The future of the organization that oversees organ transplants in New Jersey is under threat after a federal investigation found “several egregious actions and potential violations,” including whistleblower accounts of an organ being harvested from a living patient and a cover-up of the evidence, according to a letter lawmakers sent to the organization’s CEO this week.
Experts on organ donations said the allegations are likely to have a ripple effect for organ transplant groups nationally.
The letter sent by the chairs of the U.S. House Ways and Means Committee to Carolyn Welsh, president and CEO of the New Jersey Organ and Tissue Sharing Network, or NJTO, questions whether the organization should keep its tax-exempt status. Losing it would mean NJTO would be shut down. According to federal law, organ procurement organizations have to be nonprofits to operate.
The lawmakers’ investigation comes at a time of increased scrutiny of the nation’s 55 organ procurement organizations, like NJTO, that contract with the federal government to oversee and coordinate organ donations and transplants in a region. U.S. Health Secretary Robert F. Kennedy Jr. in September terminated the government’s contract with a procurement organization in Florida, citing safety concerns.
Joel Adler, a professor at the Dell Medical School at the University of Texas, Austin, said the investigation into New Jersey’s procurement organization appears to be broader than previous examples of federal oversight into organ donation groups, which have tended to more narrowly focus on a single procurement issue. He said the letter from Congress could be a sign of what’s to come for other organ procurement organizations.
“It’s certainly a very aggressive letter,” Adler said. “It will likely have implications for other organizations.
NJTO did not respond to multiple requests for comment. The letter, signed by committee Chair Jason Smith, a Missouri Republican, also cites potential Medicare fraud, “lack of patient consent before harvesting organs,” out-of-sequence organ transplants and a culture of “fear and retaliation” within the organization.
In a series of investigations into the nation’s organ transplant system earlier this year, the New York Times found organ procurement organizations skip patients on the waiting list and pressure hospitals into extracting organs prematurely. Federal agencies and lawmakers in recent years have passed legislation that created objective metrics for evaluating organizations and enabled the government to shut down underperforming procurement organizations.
According to the lawmakers’ letter, several whistleblowers alerted them to an incident at the Virtua Our Lady of Lourdes Hospital in Camden, New Jersey, where a patient “reanimated” after the donor organization began the process of recovering organs. NJTO staff contacted CEO Welsh to ask her how to proceed, lawmakers wrote, adding that she told staff they should “proceed with recovery” of organs from the patient who was still showing signs of life.
The letter also alleges the organization attempted to cover up this case by deleting both donation records and emails.
Greg Segal, CEO of Organize, a patient advocacy group fighting for reforms around organ transplants, said he found the allegation of a cover-up to be the most shocking part of the committee’s letter.
“If the allegations about the destruction of evidence are proven true, then we’re moving into potentially criminal activity,” he said.
Lawmakers also raised concerns that NJTO was extracting pancreases only to meet a federal requirement for the number of donations. NJTO claimed to have been recovering pancreases for research purposes, which count toward the metric and qualifies for federal reimbursement through Medicare. According to the letter, NJTO discarded 100 pancreases after hearing about federal on-site investigations at other organ procurement organizations.
Committee members also accused NJTO of misleading families into believing a person was registered as an organ donor through the state’s Motor Vehicle Commission. The letter cites whistleblowers who said the organization told families it had authority to remove a patient’s organs even though the patient had not registered as a donor.
The letter states NJTO does “not maintain proper documentation” regarding donations and was regularly skipping patients on the waitlist for organs. According to public data, NJTO allocated 25% of all organs out of sequence, a rate 10 percentage points higher than the national median.
Organ procurement organizations like NJTO are incentivized to go out of order so they can collect Medicare reimbursements for successful transplants, the lawmakers’ letter states, leading to a “quid pro quo” relationship with hospitals. The letter’s authors write that the committee will continue its investigation and its findings may inform legislative reforms that close these loopholes.
