Organ donation when the donor isn't dead: what records show
A Kentucky man woke up on the way to his own organ recovery. A Mississippi woman spent 15 hours alive at an organ recovery center while her family planned her funeral.
Who decides that you are dead?
Donna Rhorer was recording her brother’s honor walk at a Kentucky hospital in October 2021 when a supervisor told her to stop. Her brother’s eyes had opened, and they were tracking the people in the room.
Anthony “TJ” Hoover had come in days earlier after cardiac arrest. Rhorer said the family was told within hours that he was brain dead, but he wasn’t. His organs were to be taken after his heart stopped, a track called “donation after circulatory death.” The patient is alive until the heart stops. He was on the national organ donor registry, so when the family moved to withdraw life support, Kentucky Organ Donor Affiliates (KODA), the local organ procurement organization, had to be notified.
On the morning his organs were scheduled for recovery, he woke up during a cardiac catheterization, a procedure to assess the health of his heart. A former employee, Nyckoletta Martin, testified to Congress about what happened next. He was paralyzed and sedated right away. His family was never told he’d woken up. KODA’s protocol required an immediate halt if a patient’s neurological status changed. That didn’t happen. House investigators later found a note in the record that hospital staff were “extremely uncomfortable with the amount of reflexes patient is exhibiting.”
Martin told me she was barred from those operating rooms within days of the hearing. It ended her career in organ transplantation, after 20 years.
The supervisor called the eye movement a reflex. Rhorer says the surgeons refused to operate. Hoover lived. Then on August 5, 2026, the federal government finally moved to shut down the organization.
In October 2024, KODA merged with Cincinnati’s LifeCenter Organ Donor Network, and the combined organization is called Network for Hope. It says it will appeal. Network for Hope said it "strongly disagrees" with the decision, in a statement from chief executive Barry Massa. The territory covers 7 million people across 4 states. More than 3,000 of them are on a transplant list.
Who oversees organ procurement?
There are two legal ways to be declared dead. The brain can stop, or the heart can. The organs are recovered by 55 nonprofits called organ procurement organizations (OPOs). Each holds an exclusive territory, handed out in the mid-1980s. One rule underlies the entire system: recovering organs must never cause death.
The Centers for Medicare and Medicaid Services (CMS) oversees them. None lost a federal contract in 40 years until HHS moved to decertify a Miami OPO on September 18, 2025. That was Life Alliance Organ Recovery Agency, run by the University of Miami Health System. The department said investigators found years of unsafe practices, poor training, chronic underperformance, understaffing, and paperwork errors. One 2024 error led a surgeon to turn down a donated heart. Network for Hope is the second OPO the government has moved to shut down.
Why are more organs now taken after the heart stops?
In 2000, 118 people in the United States donated organs after circulatory death. That was 2% of deceased donors. In 2025, it was 8,129, or 49%. Nearly half of recovered kidneys and livers now come from this track. So do about a quarter of hearts and lungs. Brain-death donation fell in 2024 for the first time in more than a decade, to 9,705 donors.
Three things drove the rise in “donation after circulatory death," or DCD. Technology came first. US heart transplants from circulatory-death donors began in December 2019, using a machine that perfuses the organ after removal. Normothermic regional perfusion restores blood flow inside the body after death is declared. It entered US cardiac practice in 2020. The Food and Drug Administration approved machines that keep a liver perfused outside the body in 2021.
Federal pressure came second. In 2020, CMS replaced self-reported performance measures with hard ones. One counts donors. The other counts organs actually transplanted. OPOs in the top 25% keep their territories. Groups below the national median lose them. The pressure is on OPOs to convert more deaths into organ donors, and the pathway with room to grow is the one that doesn't require a brain death exam. That year, circulatory death accounted for 26% of deceased donors.
The third is who is dying. More patients now survive an initial resuscitation without recovering brain function. Often that follows an overdose or a cardiac arrest. Their families then face a decision about withdrawing life support. Today’s DCD donors are also older, and more likely to have diabetes, high blood pressure, or hepatitis C.
The result isn’t uniform. Across the 55 organizations, circulatory death accounts for as few as 11% of donors and as many as 73%.
Drs. Kim Olthoff, Peter Abt, and Abraham Shaked are transplant surgeons at Penn. They told me what they’d fix first. “The DCD process should be standardized among all OPOs and hospitals,” they wrote. “Currently there is a wide variation in how potential DCD donors are identified, declaration of death, end of life management prior to donation, etc. The involvement of intensivists in this process is important.” They also wanted it on the record that they think the system works well overall. “It is our impression that the public is quite trusting the system, and this is reflected by the large number of people and families who are willing to donate, more so than any other country except for Spain.”
What makes circulatory death harder to oversee?
