Close Calls and Skipped Lines: The Fraught State of Organ Donation

Summary

Close Calls and Skipped Lines: The Fraught State of Organ Donation

Podcast: The Daily
Host: Michael Barbaro
Guest: Brian Rosenthal, Investigative Reporter
Release Date: July 30, 2025

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Introduction to the Investigation

In this episode of The Daily, host Michael Barbaro engages in a deep-dive conversation with investigative reporter Brian Rosenthal about his extensive investigation into the organ transplant system in the United States. Rosenthal uncovers significant issues within the system that jeopardize donor safety and challenge the fairness of organ allocation.

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The Genesis of the Investigation

Rosenthal’s inquiry began with a "vague suggestion" to examine the organ transplant system, which was not previously on his radar.

Brian Rosenthal [01:27]: “It began when I got a vague suggestion from a source that I should look into the organ transplant system.”

Attending the American Transplant Congress in Philadelphia provided Rosenthal with the initial insights that propelled his investigation. A particularly alarming panel discussion revealed critical flaws within the system.

Rosenthal [02:11]: “One panelist was talking about how we violated trust in the system. We violated transparency. She said we have a system in chaos.”

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Government Pressure to Increase Organ Transplants

A pivotal element of Rosenthal’s findings is the substantial pressure exerted by the federal government to escalate the number of organ transplants. This push originated from President Trump's administration, particularly under Health Secretary Alex Azar, whose personal connection to the issue influenced policy reforms.

Rosenthal [04:00]: “The government, under President Trump's first administration, really tried to tackle that problem by pushing the system to recover more organs and coordinate more transplants.”

Azar and Trump implemented stringent measures, including threatening organ procurement organizations (OPOs) with the loss of their contracts if they failed to meet increased transplant quotas. This coercive approach aimed to address the longstanding issue of over 100,000 Americans awaiting transplants.

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Understanding the Organ Procurement Process

OPOs are nonprofit entities responsible for identifying potential organ donors, typically patients nearing death due to reasons like overdoses or accidents. There are two primary pathways for organ donation:

1. Donation after Brain Death (DBD): The most common and straightforward method, where donors are declared brain dead, and organs are preserved on machines until transplantation.

2. Donation after Circulatory Death (DCD): A more complex process where life support is withdrawn, and organs are harvested after the heart stops beating.

Rosenthal [05:35]: “There are these organ procurement organizations that I mentioned. They are nonprofit groups that exist in every state, and they have employees in hospitals basically looking for people who are dying and might be candidates to donate their organs.”

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Donation after Circulatory Death vs. Donation after Brain Death

The Trump administration's reforms significantly increased the use of DCD, tripling its prevalence. While this approach has enabled around 40,000 additional transplants, it introduces greater ambiguity and risk.

Rosenthal [07:58]: “There has been a huge increase in donation after circulatory death since these regulations came into effect. Usage has tripled.”

DCD requires careful determination that a patient will not recover, a judgment that can be subjective and prone to error. Rosenthal highlights cases where patients showed signs of recovery during the DCD process, nearly leading to the withdrawal of life support prematurely.

Rosenthal [08:55]: “Donation of circulatory death is just much less black and white than donation after brain death.”

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Risks to Donors: Near-Misses and Misjudgments

Rosenthal discusses alarming instances where patients, presumed to be dying, display signs of life moments before organ retrieval, risking premature withdrawal of life support.

Rosenthal [09:01]: “...one of the doctors said that they were not comfortable moving forward, and she put her foot down, and the patient was returned to his hospital room, where, unexpectedly, he recovered.”

An investigation in Kentucky revealed 73 out of 350 cases where plans to retrieve organs were halted too late, as recovery signs were initially overlooked.

Rosenthal [11:25]: “...73 of those cases, they stopped at the last minute. But they should have stopped much sooner because the patient was showing signs of regaining consciousness sooner, and those signs were initially ignored.”

This pattern suggests systemic issues where healthcare professionals may prioritize organ retrieval over patient well-being due to regulatory pressures.

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Fairness in Organ Allocation

Beyond safety concerns, Rosenthal uncovers that governmental pressure has compromised the fairness of organ distribution. The traditional, algorithm-driven process aims to allocate organs based on factors like waiting time and severity of illness, ensuring equitable distribution.

