Declared brain dead, but “comes back to life” before organ harvesting: how is this possible?

Imagine you were declared dead yes one medicobut in reality you still are vivi and, even more disturbing, you have just been transferred to operating room for theorgan removalbecause with a gesture of great generosity you had decided to donate them. You can hear everything, listen to voices and observe the specialists’ preparations. You may already see scalpels, saws, whisks and other tools needed to remove organs from your body. A real one horror moviewhich starred thirty-six-year-old Anthony Thomas “TJ” Hoover II. The man was hospitalized at Baptist Health hospital in Richmond, Kentucky in October 2021 for a drug overdose; had a cardiac arrest and it was declared brain death. In how much donor arrangements were made for the removal of organs to transplant them into needy patients.

During one of the preparatory procedures called cardiac catheterizationhowever, man has awakened, his eyes they started darting everywhere and the body wriggling, like told NPR by Dr. Natasha Miller, organ preservation specialist at Kentucky Organ Donor Affiliates (KODA). The man was also “visibly crying,” the woman said. In a first phase – that of eye movement – they were believed to be alone spasms after deaththerefore the doctors decided to continue with the procedure, then when it became evident that he was awake two of them stopped the surgery and refused to continue. They immediately went to tell the man’s sister the news – Donna Rhorer – who was waiting outside, shocked by what had happened.

The affair, beyond the necessary and in-depth investigation into the specific episode, is having important consequences in the management of the organ donation in the United States. As explained by the British newspaper Independentthe Biden administration announced a plan to overhaul the organ procurement system, increasing “transparency and accountability” in the procedures. This is highlighted by a Health Resources and Services Administration (HRSA) document published in 2023 from the US Department of Health and Human Services. Hoover’s case is not in fact the first case of this kind, although these are rare events. That there is something to review is highlighted by the words of Dr. Robert Cannon, a surgeon specializing in liver transplants at the University of Alabama in Birmingham, who spoke at a hearing in the United States Congress. “Unfortunately I have experienced this too,” the doctor said in a statement reported by NP4, citing the case of a man who he started breathing during an explant operation, fortunately noticed by the anesthetist. In that case the team contacted a coordinator who told them they were faced with a “brainstem reflex” and therefore “to continue”. But they refused, noting that the operation would turn into a homocide. “Every transplant surgeon probably has a story to tell about themselves or a colleague who had a similar situation,” Dr. Cannon said. A chilling statement.

Now, net of the individual cases mentioned above, how can it happen that a person declared in brain death you suddenly start to show vital signs and apparently wake up and come back to life? First of all, brain death refers to a condition in which bothelectrical activity of the brain that that cardiac. The presence of heart activity is the biological factor that distinguishes the irreversible coma from brain death, although both definitions are still the subject of discussion among specialists. In the case of brain death, however, it is a declared person legally dead (therefore no longer a patient), while for the irreversible coma of one alive. “The transition from a deep coma to brain death – the permanent cessation of all brain function – may not be immediately obvious to an inexperienced observer. However, recognizing this transition from life to death is critical for families, medical teams and potential organ recipients,” explained Johns Hopkins University in an article dedicated to the very delicate topic.

It is clear that similar nuances can occur very rarely medical errorsin which a person may be declared dead when they are actually not. After a cardiac arrest, as in the case of the 36-year-old protagonist of the above-mentioned story, the heart could start again throb suddenlyor it could be “read” as devoid of activity by the medical equipment (for various reasons) and mislead the doctor. It is important to underline that brain death is declared only afterwards at least 6 hours of absence of brain activity through a electroencephalogram and cardiac. In brain death “there is the irreversible cessation of all functions of the brain”, explains the Ministry of Health. “This irreversible cessation of the functions of the entire brain determines the absolute absence for the brain-dead subject of autonomous breathing, consciousness and cerebral control of motor and vegetative functions (temperature, blood pressure, etc.). In cases of confirmed brain death, we no longer speak of ‘patients’ since the person is no longer alive and, therefore, can no longer be treated”, underlines the ministry. In the awakening of a person previously declared dead there may be signs of awakening movements of limbs, fingers and eyes; reactions to pain; breathing (as in the case cited by Dr. Cannon); and clearly reactivation of the electroencephalogram.

The investigation into the case of Anthony Thomas “TJ” Hoover II is still ongoing and, at the moment, for procedural reasons There is no data available on what led the doctors to declare his brain death, consequently activating the organ harvesting procedures. What is certain is that the man has awakened and today, exactly three years after the terrible experience, he lives with his sister who is his guardian. He suffers from speech, walking and memory problems, but is alive. “I feel betrayed by the people who told us he was brain dead and then woke up. They’re trying to play God. They’re almost picking and choosing: they’re going to take this person to save these people. And you kind of lose faith in humanity a little bit,” the man’s sister angrily told NPR. It will be necessary to wait for a sentence to find out what may have happened in that terrible October three years ago.