Brain death is settled by an exam. A doctor tests for brain function, finds none, and the patient is declared legally dead at that moment. The exam itself asks nothing about other organs. In DCD, the patient is alive through every step of the planning. Clinicians judge that recovery is unlikely. The family agrees to withdraw the ventilator. Everyone waits for the heart to stop. Organs start to fail the moment blood stops moving. The same clock that governs death also governs recovery.
The safeguard is separation. The people caring for the patient are not the people who want the organs. Dr. James Bernat, a neurologist at the Dartmouth Geisel School of Medicine, has spent his career on the ethics of determining death. “There’s probably no way to make it perfectly independent,” he said. He told me that families ask about timing and independence “for very valid reasons.”
Then there’s the waiting period. After the heart stops, clinicians wait to be sure it doesn’t restart before surgery begins. Federal policy requires a wait, but doesn’t say how long. Some hospital protocols specify 2 minutes. A study of 631 patients in 20 intensive care units found hearts resumed beating on their own in 14% of cases. The longest interval was 4 minutes and 20 seconds. In November 2025, federal regulators advised OPOs to reassess any protocol shorter than 5 minutes. That was advice, not a rule.
Comfort medications are the other pressure point. Opioids and sedatives ease real suffering at the end of life. They also slow breathing. Intent is what separates comfort care from hastening a death. Intent is hard to reconstruct later.
Etan Yeshua, an intensive care nurse, told me the process often goes fine. “Sometimes things go very well and run very smoothly,” he said, “but many times a year, I’ve had really unfortunate experiences.” Patients and families, he said, end up “being treated in a way that made them seem like a commodity.”
Circulatory death means the heart has stopped and won't restart on its own. “Normothermic regional perfusion” restarts it minutes later. The vessels to the head are clamped so blood doesn’t reach the brain. The American College of Physicians wrote in 2021 that this “appears to violate one of the ethical foundations of organ donation, the ‘dead donor rule’.” It called for the practice to be paused. Transplant surgeons disagree and say it preserves organs without resuscitating anyone. A 2024 JAMA study found forty-nine of the fifty-five OPOs had used it; twenty-three of those had no policy governing it.
OneLegacy, the largest of them, told me the line holds in practice. “The recovery surgeons do not enter an operating room until death has been declared by the treating clinicians,” said Shaan M. Johri, the group’s director of communications. Discussions about donation don’t begin, he said, until a family has independently decided to stop ventilator support.
What did investigators find in Kentucky?
Investigators reviewed 351 Kentucky cases where donation was approved but never done. One hundred and three had concerning features. Seventy-three involved patients showing neurological signs incompatible with donation. At least twenty-eight may not have been dead when the process started. They also found poor neurological exams. They found questionable consent. They found causes of death misclassified, especially overdoses.
Danella Gallegos was 34. An ambulance brought her to Presbyterian Hospital in Albuquerque in September 2022. She was homeless. She had cirrhosis and a history of drug use. Doctors told her family she wouldn’t live.
Within days, she says, New Mexico Donor Services told her mother the kidneys were already matched. “They told my mom I was an organ donor, it was going to be done today, and there wasn’t going to be another option,” Gallegos told me. Her mother signed. “She didn’t know what she was doing and felt forced.”
Her sisters saw her cry and move. They were told those were reflexes. “Whenever they did see me crying again, I picked my whole body up and put my arm out, and then they’re like, no, this is reflex.” Then she opened her eyes and started following commands. The plan changed. She recovered. She has since taken herself off the registry.
The OPO disputes the account. New Mexico Donor Services CEO Sean Van Slyck told me CMS investigated in April 2025 and found the OPO was in “substantial compliance.” He asked me to remove the case from this article. Dr. David Arredondo, Chief Medical Officer at Presbyterian, said its clinicians don't make donation decisions and that New Mexico law requires the hospital to notify the local OPO when a patient dies, or death is near. Withdrawing life support, he said, is the family's decision and is "entirely separate from considerations related to organ donation." If a patient shows "unexpected neurologic responsiveness or improvement, the donation process is stopped, and the care team reassesses the patient."
Paula Denison was declared brain dead at Anderson Regional Medical Center in Meridian, Mississippi. “My mother on her license was not a donor,” her daughter Brooke Shantelle Denison told me. “She was very adamant about not being an organ donor.” The family consented anyway, and generously. “When I say we donated everything, we were going to donate everything,” Brooke said. “Our intentions were to donate bone, skin, all of it.”
The court record describes what staff found when Denison came in on the afternoon of March 17, 2022. She was drowsy and lethargic. She responded to pain. Her speech was clear. A physician ordered a CT scan and intubated her. After he read the report, he ruled she was brain dead. That was around 4:45 p.m. A nurse called Mississippi Organ Recovery Agency (MORA), the local OPO, at 4:46 p.m.