Rosenthal [17:07]: “It's an algorithm, and the biggest factors are how long you've been waiting and how sick you are.”

However, the introduction of "out of sequence allocation" allows OPOs to bypass the established list, favoring relationships with certain hospitals. This shift undermines the fairness and transparency of the system.

Rosenthal [18:33]: “They have come up with a new plan called out of sequence allocation, which is when they simply call up a hospital that they have a relationship with and say, hey, we have an organ. You can put it into any one of your patients.”

Since 2020, nearly 20% of organs have been allocated out of sequence, a stark increase from 3%.

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Case Study: Marcus's Story

A poignant example Rosenthal shares is that of Marcus, a Michigan teenager with chronic kidney issues. Despite being high on the transplant list, an available kidney was diverted to a less needy patient due to OPO's out-of-sequence practices.

Rosenthal [19:44]: “They ended up putting the kidney into a patient who had only been waiting for a few months. They were number 3,558 on the list.”

This decision was justified by the OPO based on the kidney's location and viability window, yet logistics made the transfer to Marcus feasible.

Rosenthal [21:18]: “Illinois is not that far away from Michigan. The kidney had only been outside the body for about nine or 10 hours at that point, and kidneys remain viable for up to 48 hours.”

Marcus eventually received a transplant, but with a less compatible kidney, highlighting the tangible human cost of these systemic issues.

Rosenthal [23:00]: “He did get a kidney, but it was not as good of a kidney... it's not really functioning at all. And he is gonna have to get back on the transplant list and wait for a new one.”

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Federal Response and Legislative Actions

In response to Rosenthal’s findings, the Trump administration has begun addressing these critical issues. Measures include:

• Cracking Down on Out-of-Sequence Allocation: Immediate acknowledgment of line-skipping as a significant problem, prompting policies aimed at reinstating fairness in organ distribution.

• Revising DCD Guidelines: New nationwide guidelines to regulate the increasingly aggressive procurement practices associated with DCD.

Furthermore, Congress has shown bipartisan support for these reforms, with recent hearings referencing Rosenthal's investigative report to push for comprehensive system overhauls.

Rosenthal [26:13]: “...they have cracked down on the procurement organization in Kentucky, and they have ordered the transplant system to write new guidelines around donation after circulatory death nationwide.”

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Conclusion: The Future of Organ Donation Systems

While Rosenthal acknowledges the noble intent behind organ donation and the lifesaving nature of the system, he emphasizes the urgent need for reforms to ensure donor safety and equitable organ allocation.

Rosenthal [28:28]: “This is a system that saves thousands of lives every year. But... the system is also under strain.”

He remains optimistic that bipartisan support and ongoing legislative efforts can rectify the identified flaws, honoring the invaluable gift of organ donation while safeguarding human lives.

Rosenthal [28:35]: “This is what everybody wants is to honor that tremendous gift of organ donation.”

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Implications for Organ Donors and Recipients

The revelations from Rosenthal’s investigation prompt critical reflection on trust in the organ donation system. While the process remains fundamentally life-saving, the uncovered issues necessitate vigilance and advocacy for systemic improvements to preserve both fairness and the integrity of organ transplantation.

Michael Barbaro [28:21]: “We have entrusted ourselves, our organs... to this system that you have been investigating. So should what you have found here change how we think about that decision? Being an organ donor?”

Rosenthal [28:28]: “...it seems like this is a rare issue where there is bipartisan support toward the idea that something needs to be done.”

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This comprehensive investigation by Brian Rosenthal sheds light on the complex and often troubled landscape of organ donation in the United States, urging stakeholders and the public alike to advocate for necessary reforms to uphold the sanctity and fairness of this critical system.

Transcript

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[Michael Barbaro]

From the New York Times, I'm Michael Balbaro. This is the Daily. A major investigation from the Times has found that government pressure to perform more and more organ transplants is creating greater risk for donors and threatening the overall fairness of the system. Today, my calling investigative reporter Brian Rosenthal on what he's uncovered. It's Wednesday, July 30th. Brian, thank you for coming into the studio.

[Brian Rosenthal]

Thanks for having me.

[Michael Barbaro]

Tell us about how this investigation that.

[Brian Rosenthal]

You have now been up to for.

[Michael Barbaro]

Many, many months began.

