ST. LOUIS \u2014 Lying on top of an operating room table with his chest exposed, Larry Black Jr. was moments away from having his organs harvested when a doctor ran breathlessly into the room.<\/p>\n
\u201cGet him off the table,\u201d the doctor recalled telling the surgical team at SSM Health Saint Louis University Hospital as the team cleaned Black\u2019s chest and abdomen. \u201cThis is my patient. Get him off the table.\u201d<\/p>\n
At first, no one recognized Zohny Zohny in his surgical mask. Then he told the surgical team he was the neurosurgeon assigned to Black\u2019s case. Stunned by his orders, the team members pushed back, Zohny said, explaining that they had consent from the family to remove Black\u2019s organs. \u00a0<\/p>\n
\u201cI don\u2019t care if we have consent,\u201d Zohny recalled telling them. \u201cI haven\u2019t spoken to the family, and I don\u2019t agree with this. Get him off the table.\u201d<\/p>\n
Black, his 22-year-old patient, had arrived at the hospital after getting shot in the head on March 24, 2019. A week later, he was taken to surgery to have his organs removed for donation \u2014 even though his heart was beating and he hadn\u2019t been declared brain-dead, Zohny said.<\/p>\n
Black\u2019s sister Molly Watts said the family had doubts after agreeing to donate Black\u2019s organs but felt unheard until the 34-year-old doctor, in his first year as a neurosurgeon, intervened.<\/p>\n
Today, Black, now 28, is a musician and the father of three children. He still needs regular physical therapy for lingering health issues from the gun injury. And Black said he is haunted by what he remembers from those days while he was lying in a medically induced coma.<\/p>\n
\u201cI heard my mama yelling,\u201d he recalled. \u201cEverybody was there yelling my name, crying, playing my favorite songs, sending prayers up.\u201d<\/p>\n
He said he had tried to show everyone in his hospital room that he heard them. He recalled knocking on the side of the bed, blinking his eyes, trying to show that he was fighting for his life.<\/p>\n
Organ transplants save a growing number of lives in the U.S. every year, with more than 48,000 transplants<\/a> performed in 2024, according to the Organ Procurement and Transplantation Network, which oversees the nation\u2019s transplant system. And thousands die<\/a> awaiting donations that never come.<\/p>\n But organ donation has also faced ongoing<\/a> criticism<\/a>, including reports of patients showing alertness before planned organ harvesting. The results of a federal investigation<\/a> into a Kentucky organ donation nonprofit, first disclosed by The New York Times<\/a> in June, found that during a four-year period, medical providers had planned to harvest the organs of 73 patients despite signs of neurological activity. Those procedures ultimately didn\u2019t take place, but federal officials vowed in July<\/a> to overhaul the nation\u2019s organ donation system.<\/p>\n \u201cOur findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying,\u201d Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. \u201cThe entire system must be fixed to ensure that every potential donor\u2019s life is treated with the sanctity it deserves.\u201d<\/p>\n Even before this latest investigation, Black\u2019s case showed Zohny that the organ donation system needed to improve. He was initially hesitant to talk to KFF Health News when contacted in July about Black. But Zohny said his patient\u2019s story had stuck with him for years, highlighting that while organ donation must continue, little is understood about human consciousness. And determining when someone is dead is the critical but confusing question at play.<\/p>\n \u201cThere was no bad guy in this. It was a bad setup. There\u2019s a problem in the system,\u201d he said. \u201cWe need to look at the policies and make some adjustments to them to make sure that we\u2019re doing organ donation for the right person at the right time in the right place, with the right specialists involved.