HHS Overhaul of Organ Harvesting is Long Overdue
Updated
“One organ donor can save eight lives,” as the saying goes. That accurate and crafty claim with an emotional punch likely emerged in the late 20th century as organ transplantation became more established. The phrase reflects the medical reality that a single donor—assumed to be deceased, of course—can provide up to eight major organs: heart, two lungs, liver, two kidneys, pancreas, and intestines, allowing those in desperate need to continue living following their donor’s death. With that delicate fact in mind, should hospitals, which profit hugely from organ transplantation, authorize the organ procurement process to commence while the potential donor still shows signs of being alive? U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy rightly doesn’t think so. Yet, an eye-opening HHS investigation under his leadership highlights that it is indeed happening. In a July 21, 2025, statement announcing “a major initiative” to reform the organ transplant system, Kennedy remarked:
“Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying. The organ procurement organizations that coordinate access to transplants will be held accountable. The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves.”
Indeed, an investigation by the HHS’s Health Resources and Services Administration (HRSA) has recently uncovered a disturbing case (there are many) involving potentially preventable harm to a neurologically injured patient by the organ procurement organization (OPO), a federally funded group that serves Kentucky, southwest Ohio, and part of West Virginia. During the Biden administration, the unsettling case was closed by the Organ Procurement and Transplantation Network (OPTN), which oversees organ donation processes. Under Secretary Kennedy’s leadership, HRSA has directed OPTN to reopen the case.
Kennedy’s announcement of the “systematic disregard for the sanctity of life in the organ transplant system” came a day after a report in the New York Times vividly described the case of a patient who was removed from life support and declared dead. But they weren’t dead. Instead, the patient’s heart and respiratory systems were found to be actively still working after surgeons made an incision into her chest to harvest her organs for donation. While noting the “carefully calibrated protocols” in place “to protect both donors and recipients,” the NYT also reported that lately, as the system has pushed for more transplants, “a growing number of patients have endured premature or bungled attempts to retrieve their organs.” The news outlet further asserting:
“A New York Times examination revealed a pattern of rushed decision-making that has prioritized the need for more organs over the safety of potential donors.”
Along with that unthinkable case, as recently reported by The Highwire, the HHS investigation found that a shocking 28 patients may have been alive when organ procurement was initiated. Stories like these have become increasingly common as the transplant system has switched to a type of organ removal called “donation after circulatory death (DCD).” Specifically, this type of organ procurement occurs when a patient is on life support but still has some level of brain function. Many times, the patient can be in a coma. If the family consents to organ donation, the patient is taken off life support and must die within an hour or two for the organs to be viable. The staff with the OPO must wait a mere five minutes to ensure the patient is actually dead before organ harvesting can begin. This type of organ procurement accounted for one-third of all donations last year, or approximately 20,000 organs. That figure is three times more than it was five years prior.
Undoubtedly, questions surrounding the moral and ethical implications of organ donation have existed for decades. An article in the BMJ published in June 2005, titled “Does it matter that organ donors are not dead? Ethical and policy implications,” wrote that the “standard position” on organ donation was that the donor must be dead for vital organs to be removed. Seems logical, but clearly, with the viability window for organ harvesting slim, the seemingly straightforward definition leaves room for interpretation. The authors, M. Potts and D. W. Evans, agreed with the position that the donor must be dead before organs are harvested. They further wrote that “recently, Robert Truog and Walter Robinson have argued that (1) brain death is not death, and (2) even though ‘brain dead’ patients are not dead, it is morally acceptable to remove vital organs from those patients.” What? Again, Truog and Robinson assert it is “morally acceptable to remove vital organs from those patients.”
Did these two, Truog and Robinson (who are both bioethicists who have challenged the concept of brain death), help lay the groundwork for the “horrifying” reality of organ harvesting currently preying on the families of those with a loved one wavering close to death? Maybe so. In 2003, in a PubMed review titled “Role of brain death and the dead-donor rule in the ethics of organ transplantation,” Robinson and Truog wrote that the “dead-donor rule” requires patients to be declared dead before “life-sustaining organs” can be removed for transplantation. While noting that the concept of brain death has long been recognized to be plagued with serious inconsistencies and contradictions and fails to correspond to any coherent biological or philosophical understanding of death, they explained:
“The concept of brain death was developed, in part, to allow patients with devastating neurologic injury to be declared dead before the occurrence of cardiopulmonary arrest. Brain death is essential to current practices of organ retrieval because it legitimates organ removal from bodies that continue to have circulation and respiration, thereby avoiding ischemic injury to the organs.”
The pair then radically proposed that individuals who desire to donate their organs and who are either “neurologically devastated or imminently dying” should be allowed to donate their organs, without first being declared dead. Had such “playing God” standards been formally adopted, instead of being terribly alarming and potentially criminal, many of the cases coming to light thanks to Secretary Kennedy and others would be standard operating procedure in transplant hospitals nationwide. Nevertheless, the push to allow dying patients to effectively be killed for their organs—and the hefty profits tied to doing so—has essentially turned organ sources into commodities. They are harvestable natural resources. Indeed, Potts and Evans were spot on in their 2005 article when they disputed the claim that the removal of vital organs is morally equivalent to “letting nature take its course,” writing:
“Unlike ‘allowing to die,’ it is the removal of vital organs that kills the patient, not his or her disease or injury.”
And here we are today, rightly terrified to check the organ donor box on our driver’s license. Indeed, Secretary Kennedy and the HHS have uncovered that outdated systems and negligent bureaucracies have failed to protect vulnerable people, as the Trump administration had previously warned. Under Secretary Kennedy’s leadership, HHS maintains it is working to restore organ procurement and transplant policies by focusing on the lives of patients, while rebuilding trust, ensuring informed consent, and respecting the rights and dignity of potential donors and their families. Reform can’t happen soon enough.