[Brian Rosenthal]

So it began when I got a vague suggestion from a source that I should look into the organ transplant system.

[Michael Barbaro]

Something presumably not on your radar.

[Brian Rosenthal]

Not at all. And so I ended up going to this conference, the American Transplant Congress, in Philadelphia last summer. And it was a gathering of thousands of doctors and researchers talking about all aspects of the transplant system. You know, these conferences are not the most exciting events in the world. It was a lot of minutiae, a lot of technical terms. But then I attended one panel that really stuck with me.

[Michael Barbaro]

Why?

[Brian Rosenthal]

The panelists were speaking in really stark terms about the dramatic failings of the transplant system. One panelist was talking about how we violated trust in the system. We violated transparency. She said we have a system in chaos. And I wanted to learn what that was about.

[Michael Barbaro]

Right. That's a pretty damning assessment of a system that I think most of us from a distance, think of as very noble.

[Brian Rosenthal]

Exactly. So I started to investigate. I ended up embedding with two organ procurement organizations. These are the organizations that coordinate transplants. And I saw a lot of good things. The transplant system performs thousands of life saving transplants every year. But pretty quickly I also started hearing about problems in the system, problems with both how we obtain organs and how we allocate them to recipients who need transplants.

[Michael Barbaro]

Hmm. So at both ends, basically, of the system, the beginning and the end.

[Brian Rosenthal]

That's right. And in short, I learned that there are significant problems with how patients who donate their organs are treated and, and also problems with the fairness of how organs are allocated to recipients. And I came to understand that these problems were linked.

[Michael Barbaro]

How so?

[Brian Rosenthal]

Well, both problems Come back to a push in the transplant system to increase the number of transplants.

[Michael Barbaro]

And who's making that push?

[Brian Rosenthal]

The government.

[Michael Barbaro]

Okay.

[Brian Rosenthal]

It all started with an executive order that was issued by President Trump back in 2019.

[Michael Barbaro]

So in his first term.

[Brian Rosenthal]

That's right. So for years, there has been a long waiting list. There are more than 100,000Americans right now who need a transplant. And so the government, under President Trump's first administration, really tried to tackle that problem by pushing the system to recover more organs and coordinate more transplants, do better, do more. Correct. And one of the biggest proponents of reforming the system was Trump's health secretary, Alex Azar. This was personal to him. His father had been waiting for a kidney, and he had seen the system as being insufficient. And so he and President Trump ordered a number of reforms. And the big one was a really explicit threat to the. The organ procurement organizations which arrange all these transplants, saying that if you do not increase the number of transplants, you are going to lose your contract. You're not going to be able to work in this space anymore.

[Michael Barbaro]

Wow.

[Brian Rosenthal]

Yeah. It was a very direct threat to the existence of these groups. And so they reacted by becoming much more aggressive in pursuing organs and coordinating transplants.

[Michael Barbaro]

So help me understand how the government's desire to kick this system into higher gear and ultimately, of course, save more lives, how that starts to do the two things that you described a bit earlier. And let's start with the getting of the organ, since it comes first in the process.

[Brian Rosenthal]

So let me explain how the system works, please. There are these organ procurement organizations that I mentioned. They are nonprofit groups that exist in every state, and they have employees in hospitals basically looking for people who are dying and might be candidates to donate their organs. So people who have been shooting victims or drug overdose victims or motor vehicle crashes who are in the hospital, who are nearing death, the organ procurement organizations are going to try to pursue their organs. And there are basically two different ways that they can do that. The normal way, the way that happens more often, is when the patient becomes brain dead. This is a patient who has lost all functioning in their brain permanently. It's irreversible. It's confirmed by scientific tests. And the organ procurement organizations can keep their organs viable on machines until they're ready for a transplant. But that is really the extent of what happens in that case, is that.

[Michael Barbaro]

The most common form of death, at which point organs are harvested, it's the.

[Brian Rosenthal]

Most common form of donation. And it used to be the only form of donation.

[Michael Barbaro]

Okay.

[Brian Rosenthal]

But more recently, and especially after this executive order, there has been a growing use of another type of organ donation called donation after circulatory death.

[Michael Barbaro]

Donation after circulatory death. And what is that? How is it different from getting an organ when someone's brain dead?