\u201d<\/p>\n LJ Punch, a former trauma surgeon who was not involved with the case but reviewed Black\u2019s medical records for KFF Health News, questioned whether Black\u2019s injury \u2014 from gunfire \u2014 possibly contributed to how he was treated. Young Black men like Larry Black are disproportionately victims of gun trauma<\/a> in the United States, and research on such violence is scant<\/a>. His experience exemplifies \u201cthe general neglect\u201d of Black men\u2019s bodies, Punch said.<\/p>\n \u201cThat\u2019s what comes up for me,\u201d Punch said. \u201cStructurally, not individually. Not any one doctor, not any one nurse, not any one team. It\u2019s a structural reality.\u201d<\/p>\n The hospital declined to comment on the details of Black\u2019s case. SSM Health\u2019s Kim Henrichsen, president of Saint Louis University Hospital and St. Mary\u2019s Hospital-St. Louis, said the hospital system approaches \u201call situations involving critical illness or end-of-life care with deep compassion and respect.\u201d<\/p>\n Mid-America Transplant, the federally designated organ procurement organization serving the St. Louis region, does not comment on individual donor cases, according to Lindsey Speir<\/a>, executive vice president for organ procurement. She did tell KFF Health News that her organization has walked away from cases when patients\u2019 conditions change \u2014 though not as late as when they are in the operating room for harvesting.<\/p>\n \u201cLet me be clear about that. It happens way before then,\u201d she said. \u201cIt definitely happens multiple times a year where we get consent. The family has made the decision, we approach, we get consent, it\u2019s all appropriate, and then a day or so later they improve and we\u2019re like, \u2018Whoa.\u2019\u201d<\/p>\n But Speir said the recent media stories about the nation\u2019s donation system are prompting a lot of questions about a process that also does a lot of good.<\/p>\n \u201cWe\u2019re losing public trust right now,\u201d Speir said of the industry. \u201cAnd we\u2019re going to have to regain that.\u201d<\/p>\n Blink Twice for a Chance at Life<\/strong><\/p>\n It was a Sunday afternoon when gunshots rang out in downtown St. Louis. Black had been on his way to his sister\u2019s apartment.<\/p>\n \u201cI didn\u2019t know I was shot at first,\u201d Black said, sitting in his living room six years later. \u201cI literally ran like a block or two away.\u201d<\/p>\n He collapsed moments later, he said, crawling to the back door of a woman\u2019s home, where he asked for help. He said he asked the woman to give him two large towels, one covered in rubbing alcohol and another soaked with hydrogen peroxide. He wrapped those towels around the back of his head.<\/p>\n When his sister Macquel Payne found him, he was lying on the ground near the leasing office of her apartment complex, a crowd gathered around him.<\/p>\n Before an ambulance took him to the hospital, Black told his sister not to worry about him.<\/p>\n \u201cI\u2019m hearing Larry say, \u2018I\u2019m good, sis,\u2019\u201d Payne recalled. \u201c\u2018I\u2019m OK.\u2019\u201d<\/p>\n Black said he went in and out of consciousness on the way to the hospital and once he was there.<\/p>\n \u201cI got to hitting my hand on the side of the ICU bed,\u201d Black said. \u201cThey was like: \u2018That\u2019s just the reaction, the side effects of the medicine. Ask him some questions.\u2019\u201d<\/p>\n Payne said she asked her brother to blink twice if he could remember his first pet, a dog named \u201cLittle Black\u201d that looked like the Chihuahua from the Taco Bell commercials.<\/p>\n Black said he remembers blinking twice. His sisters remember the same.<\/p>\n Payne asked him another question. This time she wanted to know whether her brother recognized their family. Black said he blinked twice when he saw his mom and sister standing nearby. \u00a0<\/p>\n Black said his sister then asked him \u201cthe main question\u201d that everyone needed him to answer.<\/p>\n \u201cShe\u2019s like, \u2018If you want them to pull a plug, if you tired and you giving up, blink once,\u2019\u201d Black recalled. \u201c\u2018If you still got some fight in you, blink more than once.\u2019\u201d<\/p>\n Black said he started blinking and hit the bed to let his family know that he was still with them.