Whistleblower Pushes to Regulate Controversial Organ Retrieval Technique

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Daylight hadn’t yet broken, and the Chapel Hill operating room was buzzing. Nurses were opening tools and surgeons chatted while scrubbing in.

They were waiting for a 37-year-old man to die.

After a moment of honor, the clinical team withdrew life support as transplant surgeons lingered in a neighboring room. After his heart stopped, everyone waited another five minutes to make sure it didn’t naturally restart before the transplant team dove in. 

The heart surgeons were hustling. Every minute counts when organs are deprived of oxygen. Claire Morgan, another surgeon, was there for the kidneys.

She remembers feeling curious and comfortable. The heart surgeons from Vanderbilt Health in Tennessee were skilled and eager to demonstrate a new organ procurement technique. Morgan, who was working for the organ procurement organization HonorBridge, believes it was the first time the procedure had been used in North Carolina, and she was keen to learn more.

Called normothermic regional perfusion, or NRP, the technique involves hooking an organ donor up to equipment that enriches blood with oxygen. This machinery was designed to save patients’ lives, but for an organ donor, it can be used to restore blood flow into their torso. The apparatus prompts the donor’s heart to pump again and sends fresh blood to the organs, effectively reversing damage caused by death.

The donor remained on the machinery for more than an hour, until the surgeons felt his organs were rejuvenated. The Vanderbilt team retrieved the heart and rushed to catch a flight. Then it was Morgan’s turn to retrieve the kidneys, which can withstand a longer time between bodies.

Team members tidied up and chatted, remarking on how smoothly things had gone. Morgan remembers a donation coordinator, a role that assists and has less medical training, excitedly telling her that the donor had great blood pressure throughout. 

“What do you mean?” said Morgan, a surgeon for more than 20 years. “What blood pressure?”

That’s when she realized that the arteries that supplied blood to the donor’s brain might not have been entirely blocked.

She looked back at the donor, sliced open and emptied out, and was horrified. Could he have regained some level of consciousness? There is no proof that happened, but there’s no evidence it didn’t, either.

Typical NRP protocol involves clamping specific blood vessels in the heart that deliver blood to the brain before turning on the oxygenating machinery. Though the intervention isn’t codified nationally, nearly all experts agree that blood to the brain should be stopped so there’s no possibility that the donor regains brain function.

Morgan believes it’s possible that not all of the necessary vessels were clamped in this case; a steady blood pressure reading would indicate the donor had at least partial, if not full, blood flow to his brain for over an hour.

“We do have work instructions and our staff did not use them,” Kimberly Koontz, the chief operating officer of HonorBridge, wrote to her in a 2021 email after she raised concerns about the retrieval. 

The case haunted Morgan. Then, she says, there were two more like it where surgeons allowed blood to flow into donors’ brains while collecting their organs.

Morgan shared a trove of emails, notes, and redacted medical records with The Assembly, documenting the cases and her attempts to raise concerns. 

HonorBridge is North Carolina’s largest organ procurement organization. Chuck Heald, its spokesperson, declined to answer specific questions about the cases, citing donor privacy. He said the organization’s top priority is donor safety, and it constantly reviews its practices and procedures to align with the latest ethical standards and scientific advancements.

“We immediately and systematically review and address any concerns according to established policy, whether those concerns are raised by employees, contractors, transplant partners, or members of the public,” he said in a statement. 

Vanderbilt Health declined to comment.

Exasperated by the repeated incidents and her belief that HonorBridge hadn’t done enough, Morgan filed complaints to federal regulators and the national transplant network in 2024. The Assembly is the first media outlet to report on her complaints.

Morgan’s reports triggered a drafting of NRP policies that is ongoing. She and others hope to establish written national protocols for what has been an unregulated procedure. Surgeons could be required to clamp and cut blood vessels to prevent blood flow to the brain, verify the clamping with a second observer, and monitor brain activity. 

Much of the debate around NRP has centered on philosophical questions of the nature of death, and whether a person declared dead could regain some level of consciousness.