[Brian Rosenthal]

It's a totally different process. So usually the patient is in a coma, they have some level of brain activity, but a doctor has determined that they will never be able to survive without life support. And so the family can authorize the withdrawal of life support in order to donate organs. And, and if that happens, the patient is taken to an operating room, the life support is withdrawn, they wait for the patient's heart to stop, which means they have died by circulatory death. And then after that, they remove the organs.

[Michael Barbaro]

So how has this effort from the federal government to get more organs and more transplantations been affecting this second pathway that you've just described?

[Brian Rosenthal]

There's been a huge increase in donation after cigarette or death since these regulations came into effect. Usage has tripled. And that's great for the people who have received the organs. Some 40,000 people who needn't a transplant have gotten one. But doctors say that there have also been problems. And the reason why is that donation of Soka toy death is just much less black and white than donation after brain death. So one of the key things with donation after circulatory death is you're supposed to identify a patient who is on life support and has no chance of recovering. But that's a medical judgment call. Right. And what we have found in our reporting is that a growing number of patients who are being pursued for organ donation are actually ending up showing signs of recovering.

[Michael Barbaro]

In other words, they were not headed for death.

[Brian Rosenthal]

Correct.

[Michael Barbaro]

That's a really bracing thing to hear. Just explain and maybe give an example of what you're talking about.

[Brian Rosenthal]

So the best known case happened a few years ago in Kentucky. It was a man who had suffered from an overdose. He had fallen into a coma. He was not expected to recover. And so his family had authorized the, the organ procurement organization to pursue his organs via this type of donation.

[Michael Barbaro]

And he was not brain dead.

[Brian Rosenthal]

Correct. And so they started testing his organs, they started lining up recipients for his organs, lining up people to do the surgery. And while they were doing those preparations, he started opening his eyes, he pulled his knees to his chest, and this was noted, but kind of dismissed as meaningless body reflexes. And so they continued moving forward. They took him into the operating room. They were about to withdraw his life support, wait for him to die and take out the organs. And all of a sudden, one of the doctors said that they were not comfortable moving forward. And we actually have reporting that the procurement organization wanted to keep moving forward, but the doctor refused, and she put her foot down, and the patient was returned to his hospital room, where, unexpectedly, he recovered. Years later, he is still alive after being minutes away from dying in the operating room.

[Michael Barbaro]

Wow. Clearly, it's very alarming that a medical team almost withdrew his patient's life support, but in the end, they didn't. That seems important to highlight.

[Brian Rosenthal]

Yeah, that's absolutely true.

[Michael Barbaro]

So how frequently is a situation like that occurring where they get real close to withdrawing life support and it turns out there are signs of life?

[Brian Rosenthal]

Well, there's no official count of that, but here's what we do know. After this case was reported, the federal government did an investigation in Kentucky, and they looked at 350 cases where plans to retrieve organs were canceled at the last moment. And what they found was that in 73 of those cases, they stopped at the last minute. But they should have stopped much sooner because the patient was showing signs of regaining consciousness sooner, and those signs were initially ignored.

[Michael Barbaro]

So what have you come to understand about why a group of doctors and nurses would be missing signs of life? I keep thinking about anytime I've been in a hospital and there are machines after machines on the wall telling you about people's vital signs. So this seems a little hard to understand.

[Brian Rosenthal]

Well, the vital signs are staying consistent because they're on ventilators, they're on machines. You're really looking for signs of brain activity. And it turns out that that can be quite subtle. And so, yes, doctors are supposed to be looking for these signs, but instead of doing that, once the patient has been authorized for organ donation, the system kind of sees them as an organ donor.

[Michael Barbaro]

They put on blinders.

[Brian Rosenthal]

That's exactly right. We talk to nurses, doctors, organ procurement employees all around the country. They who all said that this system is not working as well as it should. And we confirmed a dozen cases in which patients endured either premature or bungled attempts to retrieve their organs separate from those in Kentucky. Correct.

[Michael Barbaro]

Huh.

[Brian Rosenthal]

In nine other states, different types of patients and different types of mistakes.

[Michael Barbaro]

I mean, how should we think about this? Because at the end of the day, these almost horrifying outcomes were averted. We don't know. And maybe it's not knowable whether anyone had their life support withdrawn when they might have made a full recovery.

