HRSA) looked at 351 organ procurement cases in the same program. They found 103 with "concerning features." Seventy-three patients showed signs that were, in plain terms, not compatible with deathlike reflexes, breathing motions, or movementafter being cleared for organ recovery.

Can you imagine? Your loved one, already treated as goneand then, their body says otherwise.

Staff raised concerns. Families asked questions. But in too many cases, those voices were ignored. No second brain death exam. No pause. Just a rush forward.

Its no wonder people are scared. As one lawmaker put it, "These are horrific reports."

But heres the thing: just because the system failed in one place doesnt mean its broken everywhere. It means it needs to changeurgently, transparently, and with all of us paying attention.

How it should work

The U.S. organ donation system is actually a carefully designed chain of checks and balances. When it works, its a miracle of coordination. Lets walk through itplain and simple.

First, death has to be confirmedalways by hospital doctors, never by the organ donation team. Thats a huge deal. It keeps things ethical. Two teams: one that tries to save you, another that steps in only after death is certain.

There are two main ways someone becomes a deceased donor:

Type	How It Works	When Its Used
Brain Death Donation	No brain activity. Body supported by ventilator. Organs stay oxygenated.	Most common (~80% of deceased donations)
Donation After Circulatory Death (DCD)	Life support withdrawn. After heart stops, wait 5 minutes. Death confirmed.	For kidneys, livers, lungswhen brain death isnt present
Living Donation	Someone gives a kidney or part of their liver while alive.	Can bypass waitlists entirely

After death is confirmed, the local Organ Procurement Organization (OPO)there are 55 across the U.S.is notified. They check if the person is registered to donate (you can sign up online or at the DMV). Then, they talk to the familyeven if the person is registered, families are always consulted.

Medical tests follow: Are the organs healthy? Any infections? Then comes the match. UNOS, the United Network for Organ Sharing, runs a national waiting list. They match based on blood type, body size, urgency, and distance. No money, no fame, no favoritism.

Finally, the recovery. A surgical team (separate from the care team) removes the organs. Respectfully. Surgically. And thenoff to the recipient, whos already in surgery.

And yesdonation doesnt stop you from having an open-casket funeral. The body is treated with dignity. Always.

Trust is everything

But all of thisevery life saved, every surgery, every second chancedepends on one fragile thing: trust.

And after what happened in Kentucky, that trust is rattled.

Some families have pulled out of donor registries. Others are second-guessing. And while we should never rush into anything blindly, we also cant let fear erase decades of progress.

Because the need is real. Right now, over 103,000 people are on the U.S. transplant waitlist. Every day, about 13 people die waiting for an organ. Meanwhile, we perform around 48,000 transplants a yeareach one a victory, but still not enough.

I think of stories like that of Rep. Brett Guthrie, whose mother died waiting for a liver. Even after that pain, he still supports organ donation. "But I still believe in donation," he said. That kind of hope? Its powerful.

We dont have to choose between caring about safety and believing in the system. We can demand both.

Protections we need

So whats being done?

A lot, actually. And its happening fast.

HRSA has rolled out a new "pause" policyanyone can stop the donation process at any time if something feels off. Nurse, doctor, family member, transporterdoesnt matter. If you have concern, you have the power to say, "Wait a second. Lets double-check."

Were also getting clearer rules:

• Standardized checklists for hospitals during donor care
• Anonymous reporting systems for medical staff to flag issues
• Root-cause analysis for any errorno more sweeping things under the rug

Plus, the OPTN (Organ Procurement and Transplantation Network) is launching a major modernization push. That includes a public dashboard showing how each OPO performstransparency weve never had before.

And this is key: hospitals will now have stronger oversight. The final word on death declaration stays with doctorsnot donor coordinators, not OPOs.

This isnt just about fixing what went wrong in Kentucky. Its about fixing a culture that, in some places, prioritized speed over safety.

Ethics matter most

Lets talk about the tough questions. Because if youre thinking about them, so am I.

Is it ethical to take organs after circulatory deathafter the heart stops?

The answer, according to medical guidelines, is yesif strict rules are followed. The patient is fully sedated. After life support is withdrawn, theres a mandatory five-minute wait with no pulse or breathing before death is declared. And the organ team isnt involved in the withdrawal processthey step in only after death is official.

But heres where it gets complicated: sometimes, after the heart stops, a body might still make movements. A gasp. A twitch. These are reflexes, not consciousness. But to a family member watching? Its terrifying. And we cant dismiss that.

Thats why informed consent is so crucial. Families need to understand what DCD meansexactly what happens, what they might see, and why its still considered ethically sound.

And about living donation? Its safer than you might think. Donors go through intense medical and mental health screenings. No pressure. No incentives. Just compassion.

Heres something beautiful: when someone gives a kidney while alive, it doesnt just save one life. It often frees up a deceased donor organ for someone else on the list. So one acttwo lives saved. Thats the ripple effect of generosity.

How you can help

You dont have to be a doctor, a politician, or a policy expert to make a difference. You just need a voice.

First, register as a donor. It takes less than a minute at organdonor.gov. You can also sign up at the DMV or through your iPhone Health app. Its free. Its legal. And its binding.

But heres the part people forget: tell your family. Even if your license says "organ donor," hospitals will still talk to your loved ones. If theyre unprepared, they might say noeven if you wanted yes.

So have the conversation. Over coffee. After dinner. Say, "Hey, if something happens to me, Id want to donate. Heres why." It doesnt have to be heavy. It just has to happen.

If youre waiting for a transplant, talk to your doctor. Get referred to a transplant center. The process includes medical tests, psychosocial evaluation, and placement on the UNOS list. Its not fast, but its fair.

And if youre ever in the heartbreaking place of losing a loved one who might be a donor?

Ask questions.

You have the right to know how death was confirmed. You can request a second neurological exam. You can pause the process if your gut says "no." Youre not a background character in this story. Youre the voice of someone loved.

Hope is stronger

Look, I wont pretend the system is perfect. Its not. Mistakes happened. Lives were almost lost. And families lost trustfairly, painfully.

But heres what I also know: every day, people choose hope.

They choose to believe that even in loss, there can be life. That from grief, healing can grow.

The U.S. organ donation system is flawed, yes. But its also fixable. And with more transparency, better safeguards, and louder voices like yours and mine, it can become stronger than ever.

So heres my ask: dont walk away from donation because of fear. Walk into it with awareness.

Register. Talk. Question. Care.

Because at the end of the day, this isnt just about policy or protocols. Its about people. Real people. On waiting lists. In recovery rooms. Holding newborns they might not have lived to see.

Its about you. And what you believe is possible.

If we get this right, organ donation isnt just medicine.

Its hope. Raw, human, unstoppable hope.

And that? Thats worth fighting for.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.