Three years ago, Anthony Hoover woke up in a Kentucky hospital to find people shaving his chest, bathing his body in surgical solution and talking about harvesting his organs.
TJ was also registered as an organ donor. He was young and relatively healthy. His family heard from an organization then called Kentucky Organ Donor Affiliates, or KODA, about all the lives he could save as his was ending. They agreed that they should do as he wished and allow his organs to go to people in need.
On October 29, 2021, TJ was wheeled to the OR for the five-hour procedure. Less than two hours later, a staff member came to talk with his family.
“He’s not ready,” they said. “He woke up.”
TJ’s family thought it was a miracle.
But former employees of the organ procurement organization working on TJ’s case say it was a breach of trust – one called it a “disaster” — that a man who was making eye contact, shaking his head “no” and thrashing on the table should never have been in the operating room, that a man who left the hospital to live with family weeks later shouldn’t have been at risk of losing his life.
The hospital said in a statement that “the safety of our patients is always our highest priority. We work closely with our patients and their families to ensure our patients’ wishes for organ donation are followed.”
KODA, now known as Network for Hope since a merger with another organ procurement network, said it has reviewed the case and “remains confident that accepted practices and approved protocols were followed.” It also says the case has been “inaccurately represented,” including by “individuals never involved with this case.”
But disturbing details about TJ’s case — including allegations of pressure to harvest his organs despite signs that he was aware and resisting — recently prompted Kentucky’s attorney general to investigate whether criminal charges are warranted in this case. At the federal level, the Health Resources and Services Administration, through the Organ Procurement and Transplantation Network, is investigating, as well. A bipartisan congressional Oversight and Investigations Subcommittee that heard about the case this fall has also been looking into the incident.
And critics of the country’s organ procurement system say TJ’s story is not unique. Without major reform and oversight, they worry that it could happen again and that not all patients will be lucky enough to survive.
Honoring TJ’s wishes
By October 2021, TJ Hoover had struggled with anxiety, depression and post-traumatic stress disorder, his sister said. He had dropped out of high school years earlier, after he lost two brothers to drug addiction. At 16, he joined the Job Corps in search of a sense of purpose, but he could never shake memories of the dead bodies that he said he saw when he was sent to clean up after Hurricanes Katrina and Rita. Prescribed medications left him feeling like a zombie, she said, and made it difficult to work. Eventually, he turned to illicit drugs to help cope.
“Knowing what drugs did to his brothers, he would try to quit and was occasionally successful,” Rhorer said.
But not on the night of October 25, 2021. His mother had died months before, and that would have been her birthday. TJ went outside to load his car and was later found face-down on the pavement. He had overdosed.
When EMTs arrived, TJ had no pulse and wasn’t breathing. They performed CPR, shocked his heart and rushed him to nearby Baptist Health.
A scan in the emergency room revealed that TJ had brain damage, but doctors couldn’t say how serious it was because of swelling. TJ was transferred to the ICU.
“I felt like the doctor was doing everything he could,” said Rhorer, 48. She snapped photos and videos of her baby brother and eventually posted some on TikTok, hoping to show what a drug overdose could do to someone and deter others from the same fate.
At that point, hospital staff talked to the family about changing TJ’s status to Do Not Resuscitate, which would keep him from receiving CPR if his heart stopped beating or if he stopped breathing. With little change two days after the overdose, TJ’s family allowed it.
Rhorer said they expected health-care workers to come to remove life support, but instead, representatives from KODA arrived.
TJ’s name was on the organ donor registry, they told Rhorer. His organs could save multiple lives if his family would honor his wishes.
“Of course, if that were his wishes,” she told them.
About 170 million people in the US are signed up to donate organs when they die, but less than 1% of those who register can actually donate. Consequently, about 17 people in the United States die every day waiting for a transplant.
“If I lost my brother and eight people could live, then I felt like my brother wouldn’t die in vain,” Rhorer said later.
The medical records Rhorer has for TJ say he was “declared brain-dead patient being maintained for harvesting of organs” on October 29. TJ underwent procedures to make sure his organs were fit for donation, and that afternoon, hospital workers came to the family and told them it was time.
They held what’s known as an honor walk, a tradition in many hospitals when someone donates organs. A video shot by Rhorer’s friend and posted on TikTok shows TJ in a bed being rolled down a corridor. Hospital staff stop what they are doing, line the halls and stand in silence in their blue scrubs and white coats. Some hold tissues and dab at their eyes.
The walk pauses so TJ’s family can see him one more time. A man in a camo hat and flannel bends to kiss his forehead, and others lean forward to tell TJ they love him.