[Brian Rosenthal]

We don't know. I think it's impossible to know. But I can say that we did speak with a lot of doctors and nurses who felt that that has happened. And they say given how much this donation type has increased in the last few years and the subjectivity, they think it's hard to imagine that this has not happened.

[Michael Barbaro]

And how much do all the folks that you've spoken to who are involved in this attribute what you're describing to the federal government asking, demanding, really more organs?

[Brian Rosenthal]

Almost everybody blames those regulations. They say that ever since they've gone into effect, the organ procurement organizations have become very aggressive, that they want to get as many organs as possible, they want to save lives, and that as a result, they're pushing the limits.

[Michael Barbaro]

Good intentions in this case, they seem to be saying, are leading to greater risk.

[Brian Rosenthal]

And remember, that is only the first half of the problem. Our reporting also found that these regulations have had an effect on the fairness of who gets all of these organs.

[Michael Barbaro]

Which is what we're going to talk about after the break. We'll be right back.

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[Michael Barbaro]

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[Brian Rosenthal]

So basically these regulations have led the procurement organizations to try to allocate as many organs as quickly as they can, and that has led them to look for ways to cut corners and to not follow the rules. So you've probably heard of the Organ waiting list. But there actually is not one official list of everybody in the country who needs an organ. It's not like you're number 1000 today and you'll be number 999 tomorrow. There is a pool of people who need an organ, and every time an organ becomes available, there is a unique list that is generated for that organ of the people who, first of all are the best match, who are the right size, who are the right blood type, who are close by, and also who have been deemed by the system to be most deserving of that organ.

[Michael Barbaro]

And how is that determination made?

[Brian Rosenthal]

It's an algorithm, and the biggest factors are how long you've been waiting and how sick you are.

[Michael Barbaro]

Seems pretty straightforward. Basically, anytime an organ, a liver, a kidney, a heart, becomes available, you're saying the system creates this smaller list from the pool you just described.

[Brian Rosenthal]

Exactly. And so once that smaller list for that specific organ is created, it is the job of the procurement organization to go down the list, starting with the very first person on the list. And it's spelled out, actually how they do that. They don't contact the patient. They contact the patient's doctor. The patient's doctor has 30 minutes to respond yes or no. If they say no, which does happen, the procurement organization is supposed to go to the second person on the list and make that offer. They've got 30 minutes to respond, then they go to the next person. And the underlying principle of all of this is fairness, which is extremely important to the system. I mean, you can imagine if we didn't have rules, the best heart could go to the wealthiest donor to the.

[Michael Barbaro]

Hospital, the member of the board.

[Brian Rosenthal]

Correct. It's also worth noting that following these steps is federally required. These steps are spelled out in regulations.

[Michael Barbaro]

Okay, so back to our thesis here. How has this new push from the federal government to do more in this space influenced the fairness of this all?

[Brian Rosenthal]

So instead of calling number one on the list, taking the chance that they say no, then having to call the next person, maybe they'll say no. Instead of waiting and going through that process, they have come up with a new plan called out of sequence allocation, which is when they simply call up a hospital that they have a relationship with and say, hey, we have an organization. You can put it into any one of your patients.

[Michael Barbaro]

And what did you find in your reporting about how frequently this alternative process is happening?

[Brian Rosenthal]

So today, nearly 20% of organs do not go to the people at the top of the list. And back in 2020, it was only 3%.

[Michael Barbaro]

Wow.

[Brian Rosenthal]

I heard many, many stories about people being skipped over. And one that really stuck with me was about a teenager named Marcus who lives in Michigan. Marcus has been fighting kidney trouble his whole life. He'd been waiting for nearly a decade for a transplant. And he had a unique medical condition, which meant that he was not a match for very many organs.

[Michael Barbaro]

Okay.

[Brian Rosenthal]

And then last spring, his doctor called to say that there was a match. He was on the top of the list. This kidney had been in Illinois. It was supposed to be used in another procedure, but that had fallen through. And so Marcus was next up. He and his family were really excited. They rushed to his hospital in Michigan to prepare for the surgery, but the kidney did not go to him that night, and it didn't go to the next person on the list or the next person after that. Wow.

[Michael Barbaro]

That very much sounds like a list being ignored, Skipped. So what did you find actually happened there?

