Recently in Kentucky, USA, the attorney general questioned whether criminal charges were appropriate in a troubling case involving a man who almost had his organs harvested while he was still alive. Three years ago, Mr. Anthony Hoover was brought into the emergency department for drug overdose. He was eventually placed under a DNR (do not resuscitate) order, and an organ donation agency reached out to his family about donating his organs. Mr Hoover was a registered organ donor, and although there was no registered brain activity, the rest of his organs were functioning.
And as the story goes, 2 hours into the operation a staff member came out of the operating room to inform that the patient was not ready for organ donation. The family thought they experienced a miracle.
Except that this was an unfortunate and unnecessary demonstration of confirmation bias, misinformation, and people pushing their agenda. Soon after the family agreed, the patient was prepped for a 5-hour long operation, starting with a heart catheterization commonly performed prior to organ transplant. What was not informed to the family members was how their loved one "had 'purposeful movement to pain' during the heart procedure. His eyes were 'open and tracking,' and he was 'thrashing around'". It almost seemed like he was resisting.
Rather than stopping to query if the patient was waking up, the cardiologist succumbed to confirmation bias and dismissed it as typical spinal reflexes. He went on to administer more medications to paralyze and sedate the patient, to the point where others felt it was essentially euthanasia. When he was on the operating table, head shaking and eyes tearing, staff went ahead to drape and shave him anyway. Ultimately the independent doctor tasked to terminate life-support and pronounce the patient dead refused to proceed, citing "too much function" and indicating that the patient was not entirely brain-dead.
Someone else was trying to speak up that day too. The case coordinator from the organ procurement agency called her supervisor to explain the situation, but was screamed at from the other end of the line while being told to "find another doctor to do it". The agency was “pushing, pushing, pushing to go.”.
Humans can be blinded by personal interest and partisan agenda. And, like cognitive heuristics (biases) serving as mental short-cuts, interest and agenda are not bad things. A donor's life, when done right, can save nine others. Meaningful work demands devotion so that people have the tenacity to plow on despite exceptional challenges. However, conflicts of interest or moments of heightened emotions can cloud our reasoning, and we simply cannot "hold two opposing thoughts in our heads" and still make neutral judgments.
When organizations become singularly focused with their own agenda of delivering results, a toxic environment can emerge as employees feel relentless pressure to meet goals, often at the expense of collaboration, integrity, and well-being. This intense focus on outcomes can encourage shortcuts, discourage honest reporting, and foster an atmosphere of competition rather than support. Raising concerns is seen as counterproductive or even obstructive. Those who speak up may be unfairly labeled as troublemakers, which discourages open communication and accountability. Such myopic view of success risks eroding trust, and seeds vulnerabilities that will structurally hurt the enterprise.
Yet this episode might have been mere luck, since the proverbial blood rarely stains the organ procurement agency's hands. The patient was already on DNR order when the solicitation came to consider organ donation. Any subsequent reflexes could easily be explained away. By all accounts, the request to donate the organs was ethically performed with no undue pressure. With the consent legally signed, there isn't much left to hold the agency back.
Fortunately in organ donation, there exists a proper protocol to independently and objectively evaluate a patient's suitability. But in true medical drama fashion, even this can be unethically influenced.
It is easy to expect professionals to simply follow routine practices. We don't always have the power or authority in our setting to contest bosses and ignore instructions. But when your gut tells you something is off, or you're being made to swallow your values, don't keep it to yourself. Seek out colleagues and mentors who might share the same concerns as you (better still if they have influence). Do your best to speak up professionally. Your worries may or may not be allayed, or they may be unfounded, but they should at least be acknowledged and considered. Voicing out contributes to a culture where concerns are heard and valued.
And if someone is speaking up to you, please respectfully pause and ponder. Take time to reflect whether success is achieved responsibly, Establish and review processes (even informal ones) that genuinely encourage open sharing as well as impartially resolve conflicts of interest.
In the aftermath of this news, many people in the US are revoking their organ donation registrations, an ironic demonstration of availability bias. Mr. Hoover eventually recovered, and danced at his sister's wedding.
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