<\/p>\n The sisters said hospital staffers told them the movements were involuntary.<\/p>\n \u2018Not Right Now\u2019<\/strong><\/p>\n In a waiting room steps away from the hospital\u2019s intensive care unit, a woman carrying brochures explained to Payne and the rest of the family that Black had identified himself as a possible organ donor on his ID.<\/p>\n The woman wanted to know whether the family wished to move forward with the process if Black died, Payne said.<\/p>\n \u201cI remember my mom saying, \u2018Not right now,\u2019\u201d Black\u2019s sister recalled. \u201c\u2018It\u2019s kind of too soon.\u2019\u201d<\/p>\n Payne said the woman persisted.<\/p>\n \u201cShe was like, \u2018Well, can I at least leave you some brochures or something?\u2019\u201d Payne recalled. \u201cThen my mom got a little agitated because it felt like she was being, like, pushy.\u201d<\/p>\n The family was already acquainted with the organ donation process. In 2007, Black\u2019s teenage brother Miguel Payne drowned at a local lake. His organs were donated, Macquel Payne said, noting the family was told that his body parts and tissues helped multiple people.<\/p>\n \u201cI believe in saving lives,\u201d Payne said. \u201cBut don\u2019t be pushy about it.\u201d<\/p>\n Mid-America Transplant handles the organ transplant process for 84 counties in parts of Illinois, Arkansas, and Missouri, including St. Louis. Like the Kentucky organization, it is one of 55 federally designated nonprofits that facilitate organ donations throughout the country.<\/p>\n The nonprofit has never pressured a family into organ donation, Speir said. Registering to be an organ donor is legally binding, she said, but Mid-America has walked away from cases when families didn\u2019t want to move forward.<\/p>\n She said her staff tries to dispel myths about organ donation and alleviate concerns. \u201cWe want to have the families leave with a positive experience,\u201d Speir said.<\/p>\n Despite the family\u2019s initial ambivalence, they ultimately consented to moving forward with donating Black\u2019s organs. Watts said members of her brother\u2019s care team had told the family that her brother was at \u201cthe end of the road.\u201d<\/p>\n The family was told to prepare for Black\u2019s \u201clast walk of life,\u201d Payne said. Also known as an honor or hero\u2019s walk, the tradition honors the life of an organ donor before the harvesting process begins.<\/p>\n At the time, Payne said, she thought her brother still had a fighting chance. She asked the hospital staffers to take another look at him before he was wheeled down the hall.<\/p>\n \u201cI\u2019m like, \u2018My brother\u2019s in there tapping on the bed,\u2019\u201d Payne said. \u201cThey said, \u2018That\u2019s just his nerves.\u2019 But I\u2019m like, \u2018No, something\u2019s not right.\u2019 It\u2019s like he was too alert. He was letting us know: \u2018Please don\u2019t let them do this to me. I\u2019m here. I can fight this.\u2019 They were saying that\u2019s what the medicine will do, it affects his nerves.\u201d<\/p>\n After the family had agreed to move forward with the organ donation process, the two sisters said, an especially helpful member of Black\u2019s medical team no longer treated them the same way. She became standoffish, they said.<\/p>\n \u201cYou could tell the dynamics had changed,\u201d Watts said.<\/p>\n \u2018#RIPMyBrother\u2019<\/strong><\/p>\n The family put on blue jumpers for the walk of life. \u201cWe just walked around the floor, and everybody was, like, acknowledging him,\u201d Payne said. \u201cWe just thought this was the end.\u201d<\/p>\n A friend Black went to high school with filmed part of the ritual. In a short clip<\/a>, Black is seen being wheeled on a stretcher down a hallway in the hospital. His eyes are half-open. People are crying.<\/p>\n False rumors then started to swirl outside the hospital.<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t<\/p>\n Brianna Floyd said she went into shock when she heard that her friend was dead. She knew that Black had been shot in the head. But a few days earlier, a local newspaper had reported<\/a> that he was in stable condition.