Allegations from a credible witness like Morgan make the questions less abstract, and have challenged the transplant community’s ethos at an already delicate time. Demand for organs has fueled the adoption of new technology, but has introduced ethical trade-offs where opinions sharply divide. 

“The way NRP developed in the U.S. was just careless,” Morgan said. “It was hubris and carelessness.” 

Waiting For an Organ

U.S. surgeons began experimenting with NRP in the mid-2000s, but the wave of rapid adoption started in 2020 after a team at NYU Langone Health pioneered the method for organ transplants. 

It has spread briskly. Most procurement organizations across the country have tried it as a way to address the organ shortage crisis. Thirteen people in the U.S. die every day waiting for an organ, and more than 103,000 are on the waitlist. 

NRP is cheaper than using equipment capable of restoring blood flow after an organ has been removed. It relies on equipment most advanced hospitals already have: an extracorporeal membrane oxygenation machine, or ECMO. Surgical teams can quickly learn how to use ECMO to obtain organs. That immediately expands the potential donor pool, allowing surgeons to appraise organs they would have otherwise ruled out due to age or condition.

“NRP for us has completely changed the game,” said Giuliano Testa, abdominal transplant chief at Baylor University Medical Center. “Now we’re looking at a 70, 75-year-old donor that nobody would ever consider before.”

Organs harvested using the technique are considered higher quality than those that have been deprived of oxygen. Recipients have seen a greater quality of life. But the relatively new procedure is unregulated—one of many points of contention that surround it.

Only half of the 49 procurement organizations using NRP as of 2023 had adopted protocols for the procedure, according to the most recent data collected by a group of transplant researchers. 

“NRP for us has completely changed the game. Now we’re looking at a 70, 75-year-old donor that nobody would ever consider before.”

Giuliano Testa, Baylor abdominal transplant chief

Several jurisdictions don’t allow it. In the U.S., some hospitals and at least one organ group ban a version of NRP that includes procuring the heart and abdominal organs; this type is also limited or restricted in Canada, Australia, New Zealand, the United Kingdom, and Belgium. Another, less controversial version of NRP is only used to retrieve abdominal organs. 

While much of the concern is existential, some is legal. 

U.S. lawmakers codified the concept of death in 1981 to allow the budding practice of transplantation to expand. Collecting organs from donors who died from circulatory death—whose brains may still retain some function but face imminent demise—was once considered taboo. But technological advancements and shifting norms have caused this kind of donation to soar.

Last year, the number of donors from circulatory death nearly matched the number of donors who suffered brain death nationwide. 

The organs from circulatory death donors endure damage from oxygen deprivation; they are not as pristine as those from brain-dead donors, but can still be transplanted. NRP refreshes these organs. 

The Uniform Determination of Death Act established criteria for these kinds of donors, defining death after the “irreversible” cessation of breathing and a pulse. 

Dartmouth College neuroscientist James Bernat’s research was used to create the 1981 law. He and other researchers believe NRP doesn’t align with current laws since it restarts the heart after a person has already been declared dead. 

Bernat argues that death declaration laws should be adjusted to allow NRP. Still, he has reservations about the procedure because there isn’t a large body of research establishing that clamping the main arteries to the brain stops blood flow. He says more research is necessary.

Testing to determine brain death can be inaccurate, Bernat said, and scientists don’t know exactly where the threshold is. “It’s conceivable that a small amount of blood flow may be enough to keep the brainstem functioning at some level,” Bernat said. “I think it’s unlikely, but I worry about it.”

There is no formal data on how often the procedure is used in the U.S. In recent years, research suggests there have likely been thousands of cases.

Organizations that collect organs aren’t required to report adverse events related to NRP, so it’s difficult to determine how often surgeons make mistakes or whether there are more complaints like Morgan’s. 

Some stakeholders are gravely concerned by the incidents. Others, like Testa, the Baylor transplant chief, call the worries “science fiction.” While he supports stopping blood flow to the brain, he isn’t convinced that in the remote event that clamping doesn’t occur properly, that an “electrical blip” could equate to consciousness. 

