"Killed for Organs?" Update

The terrible story of the physician indicted for allegedly attempting to hasten the death of a disabled dying patient named Ruben Navarro in order to be able to harvest his organs—about which I first wrote a few days ago— is being fleshed out by the local media. As I suspected, the case involved a “non heart beating cadaver organ donor” protocol, and the problem may have arisen from inadequate training or experience. From the story in the San Luis Obispo Tribune:

The following details are included in the San Luis Obispo police report that The Tribune received Friday.

- Before the transplant team arrived at Sierra Vista, Navarro’s intensive care doctor wrote in his patient’s chart and notified a transplant nurse that Navarro was not a good candidate for organ donation because he would not die in the short time frame necessary for donation.

- Only two of the 11 people caring for Navarro that night had experience with the specialized donation procedure to be used in his case. And each had done it only once.

- Three physicians reviewed Navarro’s medical charts and determined the doses of narcotics given to Navarro were excessive and given to hasten his death.

- From his arrival at the hospital, Roozrokh took over Navarro’s care when he should not have seen him before he was declared dead by a Sierra Vista doctor.

The patient was apparently not appropriate as an organ donor in this protocol because to qualify, he or she must expire within 30 minutes of removing life support. Yet:

Dr. Erik Shultz, who attended to Navarro in the days leading up to his death, told investigators that Navarro wouldn’t have felt pain when his breathing tube was removed so the substantial amounts of painkillers given to him wouldn’t be necessary. Shultz also said he knew Navarro would not die immediately after being removed from a ventilator, or breathing machine, because he had already tried it days prior for a few minutes and Navarro continued to breathe, making him a poor organ donor candidate.

The story details what appears to be a massive overdose of morphine ordered by an organ procurement doctor (the defendant Hootan Roozrokh), who was not even supposed to be in the room until the patient is declared dead by his own doctor, and is certainly not to have anything to do with directing his care.

One has to wonder whether some of the medical personnel still considered Navarro to be a living person:

Operating nurse Jennifer Endsley told investigators the events in the operating room that night disturbed her. She said she questioned more than once why nurse Stevens was giving Navarro medications, but was ignored. After Navarro’s organs were deemed unfit for donation, Endsley said the transplant team left, leaving her and Tracy to clean up. Navarro was “frothing from the mouth and shivering,” she said.

There’s much more, too much to put into a readable entry. But this seems clear: There was inadequate training received among the personnel involved in this botched organ procurement. And second, it would appear that some of the physicians and staff acted as if crucial ethical requirements were mere suggestions. A crime may or may not have been committed here, but the organ transplant community needs to ensure adequate training and uniform national standards if such travesties are to be avoided in the future.