<\/p>\n Floyd checked Facebook to see whether the news of his death was true. Her timeline was flooded with farewell posts for Black, so she decided to write one, too.<\/p>\n \u201cI Love You So Much Brother,\u201d Floyd wrote<\/a>. \u201c#RIPMyBrother. Never Thought I Would Say That.\u201d<\/p>\n Black\u2019s father rushed to the hospital when he heard a rumor that his son was being wheeled to the morgue.<\/p>\n \u201c\u2018He\u2019s gone,\u2019\u201d Lawrence Black Sr. recalled being told. \u201c\u2018He\u2019s going to the freezer now.\u2019\u201d<\/p>\n Black Sr. said he refused to believe that his son was dead. The thought was devastating. He had already experienced that kind of loss to gun violence.<\/p>\n \u201cYou wake up and nothing\u2019s the same,\u201d Black Sr. said. \u201cThe spirit is lingering for about a week, and you can feel it, you know?\u201d<\/p>\n Overwhelmed with emotion, he prayed for his son to live.<\/p>\n \u2018I Can\u2019t Kill Your Son\u2019<\/strong><\/p>\n Zohny, the neurosurgeon, said he heard an announcement about a \u201chero\u2019s walk\u201d over a loudspeaker in the hospital. He wasn\u2019t familiar with the term, so he asked about it. Medical residents in the hospital explained and told Zohny that the walk was possibly for his patient Larry Black.<\/p>\n \u201cNo, that can\u2019t be my patient,\u201d Zohny said he told them. \u201cI didn\u2019t agree.\u201d<\/p>\n That\u2019s when Zohny called the ICU to check on Black\u2019s status. A person who answered the phone told him that Black was being wheeled to an operating room, he said.<\/p>\n \u201cThis is my first year,\u201d Zohny said. \u201cYour first year out as a neurosurgeon is the riskiest time for you. Any mistakes, anything small, basically derails your career. So the moment this happened, my legs went weak and I was very nervous because, at the end of the day, your job as a doctor is to be perfect.\u201d<\/p>\n KFF Health News, Zohny, and Punch all reviewed the medical files given to Black from his hospitalization. It\u2019s not clear from the records what led to that moment.<\/p>\n \u201cIn every case, the patient must be declared legally dead by the hospital\u2019s medical team before organ procurement begins. This is not negotiable,\u201d Mid-America Transplant\u2019s CEO and president, Kevin Lee, wrote in an Aug. 21 blog post<\/a> on the nonprofit\u2019s website, responding to the news and federal comments about the investigation centered in Kentucky. \u201cMid-America Transplant strictly follows all laws, regulations, and hospital protocols throughout the process.\u201d<\/p>\n He said in a statement to KFF Health News that a person can be pronounced dead in two ways. A person is legally dead if their heart stops beating and they stop breathing, which is when donation after cardiac death can occur. A person can also become an organ donor if their brain, including the brain stem, has irreversibly ceased functioning, which is when brain death donation can occur.<\/p>\n \u201cEvery hospital has their own process in declaring both types of death,\u201d Speir said in a statement. \u201cMid-America Transplant ensures hospitals follow their policies.\u201d<\/p>\n But Black didn\u2019t fall into either category, Zohny said. And, he said, Black hadn\u2019t had what is known as a brain death exam.<\/p>\n Zohny said he immediately informed his chairman about the situation, then started running to the operating room. Black\u2019s family was waiting in the hallway, unaware of the drama happening behind a set of closed silver doors.<\/p>\n Then Zohny emerged, pulling Black\u2019s family into an empty operating room that was nearby.<\/p>\n \u201cI remember he told my mama, \u2018I can\u2019t kill your son,\u2019\u201d Payne recalled. \u201cShe said, \u2018Excuse me?\u2019\u201d<\/p>\n Zohny put an image of Black\u2019s brain on a screen. Then he circled the part of his brain that was damaged. He explained that Black\u2019s gunshot wound was something that he could possibly recover from, though he might need therapy. He asked the family whether they were willing to give Black more time to heal from the injury, instead of withdrawing care.