Although it’s hard to see TJ, a person in scrubs says reassuringly, “sometimes they do respond, with some reflexes,” and then asks them to stop filming out of respect for patient privacy. Notes from the case say that TJ’s eyes were open all the way down to the OR.
Everyone thought this was goodbye until a couple hours later, when they heard that TJ was awake.
A ‘beautiful mission’ when done right
After Nycki Martin put her five kids to bed, she usually studied for med school acceptance tests; she wants to be a surgeon. But one night in January 2024, she was winding down with TikTok instead. She had worked in organ procurement and was swiping through videos, looking for organ donor stories.
Organ donation, Martin said, is “such a beautiful mission and saved so many lives when it’s done right.”
She discovered a video of TJ’s honor walk. Over the video, the text said, “TJ Honor Walk But God!!” with a prayer emoji. The comments explained what “but God” meant: The patient had woken up.
“I was like ‘That sounds familiar; it must have happened to someone else,’ ” Martin said. It reminded her of a case she was aware of through her previous work at KODA.
Looking closer, she recognized people in the video and realized it was the same case.
“The family trusted everyone involved,” she said. “I just feel like there were so many opportunities for someone to step in and say, we’re not doing the right thing.”
She decided to message TJ’s sister.
Martin, who worked as a surgical preservationist for KODA for about a year, was not in the room when TJ was being prepped for surgery, but she had been heading to Richmond as staff relief. She said she got constant updates from people who were there, and they were upset that that patient was awake.
In those treatment records, an eyewitness account of a heart catheterization – ordered by KODA and performed at Baptist Health several hours before TJ’s organs were expected to be harvested – noted that TJ had “purposeful movement to pain” during the heart procedure. His eyes were “open and tracking,” and he was “thrashing around.”
According to the record, the cardiologist commented, “I am no neurologist, but if I would most certainly call this purposeful movement, and they should not have said that patient was not going to have a meaningful recovery with these reflexes.”
Instead of stopping the procedure, the cardiologist gave TJ a paralytic called rocuronium and sedated him further with midazolam and fentanyl so the test could be completed.
The record added that hospital staffers were “extremely uncomfortable with the amount of reflexes” and that some complained that “this was euthanasia.”
According to the record, the representative for KODA explained that “it was the families [sic] decision to terminally extubate the patient prior to KODA approaching for donation and this is another opportunity to donate still.”
Rhorer has hundreds of pages of TJ’s records printed from the hospital medical records department, and she keeps them in a binder that’s always close by. But she did not have this record, and she said they were never told what happened during the catheterization.
Rhorer learned more details after Martin got in touch with her. Martin also got in touch with a patient advocacy organization called Organize to tell them about TJ’s case, and she wrote a letter to Congress describing what happened.
Rhorer’s attorneys have requested all of TJ’s records from the hospital and from the organ procurement organization but said they have not received the ones from KODA.
When activists first read the catheterization record to Rohrer over the phone in September 2024, she sat at her kitchen table and cried. Had she fully understood that TJ wasn’t brain-dead and that he had woken up during the heart catheterization, she said, the family would have made a different choice.
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“We would never have sent him for his organs to be harvested,” she said.
There are circumstances in which a patient who isn’t brain-dead may still become an organ donor. It’s called donation after circulatory death, or DCD, and it has become much more common in recent years, although some experts question the ethics of the practice.
“The way DCD is supposed to work is, you’ve got somebody with essentially devastating illness or injury, and their families decided to withdraw life support,” explained Dr. Robert Cannon, an associate professor of surgery and surgical director of the liver transplant program at the University at Alabama Birmingham. Cannon did not work on TJ’s case but was familiar with it because he testified about lapses in the organ procurement system at the House Energy and Commerce Oversight and Investigations Subcommittee hearing where TJ’s case came to light.
“Certainly, we have potential DCD donors with lots of reflexes,” Cannon said. “But as long as the family knows this is what’s happening with their loved one, this process is considered ethical and standard.”
What isn’t ethical, he said, is undue pressure to continue. He has been in an operating room where a patient exhibited reflexes that suggested they were not brain-dead, but he says the organ procurement agency encouraged him to harvest the organs anyway. In that case, the procedure was stopped.
One person who was in the operating room for TJ’s case felt that it went too far.
‘Pushing, pushing, pushing’ to harvest organs
Natasha Miller was an organ perfusionist – the person who packages the organs after they’ve been removed – with KODA at the time of TJ’s case, although she no longer works for the organization. An hour ahead of TJ’s procedure, she was in the OR at Baptist Health to prep equipment and brief hospital staff on what to expect, especially with a DCD case, in which patients may open their eyes or move.
