Doctors Were Preparing to Remove Their Organs. Then They Woke Up. A federal investigation found a Kentucky nonprofit pushed hospital workers toward surgery despite signs of revival in patients.

Now, a federal investigation has found that officials at the nonprofit in charge of coordinating organ donations in Kentucky ignored signs of growing alertness not only in that patient but also in dozens of other potential donors.

The investigation examined about 350 cases in Kentucky over the past four years in which plans to remove organs were ultimately canceled. It found that in 73 instances, officials should have considered stopping sooner because the patients had high or improving levels of consciousness.

Although the surgeries didn’t happen, the investigation said multiple patients showed signs of pain or distress while being readied for the procedure.

Most of the patients eventually died, hours or days later. But some recovered enough to leave the hospital, according to an investigation by the federal Health Resources and Services Administration, whose findings were shared with The New York Times.

The investigation centered on an increasingly common practice called “donation after circulatory death.” Unlike most organ donors, who are brain-dead, patients in these cases have some brain function but are on life support and not expected to recover. Often, they are in a coma.

If family members agree to donation, employees of a nonprofit called an organ procurement organization begin testing the patient’s organs and lining up transplant surgeons and recipients. Every state has at least one procurement organization, and they often station staff in hospitals to help manage donations.

Typically, the patient is taken to an operating room where hospital workers withdraw life support and wait. The organs are considered viable for donation only if the patient dies within an hour or two. If that happens, the procurement organization’s team waits five more minutes and then begins removing organs. Strict rules are supposed to ensure that no retrieval begins before death or causes it.

The investigation criticized Kentucky Organ Donor Affiliates, which was coordinating donations in the state. Now called Network for Hope after a merger, it has said it always follows the rules and never removes organs until a hospital has declared a patient dead.

But the investigation found that the organization’s employees repeatedly pressured families to authorize donation, improperly took over cases from doctors and tried to push hospital staff to remove life support and allow for surgery even if there were indications of growing awareness in patients.

Some employees failed to recognize that hospital sedatives or illegal drugs could mask patients’ neurological condition, meaning they might be in better shape than they seemed.

In December 2022, a 50-year-old overdose victim began stirring less than an hour after being taken off life support and started looking around. The retrieval attempt was not immediately ended, nor was the patient given any explanation.

“The patient had no idea what was going on but was becoming more aware by the minute,” records noted.

After 40 more minutes — when the patient’s organs would no longer qualify for donation — the attempt was called off, and he was moved to an intensive care unit. He later sat up and spoke with his family before dying three days later, the investigation found.

Overall, the investigation flagged 103 cases as having “concerning features” and said problems were more likely to occur at rural hospitals. It noted more than half of transplants arranged by the Kentucky organization were from circulatory-death patients, above the national average.

Nationwide, officials recovered about 20,000 organs from this type of donor last year, nearly double the total in 2021, according to the Organ Procurement and Transplantation Network, which oversees the transplant system.

Federal regulators told the network last week that the Kentucky organization must increase training for staff and conduct neurological assessments on potential organ donors every 12 hours, among other changes.

On Thursday, the organization said it had received a report about the government investigation. “We will fully comply with all of their suggested recommendations,” it said in a statement.

The federal inquiry began last fall after a congressional committee heard testimony about the Kentucky man, Anthony Thomas Hoover II, who had an overdose in 2021. He was unresponsive for two days before his family agreed to donate his organs.

Over the next two days, the procurement organization moved toward surgery even as his neurological condition improved, the investigation found. During one exam, records show, he was “thrashing on the bed.” He was sedated to prevent further motion.

The hospital staff “was extremely uncomfortable with the amount of reflexes patient is exhibiting,” case notes read. “Hospital staff kept stating that this was euthanasia.” A procurement organization coordinator assured them it was not.

When Mr. Hoover was taken for the retrieval, records show, he cried, pulled his knees to his chest and shook his head. A hospital doctor refused to withdraw life support. Mr. Hoover eventually recovered. Now 36, he has lingering neurological injuries.

In interviews with The Times, two former employees of the procurement organization said higher-ups tried to pressure the doctor to continue the retrieval attempt. “If it had not been for that physician, we absolutely 1,000 percent would have moved forward,” said one of them, Natasha Miller, who was in the room. Three other former Kentucky employees said they had seen similar cases.

The investigation did not say if there was pressure on doctors who treated Mr. Hoover. Network for Hope did not respond to a request for comment on that case.

The Kentucky attorney general’s office also launched an investigation into Mr. Hoover’s case. On Thursday, the office said the review was ongoing.

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