Diana DeGette Warns Hospitals Are 'Being Pressured' To Certify Death To Procure Organs

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During a House Energy Committee hearing before the Congressional Recess, Rep. Diana DeGette (D-CO) asked Chief of the Organ Transplant Branch at the U.S. Department of Health and Human Services Dr. Raymond Lynch about pressure on hospitals to procure organs.

Transcript

00:00for her five minutes of questioning. Thank you, Mr. Chairman, and congratulations on ascending

00:04to your new role. I know this subcommittee is in capable hands, and I want to say as someone who

00:12has been on this subcommittee my entire time in Congress, we've spent a lot of time over the years

00:18looking at the organ donation rules and practices, and it's really shocking when something like this

00:25happens with all of the effort that Congress has put in, and I know agencies like yours as well.

00:32Last year, there were more than 48,000 transplants performed in the United States,

00:39but right now there are more than 103,000 people on the national transplant waiting list,

00:46and tragically, as you know, Dr. Lynch, about 4,700 patients die every year while waiting for organ

00:54donation, and so there's an incentive to find more organs, and it's a life-saving thing if it's

01:05appropriately done, if the person wants to donate their organ, and if in fact they're dead, and in

01:12fact if it qualifies. That's something we all agree with, and I'm hoping everyone on this subcommittee

01:19has checked yes for organ donation, but it's horrifying to everybody to see some of these

01:26practices that are being used, and the New York Times has been in the last few weeks doing some very

01:34good investigative journalism around this practice of circulatory death certification, and there was just

01:42an article dated July 20th, updated today in the New York Times about this practice. Mr. Chairman,

01:50I asked unanimous consent to put this article in the record. So what they talk about, and Dr.

01:59Lynch, you talked about it a little bit, is the increase in the circulatory death process is part of

02:07what has led to this problem, because in a rush to get the organs, then many of the providers are saying

02:18that this is putting pressure on them to certify death when in fact the person may be even moving,

02:27and I'm wondering if you can talk about that just briefly.

02:30So to be clear, the certification of death is by the donor hospital, not by the OPO, but with regard to what I

02:39believe your question is, is that is there increased regulatory oversight in the performance of OPOs that

02:47they're required to perform similar to their peers? Is that leading to a rise in these events?

02:52Yeah, but the hospitals feel that they're being pressured by the OPOs to certify death.

02:58That's what's stated in these articles and by the investigations.

03:03So my understanding of that article was that the the hospitals, some hospital staff were recorded as

03:10saying that the the OPOs were more present in their hospital.

03:13That's correct.

03:13Yeah, so OPOs are recovering more organs than ever before, and that is a multifactorial thing.

03:22Some of it is related to increased oversight by CMS. Some of it is related to new technologies.

03:26Right. Some of it's related to the ongoing opioid epidemic.

03:31The increased emphasis on performance in any area of medicine is never an excuse for non-compliance.

03:39That is correct. I want to ask you about the structure because the OPTN board has recently

03:48been restructured, but previously the board of directors of UNOS, which was the sole contractor,

03:53was also the board of directors. And you said in your written testimony that this governance structure

04:00created a potential conflict of interest. And that's that's that goes to what I'm talking about.

04:06And so I'm wondering if you can explain the conflicts of interest as we're trying to do

04:11this oversight over these new emerging trends.

04:14So NODA at its time was a wise piece of legislation, but over time it has shown its flaws.

04:22NODA basically told HHS to build a house for transplant, and it said you can have one contractor,

04:28and that contractor is your architect, your builder, and your home inspector.

04:32HRSA was in the position of being across the street and wasn't able to directly oversee those functions.

04:38having a contractor's board also be the board of the government entity. There's no way in which it

04:45will not affect the the objectivity of that board. It's almost a per se conflict of interest, is that

04:50right? Yes. And so so does HRSA have a written plan in place to make sure that we have continued

04:56safeguards against potential conflicts of interest and make sure this board remains truly independent going

05:03forward? Yes. So HRSA this spring created a new board of directors, and that was done through a

05:11special nominating committee, what we call the transition nominating committee. They identified

05:15individuals who were volunteers coming forward from within the community. They identified a list of

05:22criteria to screen them for potential conflicts of interest, including service on the board within the

05:28last 10 years during the the period of of most concern. And from within a group that passed that conflict

05:34check, the community elected a new board. Thank you. I yield back. General Lady Yields,

05:40the chair recognizes the gentleman from Alabama, Mr. Palmer, for his five minutes of question.

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