<\/p>\n \u201cIn my opinion, no family would ever consent to organ donation unless they were given an impression that their family member had a very poor prognosis,\u201d Zohny said. \u201cI never had a conversation with the family about the prognosis, because it was too early to have that discussion.\u201d<\/p>\n Zohny knew that he was taking a professional risk when he ran into the operating room.<\/p>\n \u201cThe worst-case scenario for me is that I lose my job,\u201d he recalled thinking. \u201cWorst-case scenario for him, he wrongfully loses his life.\u201d<\/p>\n Later, Zohny said, a hospital worker who transported Black from the ICU to the operating room told Zohny that something had seemed off.<\/p>\n \u200a\u201cI remember him looking at me and saying, \u2018I\u2019m so glad you stopped that,\u2019\u201d Zohny recalled. \u201cAnd I said, \u2018Why?\u2019 And he said: \u2018I don\u2019t know. His eyes were open the whole time, and I just felt like he was looking at me. His eyes didn\u2019t move, but it felt like he was looking at me.\u2019\u201d<\/p>\n \u2018Back From the Dead\u2019<\/strong><\/p>\n After Zohny\u2019s intervention, Black was wheeled back to the ICU. Zohny said the medical team held back all medications that caused his sedation.<\/p>\n Black woke up two days later, Zohny said, and started speaking. Within a week, the neurosurgeon said, he was standing.<\/p>\n \u201cI had to learn how to walk, how to spell, read,\u201d Black said. \u201cI had to learn my name again, my Social, birthday, everything.\u201d<\/p>\n Zohny continued to care for Black during what remained of his 21 days in the hospital. During a follow-up appointment, he posed for a photo with Black and his older sister, Watts. Next to Zohny, Black is standing up, a brace on his leg.<\/p>\n \u201cIt\u2019s a miracle that despite flawed policy we were able to save his life,\u201d Zohny said. \u201cIt was an absolute miracle.\u201d<\/p>\n Zohny, who was working as a fellow and assistant professor at the time, left Saint Louis University Hospital for another job later that year when his fellowship ended. He said Black\u2019s story made him question what we know about consciousness.<\/p>\n He\u2019s now working on a new method that quantifies consciousness. Zohny said it could possibly be used to help measure consciousness from brain signals, such as with an electroencephalogram, or EEG, a test that measures electrical activity in the brain. Zohny said his method still needs rigorous validation, so he recently started a medical research company called Zeta Analytica, separate from his work at the West Virginia University Rockefeller Neuroscience Institute<\/a>, which he\u2019ll begin in October.<\/p>\n \u201cWe don\u2019t understand the brain to the level that we should, especially with all of the technology we have now,\u201d Zohny said.<\/p>\n Today, Black is trying to move forward. He said he has seizures if the bullet fragments in his head move around too much. He said he easily overheats because of the injury.<\/p>\n He doesn\u2019t blame his family for their decision. But he questions the organ transplantation process. \u201cIt\u2019s like they choose people\u2019s destiny for them just because they have an organ donor ribbon on their ID,\u201d Black said. \u201cAnd that\u2019s not cool.\u201d<\/p>\n To help him process everything that happened to him in 2019, he makes music under the name BeamNavyLooney. \u201cI am back from the dead,\u201d he recently wrote in a song about his experience.<\/p>\n Earlier this year, Black celebrated the birth of another son, who was sleeping peacefully at home as Black recounted his story.<\/p>\n \u201cHe doesn\u2019t really cry,\u201d Black said. \u201cHe just makes noises.\u201d<\/p>\n Black sat with a firearm within reach. He said he keeps the gun close to protect his family. It\u2019s still hard for him to sleep at night. Nightmares about what happened \u2014 both on the street and in the hospital \u2014 keep him awake.<\/p>\n He said he no longer wants to be on the organ donor registry.<\/p>\n This project was supported by a fellowship from the Association of Health Care Journalists, with funding from The Joyce Foundation.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n