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HHS released a bombshell report in July finding organ procurement organizations had began the procurement process while patients showed signs of life. But Suzanne Conrad, CEO of the Iowa Donor Network, an OPO that covers Iowa, disagrees with the framing of the story. Conrad explains how the process works in Iowa, what checks and balances are in place, and how this news has impacted organ donations.
In July, Secretary Robert F. Kennedy announced HHS’s discovery of what they consider to be disturbing behavior for an organ procurement organization (OPO) serving Kentucky, southwest Ohio, and part of West Virginia. “Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying.
Two Types of Death, Two Paths to Donation
Conrad laid out the two legal standards for death: brain death and circulatory death. In brain death cases, patients are completely non-responsive, unable to breathe without machines, and declared legally dead even though the heart may continue beating due to ventilator support. In circulatory death, organs are only recovered after the heart has stopped beating naturally following ventilator removal.
“We never proceed with organ donation until the patient is declared dead by hospital personnel,” she stressed, countering the idea that donation ever occurs prematurely in Iowa.
Who Declares Death, and Who Makes the Call?
Brady asked who officially declares a patient dead. Conrad clarified it can be a bedside nurse, a resident, or the attending physician. Only after this declaration does the Iowa Donor Network get involved. Their job is twofold: assess medical viability and engage with grieving families about donation options.
Organ donation, she explained, is far from immediate. “It doesn’t happen within a 60-minute TV episode. Organ donation tends to take a couple of days,” she said. Families often use this time to process their grief while the network works to place viable organs.
Misconceptions Spark Real Consequences
When asked whether Iowa has seen the same issues flagged in the HHS report, Conrad was clear: Iowa’s processes are in full compliance, and no violations have occurred. Still, public fear—fueled by headlines rather than full reports—has resulted in decreased donor registration statewide and nationally.
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Brady highlighted how misunderstanding the term “organ procurement process” can create confusion. Conrad explained, “When we say ‘organ procurement process,’ it doesn’t mean we’re cutting someone open. It means we’re preparing in case death occurs, to honor the donor’s wishes quickly.”
No Incentives, No Selling—Just Service
Brady raised the question of financial incentive. Conrad responded emphatically: “There is no financial incentive for hospitals or physicians.” In fact, federal law strictly prohibits the sale of organs. Instead, OPOs like the Iowa Donor Network bill transplant centers for the service, not the organ.
The cost covers ICU stays, operating room time, and transport. This funding model is regulated annually by Medicare, ensuring ethical compliance and transparency.
Matching Organs: No One List Fits All
Contrary to public belief, there is no single organ waitlist. Each transplant center has its own lists per organ type, and the national system determines matches based on donor data like blood type and organ size. The Iowa Donor Network inputs donor info into a federal system that returns a ranked recipient list.
The process is sensitive and time-intensive. Each transplant center has just 30 minutes to accept or reject an organ, and when centers pass, the next on the list is contacted. This delay, Conrad admits, is hard on donor families awaiting closure.
How Organs Travel: Not as Simple as You’d Think
Transportation is another complex layer. Hearts and lungs almost always make it to recipients thanks to immediate hand-delivery by surgical teams. Kidneys, with a longer viability window, are often flown commercially—even placed in cargo.
Conrad shared that the FAA recently approved cabin transport again. “Since 9/11, kidneys have been shipped in cargo, but we’re now returning to cabin transport, which increases safety and visibility.”
Transparency Is the Only Cure for Doubt
Brady commended Conrad for addressing the topic when many physicians declined. He underscored that transparency is essential—both to maintain public trust and to correct misinformation. Conrad, in turn, urged listeners to verify facts before leaving the registry.To register as a donor, visit www.iowadonornetwork.org or call 800-831-4131.