Kentucky law adds new safeguards to organ donation

A new Kentucky law mandating a "pause" before organ donation to assess any possible "indications of life" has taken effect. It was drafted after a man's organs were nearly harvested while he was still alive and aware of what was happening.

Key Takeaways:

• In 2021, Anthony Thomas ‘TJ’ Hoover II was admitted to Baptist Health Richmond in Kentucky for a cardiac arrest, and was eventually declared brain dead.

• During the "honor walk" for his organ procurement, he showed what appeared to be signs of awareness, but his family was told these signs were just meaningless reflexes.

• When taken into the operating room for the surgery, Hoover began moving around and crying, prompting several doctors to refuse to move forward with the organ procurement, even though the operating staff was instructed to continue with the surgery.

• Hoover's case prompted the passage of House Bill 510, which requires medical providers to stop the process of organ procurement if there is any sign of life.

The Backstory:

Donna Rhorer told WKYT that, in 2021, her brother — Hoover — was taken to the emergency room at Baptist Health Richmond. He had experienced a drug overdose and gone into cardiac arrest; he was soon declared brain dead. Hoover's family was told he was an organ donor, so they agreed to donation in honor of his wishes.

After testing his organs to see what was viable, he was taken on an "Honor Walk" — a tradition in organ harvesting when the donor is solemnly taken through a procession to the operating room, in which the hallways are lined with family members, loved ones, and medical staff, honoring the donor's gift of life.

Yet Hoover appeared to still be alive.

“We had his honor walk Friday afternoon. During his honor walk, his eyes started opening up," Rhorer said of her brother. "He was tracking. His eyes were tracking us around. We were told it was just reflexes, just a normal thing. Who are we to question the medical system?”

Yet Rhorer's instincts were correct, and she was proven right about the traumatizing procurement experience.

‘Brain-dead’ patient woke up in the OR. But a witness says an organ procurement group kept ‘pushing’

"He was crying visibly"

Natasha Miller, who works at the hospital as an organ preservationist for Kentucky Organ Donor Affiliates (KODA), was in the operating room when Hoover was brought in. She told NPR it was immediately evident something was wrong.

"He was moving around — kind of thrashing. Like, moving, thrashing around on the bed," Miller said. "And then when we went over there, you could see he had tears coming down. He was crying visibly."

Two doctors immediately refused to move forward with the organ procurement surgery, and Miller said the staff was extremely upset at what they had witnessed. Yet a supervisor for KODA allegedly pressured staff to continue, despite the clear signs of awareness from Hoover.

"[T]he coordinator calls the supervisor at the time," Miller said. "And she was saying that he was telling her that she needed to 'find another doctor to do it' – that, 'We were going to do this case. She needs to find someone else.' And she's like, 'There is no one else.' She's crying — the coordinator — because she's getting yelled at."

"It's very scary to me"

Several KODA workers allegedly quit over the incident, including another organ preservationist, Nyckoletta Martin. "I've dedicated my entire life to organ donation and transplant. It's very scary to me now that these things are allowed to happen and there's not more in place to protect donors," Martin said.

She noted that Hoover had shown signs of life long before he ever made it into the operating room, including during cardiac catheterization, in which the heart is tested to see if it is still viable.

"The donor had woken up during his procedure that morning for a cardiac catheterization. And he was thrashing around on the table," she said. Yet instead of stopping the organ donation process then, Hoover was sedated and staff moved forward.

"That's everybody's worst nightmare, right? Being alive during surgery and knowing that someone is going to cut you open and take your body parts out?" Martin said. "That's horrifying."

Hoover survived, and was released to Rhorer's care, though doctors said he wouldn't live long. He is still alive, though Rhorer has to care for him, as he has trouble with his memory, walking, and talking. The horrors of this case led directly to House Bill 510.

The Details:

On April 7, House Bill 510 was signed into law, and requires an immediate halt to any organ procurement if any "indication of life" is spotted. The legislation was introduced after a federal investigation into Hoover's case, and has the backing of Network for Hope, an organ donation provider for multiple states, including Kentucky.

The bill is extremely detailed in multiple areas, and defines "indication of life" this way:

"Indication of life" includes but is not limited to:

1. Spontaneous movement;

2. Vocalization or attempts to vocalize;

3. Purposeful or reflexive responses to stimuli;

4. Observed respiratory effort by a patient-initiated attempt at breath;

5. Changes in heart rate or blood pressure inconsistent with a death declaration; and

6. Any neurological or physiological sign suggesting pain perception or neurological activity;

The bill also notes:

A pause in procedure may be requested or initiated by any individual involved or present, including but not limited to:

1. Hospital physicians, nurses, or clinical staff;

2. Organ procurement organization personnel;

3. Transplant center personnel;

4. Members of the surgical or anesthesiology team; and

5. The patient’s spouse or legal representative.

It also specifies that "An individual shall not be penalized, disciplined, or retaliated against for requesting or initiating a pause in procedure."

Barry Massa, Network for Hope CEO, said in a statement:

“Organ donation is a remarkable and life-saving gift that allows thousands of individuals each year to receive life-sustaining transplants and offers hope to patients and families.

House Bill 510 highlights the importance of public trust, transparency, and ethical and clinical standards that prioritize patient safety and human dignity. These are goals Network for Hope shares.”

The organization said it had begun voluntarily implementing its own reforms in 2025, including neurological exams every 12 hours during the process of organ donation. Yet House Bill 510 goes beyond more testing.

The current standard

As Dr. Heidi Klessig, a retired anesthesiologist, explained on X, the new Kentucky law takes a stricter view of brain death than the current medical standard (emphases added):

Where the new Kentucky “pause in organ harvesting law” gets interesting is that it specifically lists things that may be considered to be an “indication of life.”

In the Bluegrass State, neurological death is defined under Kentucky Revised Statute (KRS) 446.400, which states there must be “a total and irreversible cessation of all brain function, including the brain stem.”

But the way most doctors diagnose brain death, the American Academy of Neurology (AAN) brain death guideline, explicitly allows death to be declared while parts of the brain are still working.

This disconnect between legal death and clinical practice has been flying under the radar for years, but Kentucky’s new legislation very effectively brings these discrepancies to light.

“Part of improving organ donation safety in the Commonwealth means strengthening existing safeguards to better protect organ donors,” Majority Whip Jason Nemes (R-Middletown) said. “Implementing a mandatory pause in the procedure process when changes in a patient’s medical status arise would further ensure organ donations are conducted responsibly and safely.”

The Bottom Line:

Organ donation is a beautiful, selfless sacrifice that allows someone else to receive the gift of life. However, those wishing to be organ donors deserve to know that they are safe to make such a decision, and that they will never end up in an operating room, crying and fighting for their life, as TJ Hoover did.