Troy Balderson Asks Doctor About Assessment Of The Neurological State Of Organ Donors Prior To Removal

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During a House Energy and Commerce Committee hearing on Tuesday, Rep. Troy Balderson (R-OH) spoke about the neurological assessment of organ donors prior to removal surgery.

Transcript

00:00Thank you very much, Mr. Chairman, and congratulations.

00:05Dr. Lynch, thank you for being here today.

00:07HRSA's report details many instances where the neurological condition of patients were not thoroughly assessed.

00:14Can you provide a few examples of where you found that to be the case?

00:20The initial one was what we are calling the index case.

00:23That individual was showing increased signs of consciousness over the day preceding the organ recovery attempt

00:31and then throughout that day of the organ recovery attempt.

00:34Despite the OPO noting this in its own electronic medical record,

00:39they continued without deviation from the plan and went to the operating room with the intent of recovering his organs.

00:46What changes to policy or procedures would you or have you recommended to ensure that patients are thoroughly evaluated

00:53prior to moving forward with procurement through DCD?

00:58So for DCD to be done in a safe way, for any organ, potential organ donor to be evaluated in a safe way,

01:05we need to understand what is wrong with them and to what degree there is chemical manipulation of their neurologic status.

01:12By which I mean, is this what we're seeing on a neurologic exam brain function,

01:17or is it brain function and being sedated or paralyzed in order to, you know, accomplish other medical tasks?

01:26Dr. Lynch, could you briefly describe what leads to variations in process and procedures related to DCD in hospitals and OPOs?

01:37So, again, the hospital providers have a role in this, but they are dependent on the OPO as their subject matter expert.

01:43OPOs have been, have had established areas of care for many years.

01:48They have a responsibility to provide procurement care in every hospital in their area,

01:52and so they all have hospital development divisions that are supposed to go out and provide education.

01:58That education can be in the abstract.

02:00A provider may not see somebody who could be an organ donor for many months.

02:04When a potential donor is identified by the OPO, they need to provide updated information

02:10and what we would term just-in-time training to make sure that there's a good expectation of the respective roles

02:15and the ability to reassess if this is a potential organ donor if the neurologic status changes.

02:23And I'll follow up with that.

02:24You've been interested in that.

02:25And how might this lead to different standards in patient care

02:28and occasionally patient outcomes in CDC cases?

02:31So this is meant to provide consistent care to make sure that the imaginary lines

02:38or the invisible lines over which a patient may move within a state or across states

02:44don't affect the quality of neurologic care that they will receive in a hospital

02:48and that they are able to have equal access to being an organ donor if that is the path for them

02:54or to not being subject to that procurement process if it's not appropriate.

02:59Dr. Lynch, has HRSA ever recommended that an OPO be decertified?

03:05So the decision to decertify an OPO actually rests with CMS, not with HRSA?

03:13Has an OPO ever been decertified?

03:15No.

03:17Mr. Chairman, I yield back my remaining time.

03:20The gentleman yields.

03:22The chair recognizes the gentlelady from Colorado.

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