“Nobody has ever returned from the dead to tell us,” he said. If he were a donor and a little blood escaped the clamp, he said, “I don’t give a damn whether I have a blip in my brain.” 

Two More Cases

Some stakeholders worry Morgan’s complaint could jeopardize their ability to use NRP. If the public learns of troubling details from fringe cases, some fear it could imperil the industry at a critical nexus. But Morgan felt the stakes were too high. 

The second case she witnessed, in March 2024 at Wake Forest Baptist in Winston-Salem, involved a surgical team from NYU Langone Health. Morgan said a junior-level surgeon who called her to debrief afterward told her he was “fairly sure” the senior surgeon had missed clamping an artery to the brain.

Six months later, in September 2024, she says she witnessed a third incident at Greensboro’s Moses Cone Memorial, led by a then-ECU Health surgeon. Morgan says the surgeon became irate and started slamming things when she confronted him after observing that he missed clamping a key artery to the donor’s brain. 

She called that “a catastrophic failure” in an email the next day to the HonorBridge executive team. “If I could have walked out of the [operating room], I would have, but it would have then injured a second person,” Morgan wrote, referring to the donor and the recipient. 

The Assembly reached out to NYU four times to get a response to Morgan’s allegations, but NYU did not respond. Through a representative, the former ECU surgeon declined to comment. 

Morgan filed her complaints with the Department of Health and Human Services (DHHS) and the Organ Procurement and Transplantation Network, which both oversee transplant activities, in September 2024. After a network lawyer initially told her she’d receive no further updates, she spent several days sending emails, making phone calls, and threatening to reach out to the media. 

“This situation is intolerable and cannot be dealt with over the usual timeframe,” she wrote to a network compliance and safety investigator. “I have no way of knowing how often what I have seen is occurring in other operating rooms.”

She later reached out to Richard Formica, then president of the network.

Formica asked Morgan where she was in her career; Morgan interpreted this as a threat. In a statement, Formica said he was asking out of concern to protect Morgan’s best interests and anonymity, and shared emails showing she had thanked him for his advice in trying to navigate the situation. 

“I have no way of knowing how often what I have seen is occurring in other operating rooms.”

September 2024 email from Claire Morgan to a network compliance and safety investigator

After several more calls and terse emails, Morgan finally received confirmation from DHHS that her complaint had been received. Two days later, the transplant network’s executive committee, led by Formica, directed its operations and safety committee to develop NRP policies, according to meeting minutes and letters to DHHS. That committee is chaired by Koontz, HonorBridge’s chief operating officer, who has just been promoted to chief executive officer starting next month.

Morgan was dismayed. The group charged with crafting policy to prevent possible lapses like the ones she reported would be led by someone who, in her view, failed to prevent those very incidents. 

In a statement, HonorBridge spokesman Heald said neither Koontz nor her committee was tasked with reviewing Morgan’s complaint. “The allegations have followed the proper oversight channels, and no adverse action was issued,” he said.

Network leaders directed The Assembly’s inquiries to DHHS. A DHHS spokesperson said the department took Morgan’s concerns seriously and immediately directed the network to review its policies. 

Within days of receiving Morgan’s complaint, DHHS officials sent a letter to Formica demanding that the transplant network turn over its NRP data and all related materials.

In November 2025, the network sent an NRP safety notice to all organ procurement organizations noting “verified” but “extremely rare” cases of unintended restored blood flow to donors’ brains. The network asked the organizations to review their NRP protocols to align with its recommendations and to report any incidents. 

Next month, the network’s board is expected to review draft NRP policies for the first time.

Addressing the pace of progress for the network’s top initiatives at last month’s board meeting, John Magee, the current network president, asked for patience. “We all signed up because we supported change,” he said. “And change is a process that often moves slower than we wish.”

Policing Itself

Morgan dropped a hornet’s nest on the national organ transplant system when it was already under pressure.

The Organ Procurement and Transplantation Network, a quasi-governmental agency that oversees the system, relied on a single contractor for 40 years to run the network and connect donors and recipients. But in 2023, Congress forced a breakup to allow multiple vendors. Last summer, regulators replaced the network’s entire board. 