[Brian Rosenthal]

Well, the procurement organization, knowing that the kidney was already at the University of Illinois, ended up saying to that hospital, hey, why don't you keep it? Just give it to whichever patient you want. And they ended up putting the kidney into a patient who had only been waiting for a few months. They were number 3,000, 558 on the list.

[Michael Barbaro]

That's stunning. And I want to better understand it. In your reporting, did you come to the conclusion that the procurement organization was worried, for instance, that transporting this kidney from Illinois to Michigan was going to take so long that the kidney would deteriorate? I mean, was a factor like that at play?

[Brian Rosenthal]

So they said they had to place this kidney quickly, that kidneys are only viable outside the body for a certain amount of time, which didn't really seem like a reasonable explanation.

[Michael Barbaro]

Why?

[Brian Rosenthal]

Well, Illinois is not that far away from Michigan. The kidney had only been outside the body for about nine or 10 hours at that point, and kidneys remain viable for up to 48 hours. And so they had plenty of time to send that kidney down the road. In fact, Marcus doctor had even called and offered that he would drive down and pick it up himself.

[Michael Barbaro]

Wow. From Michigan to Illinois to get it from Marcus.

[Brian Rosenthal]

That's right. But the OPO had decided that they just wanted to give it to the University of Illinois and be done with it.

[Michael Barbaro]

So that makes me wonder, what, if any, ramifications are there for a procurement organization like this one that breaks the federal rules, skips the line over someone like Marcus? Does it face any consequences?

[Brian Rosenthal]

So every time there's a violation, the case is flagged for review. But what we found in Our reporting is that basically nobody ever gets in trouble for this. More than 99.5% of the time, the case is closed without any action. And the reason for that is that the transplant system basically polices itself and it has no incentive to penalize one of its own members.

[Michael Barbaro]

What was the reaction from Marcus's family to this sequence of events that you just described?

[Brian Rosenthal]

Well, they didn't know about all that information. I just told you. They knew that they didn't get the transplant.

[Michael Barbaro]

Right.

[Brian Rosenthal]

They didn't know that they'd been skipped. And so I went to their house and met with them and told them everything that we knew. It was heartbreaking. And we told them where that kidney had ultimately gone to. And the family was just devastated. Marcus's mom actually said to me, what made them decide that Marcus wasn't good enough for that kidney. For everyone in Marcus family, this is just very hard to make sense of.

[Michael Barbaro]

How is Marcus now?

[Brian Rosenthal]

So Marcus was ultimately able to get a transplant a couple months after this all happened. He did get a kidney, but it was not as good of a kidney. It came from somebody who was older that wasn't as perfect of a match.

[Michael Barbaro]

As the one he didn't get.

[Brian Rosenthal]

Correct. And so that kidney is not doing so well. In fact, it's not really functioning at all. And he is gonna have to get back on the transplant list and wait for a new one.

[Michael Barbaro]

That's really heartbreaking. Brian, putting aside for just a moment the specifics of this kidney and of Marcus, is there evidence that when procurement organizations skip the line, they're more effective at getting organs placed in patients?

[Brian Rosenthal]

No, there is not. In the transplant system, there is a closely Watts metric called the discard rate, which is the percentage of organs that are recovered that do not end up getting transplanted. And you would expect that if the skipping the line is so effective at getting more organs placed, then the discard rate would be going down. And that is not happening. The national discord rate is not going down. And in fact, the procurement organizations that are skipping the list the most do not have a lower discord rate than the ones that are not skipping the list as much. And it also leads to some measurable bias.

[Michael Barbaro]

Explain that.

[Brian Rosenthal]

Well, when procurement organizations skipped the list, our reporting found that organs disproportionately go to white men, to Asians, and to people with college degrees. As one doctor put it to me, this is why we have policies in place to root out these biases and make sure that the system is fair.

[Michael Barbaro]

I'm curious what the Federal government's response has been to your investigation. Because what the reporting clearly demonstrates is that the actions of the first Trump administration is encouraging these procurement organizations to increasingly ignore the lines and be much more aggressive with how they're trying to procure the organs. And since Trump is now president again, are you finding that the regulators working for him are defensive of the system, or are they open to the idea that the actions they took in the first term have now created a set of problems?

[Brian Rosenthal]

The Trump administration has been very responsive to our findings on both of these issues. When we contacted them about the issue of line skipping, they immediately sent a letter to the transplant system saying that this was a big problem and that new policies needed to be written to address these issues. And as for the aggressively procuring organs from donation after circulatory death, they have cracked down on. On the procurement organization in Kentucky, and they have ordered the transplant system to write new guidelines around donation after circulatory death nationwide.