“It is very shocking for people who have never experienced it before,” she said.
As Miller headed to the hospital the day of TJ’s procedure, she got texts that questioned why the organ procurement was happening, since TJ seemed aware and resisting.
“No one was comfortable doing the case from the hospital,” she said. But KODA was “pushing, pushing, pushing to go.”
Miller and a trainee arrived at the hospital, where she said hospital staff was “very agitated.” She warned her trainee that “not everyone is pro-KODA.”
When Miller, an award-winning body builder and an unflappable former Marine, saw TJ for the first time, she could understand the concern. He thrashed around the entire time, and hospital staff was telling him to calm down.
“This was no ordinary movement,” Miller said. “He was very aware.”
Despite TJ’s agitation, the process continued. He was draped and shaved.
Miller said she noticed tears rolling down his face. He kept shaking his head as if to say no.
“I can’t even imagine, probably, the fear he felt,” Miller said.
In typical DCD cases, family and a doctor who is not from the organ procurement team are there for the patient’s final moments. The doctor removes the life-sustaining equipment and waits. Sometimes, it can take more than an hour for a patient to die. Once it’s clear that their heart is no longer beating, the family leaves.
The doctor waits another five minutes and listens to the heart and lungs, and only then does that doctor pronounce the patient dead. That’s when the procurement team gets to work.
In TJ’s case, it never got that far.
“The pronouncing physician, she comes in, takes one look at him and says, ‘No, I’m not doing this. He has way too much function,’” Miller said. The record activists say is from KODA said that the doctor felt this was “inhumane” and “unethical.”
The coordinator from KODA told the doctor she’d been trying to get the case shut down all day, Miller said.
Miller added that the KODA coordinator called her manager, who yelled and pushed to get another doctor to pronounce TJ dead. The coordinator was in tears, Miller said, and the doctor who was supposed to do the organ procurement was upset and left.
“It was just a disaster,” Miller said.
The procedure was stopped.
Miller said that as soon as the staff told TJ they’d take him back to the ICU, he calmed down.
“So that’s how we know he was very aware,” Miller said.
Survivor’s guilt
TJ spent the next few weeks at the hospital. Employees there suggested sending him to an out-of-state nursing home, but Rhorer took him to her home in Richmond instead.
Rhorer spent so much time caring for TJ, she lost her job as a restaurant manager. Instead, she made it her job to heal her brother.
Rhorer helped build TJ’s strength so much that he became fit for therapy, and he was able to walk his sister down the aisle at her wedding in May 2023.
TJ has challenges, including limited short-term memory, vision issues and balance problems. But he’s strong enough for physical therapy several times a week, and he still has a sense of humor. Admire his tattoos, and he’ll show two fists: Across his right knuckles, it says “Y’all,” and across his left, it says “suck.”
“We’re blessed, because he’s not supposed to be here,” Rhorer said. “He wasn’t supposed to make it a year, and he made it, and we’re three years in, and he’s thriving.”
When Rhorer talks to TJ about what happened at the hospital, he sometimes asks why people were trying to kill him. Other times, he expresses guilt that his organs didn’t save others.
“He has survivor’s guilt,” Rhorer said.
She believes that the family was misinformed about TJ’s condition and that people were dismissive of her brother. His humanity got lost, she said.
“He’s an overdose,” Rhorer said. “I think they saw organs where we saw a family member.
“To them, it was just their day job.”
She keeps dozens of painful images of TJ’s hospitalization in an album. She still posts videos on TikTok, knowing that her posts from 2021 helped piece together her brother’s story.
“I had no idea what I was getting myself into,” Rhorer said. Until she saw the TikTok message from Martin, she believed that her brother’s survival was a miracle that came at just the right moment. And a part of her still thinks this is a miracle.
On her back porch, there’s a bright blue chair with TJ’s handwritten initials and dates: his birth date, the day his heart stopped beating and the day doctors stopped the procedure that would have ended his life. On the seat of the chair is a Bible verse, John 11:25-26: “I am the resurrection, and the life: he that believeth in me, though he were dead, yet should live. And whomever liveth and believeth in me shall never die.”
Now, her determination to help TJ extends beyond the physical. She is telling their story so what happened to her baby brother doesn’t ever happen to anyone else.
“Organ donation is a beautiful thing,” Rhorer said. “What can you give somebody more precious than love? But at the same time, it shouldn’t be abused.”
Videos by Lacey Russell and Deborah Brunswick.