Experts say the vast majority of hospitals abided by those guidelines even without the network's formal guidance.
In the San Luis Obispo case, Roozrokh and another transplant surgeon, Dr. Arturo Martinez, were in the room, and Roozrokh ordered narcotic painkillers and sedatives for the patient, Ruben Navarro, according to a report by federal regulators. Both worked at Kaiser Permanente's now defunct kidney transplant center in San Francisco but were retrieving the organs on behalf of a regional organ procurement group, not Kaiser.
Roozrokh's attorney has said his client did nothing wrong and did not hasten Navarro's death.
The network board has found fault with the handling of the incident and wants to avoid a recurrence, officials said.
The network is under pressure from lawmakers to improve its oversight of transplantation, and an influential senator is asking whether the group is doing enough to protect patients.
"I continue to be concerned about lax oversight of the transplant system," Sen. Charles E. Grassley (R-Iowa), ranking member of the Senate Finance Committee, said in a statement this week. "At first the focus was on risk to patients waiting for donors, and now we see we need to do more to protect donors, too."
Removing organs from brain-damaged patients once their hearts stopped was standard practice until about four decades ago, when the medical community arrived at a means of defining brain death; that then became the standard for selecting donors.
In Southern California, 15 of 432 donors last year came from donations after cardiac death, according to OneLegacy, the regional organ procurement agency. This year, there have been nine.
Western Medical Center-Santa Ana supports donation after cardiac death as a way "to give the family an option to make something better come out of a bad situation," said Sherri Lamon, director of the intensive care and critical care units. It has done six such procedures since 2002, one this year.
But like most other hospitals that allow such retrievals, Western Medical already had a policy to ensure transplant surgeons didn't influence or take part in end-of-life decisions. Transplant surgeons are not allowed in the operating room with a dying patient until five minutes after the patient's heart has stopped, Lamon said.
"We are very strict with that," she said. "Someone is watching the clock, keeping time, standing at the door."
charles.ornstein@latimes.com
