Every year thousands of people die who desperately need organs. In an effort to match organ supply with demand, the House of Representatives provided an incentive in the form of a federal grant. The 2004 Organ Donation and Recovery Improvement Act expanded the Health Resources and Services Administration’s Division of Transplantation’s ability to provide grants to hospitals and organ procurement organizations in order to develop programs. The act expands upon grants that began in 2002. In 2007, both grants focused on Uncontrolled Donors after Cardiac Death, a relatively new concept for the grant.

Judicial Watch obtained records on these grants after litigation. The records are a prime example of what can happen without proper oversight and transparency. Millions of taxpayer dollars are being used to fund a medical program that follows a very similar failed program from the 1990s and that is corrupted by serious shortcomings.   

In 2007, there were 6 applicants for the grant while only 2 programs were recommended for funding by the Objective Review Committee: New York City’s, “Opportunities for Organ Donation: Expanding the Right to Donate Organs Following Uncontrolled Circulatory Determination of Death” and the University of Pittsburgh’s, “Development and Dissemination of a Rapid Response System for Uncontrolled Donation after Cardiac Death.”  Announcement # HRSA-07-077 specifies criteria to apply for the grant.  The proposed solution involves Uncontrolled Donation after Cardiac Death (UDCD) which is

uncontrolled or unexpected death…in which cardiopulmonary function ceases spontaneously, often with death occurring in an unanticipated fashion, frequently outside the hospital setting or in a situation with project reach and complexity. 

The review committee gave the New York consortium a grade of 84 while evaluating the University of Pittsburgh as 87.  The U.S. Department of Health and Human Services’ Health Resources and Services Administration awarded the New York medical consortium $470,471.00 for year 1 of a 3 year experimental program to increase organ procurement (total proposed funding for 3 years is over $1.6 million). The program began in September 2007 and in the fall of 2008 was supposed to begin procuring organs.  

Before even considering the current experiments, previous research is relevant.  In 1995-1997, the Washington Hospital Center and Medlantic Research initiated a program to recover organs using ambulances (very similar to the New York program). The program prepared the organs so families could have more time to make a decision about donation.  After less than 3 years, however, the program ended. Rick Weiss with the Washington Post (and current Assistant Director of Strategic Communications and Senior Policy Analyst for Obama’s Office of Science Technology and Policy) questioned the program's notions of presumed consent including religion and the notion of death. During the 3 year study, there were only 5 cases where the next of kin was not immediately available and could be reached within the narrow window of 2 hours; only 2 of those families wanted to proceed with organ donation. Despite the program failing in 1997 in Washington DC, the government funded the New York program.  

The Uniform Anatomical Gift Act, section 8e indicates that the lack of any expressed consent or refusal does not limit donation, the ultimate decision does not reside as an assumption of donation, but rather resides with the next of kin. That is, legally in the United States, donation must be through expressed consent; presumed consent is illegal  (other countries like Spain operate under presumed consent and so some research programs would be viable there). In the years that have passed since the Washington Program, the medical community has not come to a new understanding on the ethical issues and the Uniform Anatomical Gift Act still stands. The new funding does not specifically address these issues, but may jeopardize the decision rights of the next of kin. It is curious that with the same problems and a previously failed attempt why the government would throw millions of additional dollars chasing this experiment. 

A three part blog series will examine the New York program in terms of its deviations from medical and legal standards, discriminate population targeting, and involvement of dubious institutions.