The organization is undergoing a painful modernization process as federal regulators wrestle back control. Shaping NRP policy is one item on an already stacked plate.

“It’s important to recognize we’re in the midst of a fundamental transition in the way we do things,” Magee said in a board meeting last month. 

The network, which has been hammered by accusations of self-interest, shapes policy for the nation’s 55 organ procurement organizations. DHHS outsources its policymaking to the network, a job many argue it hasn’t done well.

“We’re in the midst of a fundamental transition in the way we do things.”

John Magee, Organ Procurement and Transplantation Network board president

“Expecting the system to police itself simply did not work,” Seth Karp, a former network board member and the director of Vanderbilt’s transplant center, told lawmakers at a congressional committee hearing in December.

Jerry Mande worked for then-U.S. Sen. Al Gore and helped write the law that created the transplant system in 1984. 

The public-private partnership arose as a compromise. But it evolved to be governed by a self-interested board, Mande said, straying from the law’s original intent. Most board members are affiliated with organ procurement organizations or transplant hospitals. 

“We’ve ended up with a system dominated by conflicts of interest that we sought to prevent,” he said. “That needs to change.” (Mande, a current member of the overhauled board, declined to comment on current policies before the board.) 

Decades later, Congress has taken a renewed and bipartisan interest in the system. 

Lawmakers’ focus has been on the living—rare cases of would-be donors waking up or showing signs of distress during a transplant. But Morgan’s concern for the dead recently caught the attention of Sen. Charles Grassley, the Senate’s most senior Republican, and Sen. Ron Wyden, the highest-ranking Democrat on the Senate Finance Committee.

In a July 2025 letter to U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., who oversees the transplant network, the lawmakers said they had concerns with NRP and cited Morgan’s federal complaint.

Earlier this month, the senators again wrote to health department officials, this time related to allegations that the transplant network’s previous contractor “deleted or modified” patient safety records.

“Americans expect the organ donation system to deliver life-saving organs to patients in a manner that prioritizes safety and accuracy above all else,” Wyden said in a statement to The Assembly. “Too often in recent history the system has failed American patients and their families.” He wants to bolster federal oversight and enforcement.

Some organ procurement groups, including HonorBridge, say federal regulators have gone too far. The groups are suing the government over new performance-based metrics slated to take effect this summer. Under the new metrics, HonorBridge could be decertified. 

Blaming the System

Morgan found the lack of urgency among network leaders bewildering, and says they never investigated the cases she reported. She asked those in charge to institute a moratorium on NRP until the transplant network imposes policies.

“I wasn’t actually blaming people,” she said. “I was blaming the system.”

Procurement procedures often fall on junior-level surgeons, Morgan said, who are under pressure to obtain a usable organ. “The surgeons may not know they’ve done anything wrong,” she said. Without brain monitoring and a more senior-level surgeon present—or even anyone required to double-check their work—Morgan argues no one will know if they erred.

While some stakeholders advocate for pausing the procedure to wait for more robust research to prove its safety, many argue that avoiding NRP is an ethical choice, too. People are dying while waiting for organs, the donors in question already signed up on the registry, and they have a near-zero chance of survival.

Just one donor could save up to eight lives. 

Charles Strom, chief of surgical services for New England Donor Services and a board member of the Association of Organ Procurement Organizations, specializes in the less controversial version of NRP that excludes the heart. His regional service area, which covers five New England states and part of Vermont, is among the few in the U.S. that does not allow NRP heart retrieval out of legal concern. He personally supports both types of NRP and efforts to standardize procedures.

Before procuring organs, he’s had nurses and technicians express discomfort. He’s drawn diagrams to illustrate how he ensures donors are dead and blood flow stays where it’s supposed to. “I think people who have concerns about NRP, it’s not malice,” he said. “More than anything, it’s a lack of understanding.”

Strom used to operate on transplant recipients, and what he remembers most is calling patients to say an organ was ready for them. A donor sharing their organs is “an incredibly altruistic, powerful thing,” he said. He believes adverse incidents are “beyond rare.”