[Michael Barbaro]

Wow. They're taking it very seriously.

[Brian Rosenthal]

Yes, and they're being pushed to take it very seriously by Congress.

[Michael Barbaro]

The Subcommittee on Oversight and Investigations will now come to order.

[Brian Rosenthal]

So last week in the House, there was a hearing of the committee that oversees the transplant system.

[Michael Barbaro]

The New York Times has written on chaos in the waiting list.

[Brian Rosenthal]

And lawmakers in both parties were mentioning our reporting, a recent investigative report highlighting.

[Michael Barbaro]

One of the most horrific cases of patient abuses.

[Brian Rosenthal]

We're asking hard questions of the transplant system officials.

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Were those protocols in place?

[Michael Barbaro]

They were.

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And why were they not followed?

[Brian Rosenthal]

And we're calling for reform.

[Michael Barbaro]

If you see a patient crying, if you see these kind of neurologic responses, the process should be immediately stopped. Do you agree? I agree. You know, it strikes me that a lot of people listening to this conversation are gonna remember, as I have, that I'm an organ donor. I mean, I have it right here on my driver's license. The heart. A lot of us are organ donors proudly. And in becoming an organ donor, we have entrusted ourselves, our organs, perhaps even the process by which our life ultimately ends, to this system that you have been investigating. So should what you have found here change how we think about that decision? Being an organ donor?

[Brian Rosenthal]

I think that being an organ donor is. Is a beautiful gift. And the whole system is based on that act of giving. It's a system that saves thousands of lives every year. But, you know, as we've talked about today, the system is also under strain. And it seems like this is a rare issue where there is bipartisan support toward the idea that something needs to be done, and it's never going to be perfect. This is a system that will always have people making tough decisions under pressure. But we'll see if these fixes can help, because what everybody wants is to honor that tremendous gift of organ donation.

[Michael Barbaro]

Oh, Brian, thank you very much.

[Brian Rosenthal]

Thank you.

[Michael Barbaro]

We'll be right back.

[Jasmine Uloa]

My name is Jasmine Uloa, and I'm a national politics reporter for the New York Times. I grew up in Texas, on the border with Mexico, and I've been reporting in the Regency since I was in high school. Now I travel the country looking for stories and voices that really capture what immigration and the nation's demographic changes mean for people. What I keep encountering is that people don't fall into neat ideological boxes on this very volatile issue. There's a lot of gray, and that's where I feel the most interesting stories are. I'm trying to bring that complexity and nuance to our audience, and that's really what all of my colleagues on the politics team and every journalist at the New York Times is aiming to do. Our mission is to help you understand the world, no matter how complicated it might be. If you want to support this mission, consider subscribing to the New York Times. You can do [e-mail] subscribe.

[Michael Barbaro]

Gun injuries are the leading cause of death for children and teens in the United States. Some people avoid talking about gun violence because they don't think they can make a difference. But every conversation matters. When it comes to gun violence, we agree on more than we think, and having productive conversations about gun violence can help protect children and teens. Learn how to have the [e-mail], brought to you by the Ad Council. Here's what else you need to know today. The gunman who killed four people in a midtown Manhattan office building on Monday was carrying a note that criticized the National Football League, the apparent target of his shooting, and claimed that he had developed a degenerative brain disease from playing the sport. Police said that the shooter's plan to target the NFL was thwarted after he entered an elevator bank that did not have access to the league's offices. And Representative Marjorie Taylor Greene of Georgia, a close ally of President Trump, became the first member of her party in Congress to call Israel's conduct in Gaza a genocide. In a post on social media, Representative Green said that the October 7 attacks against Israel were, quote, horrific, but so is the genocide, humanitarian crisis and starvation happening in Gaza. Today's episode was produced by Olivia Natt and Anna Foley. It was edited by Patricia Willins and Brendan Klinkenberg. Contains original music by Dan Powell, Marion Lozano and Rowie the Misto and was engineered by Alyssa Moxley. Our theme music is by Jim Runberg and Ben Landsberg of Wonderland. That's it for the Daily I'm Michael Bavara. See you tomorrow.

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