“When you’re in the OR … and you can see with your eyes and feel with your hands how above-board everything is,” he said, “it really informs your decision making and your belief structure.”

A Shrinking Donor Pool

One of the nation’s leading medical groups, the American College of Physicians, came out early and strongly against NRP. Matthew DeCamp, a physician, bioethicist, and co-author of the group’s NRP position statements, said discussions around the procedure must be brought into the public sphere. 

“There is a place in medical practice for surgical innovation,” he said. “It just happens that, in this case, the types of innovations that are being pursued appear to contravene fundamental ethical issues.”

Network officials have debated whether and to what extent organ coordinators should disclose details about NRP and its potential risks to donors’ families. The Association of Organ Procurement Organizations opposes any uniform NRP disclosure requirement, but supports families receiving transparent answers to any questions they may ask. 

Debra Sudan, a council member for the American Society of Transplant Surgeons and division chief for Duke University’s abdominal transplant program, said that could cause families distress in an already difficult moment. 

“To get into the nitty gritty of, you’re going to have a cannula here and a catheter there, and we’re going to cut like this, I mean, that’s too gruesome for some families,” she said. “It’s a terrible time for them. And this is some level of hope.”

Because a donor has already signed up through the registry, Sudan said it’s up to clinicians to honor that decision using the techniques they have available. But even those who support the procedure have raised issues around consent. 

“It’s a terrible time for them. And this is some level of hope.”

Debra Sudan, Duke abdominal transplant chief

Testa, the Baylor transplant chief, said the field has evolved rapidly in the decades since the question of donation arose in DMV offices across the country. He said he would sleep better if, rather than just checking a box at the DMV, donors fully understood what they were signing up for. 

“What kind of consent is that?” he said. “It’s not consent. Bullshit.”

As the industry faces its reckoning, the donor pool appears to be shrinking. Tiffianna Elmore, the director of programs and partnerships at Donate Life North Carolina, the nonprofit that manages the organ registry, said the group has seen a decrease in sign-ups and an uptick in people removing themselves from the registry. 

The troubles started in July, Elmore said, after the New York Times reported on cases of premature retrieval attempts. “We had hundreds of people contact us directly to be removed from the registry,” she said. “Disinformation on social media has really damaged public trust in the system.”

In January, 52% of people getting a license, permit, or identification card at the North Carolina DMV agreed to organ donation, lower than the pre-pandemic acceptance rate of nearly 57%. Young drivers—16 and 17 years old—have the lowest registration rate at 37%, Elmore said; this group was previously the highest, at 56% in 2019. 

‘I Called All the People’

At work, Morgan is immersed in death. But at home, she’s surrounded by life. 

From her farm in Greenville, North Carolina, Morgan tends to her massive Kangal dog, various ducks, chickens, and 28 goats—which she can mostly name. Having all these animals wasn’t the plan; they just kept making babies. 

For someone who was raised in Manhattan, running a farm in the South also wasn’t in the stars. “I don’t at all believe that God is sitting here moving me around on a chessboard,” Morgan said. “But I do find that things sort of open up in a direction for you. I was looking for two acres, and found 50.”

When Morgan first filed her federal complaint, she was prepared to never work in the field again. But she’s since found a contract job working as a transplant surgeon for another organization, and still avoids NRP cases.

“Somebody is going to get sued over this, and it’s not going to be me,” she said. 

In her quest to regulate NRP, Morgan cast a wide net, contacting anyone in the field who would hear her out. Looking back, she feels silly that she thought people would be grateful for her diligence. 

“It’s so dumb. I called all the people! I told them something bad was happening!” she said, mocking her own naïveté. Still, she can’t grasp why people aren’t taking the concerns as seriously as she is. “How do you stand by knowing this? Do I have a strong, self-righteous streak? Sure, probably.” 

Morgan has told close friends and family they should stay on the donor registry. In the unfortunate event they become donors, she said she knows what to do to ensure things are done right. 

As for Morgan, there’s no longer a heart on her license.