The family was asked to leave for the apnea test. The ventilator stops delivering breaths while oxygen keeps flowing. Carbon dioxide builds up. That buildup is the strongest signal a brainstem has to trigger a breath. Doctors watch to see whether the patient tries. One breath means the patient is not brain dead.
The curtain was closed. A hospitalist called time of death at 6:51 that evening. Denison was moved by ambulance to an organ recovery center MORA runs in a converted car dealership, 90 minutes away. MORA calls it a donor care unit. OPOs run these centers. They aren’t licensed as hospitals.
The family’s complaint, quoted in the Mississippi Supreme Court opinion, says staff there opened her abdomen and took biopsies of her liver. A placement coordinator found matching recipients for her liver and both kidneys. Notes in MORA’s records document reactive pupils. Then pulling away from pain. Then breathing on her own. Then coughing and gagging. The record puts the first of those signs no later than 7 p.m. on March 18, 2022. MORA told the hospital, but not the family. Denison stayed through the night on rising doses of medication. MORA sent her back at 10:16 a.m. on March 19, having ruled she “did not meet neurologic criteria.” More than 15 hours passed between the first sign she was alive and the ambulance out. “She wasn’t brain dead,” their attorney, Michael Jaques, told me. “She was alive when they began to cut.”
Her daughters learned she was alive two days later, at a funeral home planning her service. Brooke walked into the intensive care unit and found her mother breathing. “There were dried tears down her eyes,” she said. Denison died at the hospital days later.
MORA tells it differently. Trisha Byrd, MORA’s director of community services and relations, told me in writing that hospital physicians pronounced Denison dead under state law. Her family then authorized donation. Denison “unexpectedly began to respond to stimuli about 12 hours after her transfer,” Byrd said. MORA informed the hospital physician immediately, canceled all recovery plans, and returned her the next morning “once it became feasible.” “At no point was the patient either prepped for surgery or operated upon,” Byrd said. She called it “a uniquely rare situation that the Mississippi Organ Recovery Agency (MORA) had not previously experienced in our 30-year history.”
MORA had no protocol for returning a patient to the hospital in these circumstances. CMS made it write one, then approved it. A trial court threw the family’s lawsuit out. State law, it held, makes OPOs immune. The family appealed. At oral argument, a justice asked MORA’s lawyer what duty it owed a patient it knew was still alive. “It may seem harsh to say ‘none’,” counsel answered, “but that would be my response.”
On April 16, 2026, the Mississippi Supreme Court reversed and sent the case back. No Mississippi court has ever ruled on what that immunity covers, the justices wrote, and this record is too thin to be the first. Two of them would have ended the case now, holding that the law shields what MORA did. Brooke lost the other half of the appeal. She had sued in her own name too, for her own distress. Mississippi allows that only if you were close enough to witness the harm. She was 90 minutes away.
On May 7, MORA’s medical director asked the trial court to throw out the claims against her. The motion calls Denison “the body” and “the gift.” It lists as undisputed that her body showed “signs that were inconsistent with the prior determination” that all brain function had ceased. It says the statute gave MORA rights “superior to the rights of all others” over her. MORA “exercised its superior, statutory right to maintain possession of the body.” A footnote says there is “no allowance for second-guessing the accuracy of the death determination.” Another says a family’s revocation counts only if the OPO hears it “before an incision has been made.”
Four years in, nobody has been deposed. The family sent written questions in January 2024. They’re still unanswered. MORA’s records, Jaques wrote in May, “do not identify the individuals who determined that Paula Denison should remain at MORA or administered drugs” to her after she was found to be alive. “The defendants do not want us to take any depositions or have any opportunity to find out what happened,” Jaques told me.
The 8-year-old on the circulatory death track.
Cole Hartman was 8 years old. He had Fragile X syndrome. On July 31, 2013, his stepmother found him head down in a top-loading washing machine full of water and clothes. He was resuscitated at Henry Mayo Hospital. The sheriff’s homicide unit was assigned because the injury looked suspicious. The next day he was moved to Ronald Reagan UCLA Medical Center. His pupils became reactive. He was minimally responsive. He did not meet the criteria for brain death. He was placed on the DCD track.
I asked the Los Angeles County medical examiner for its file on the case under the California Public Records Act. The county released it, with redactions, in April 2026.
Denise Bertone was the pediatric death investigator assigned to it. She had conducted more than 2,500 death investigations. On August 4, 2013, Hartman was taken to the operating room. Bertone says his intensive care physician also sat on UCLA’s liver transplant team, and served as the anesthesiologist for the recovery. Those roles are supposed to be held by different people. He was on a continuous morphine drip. When the ventilator came off, he kept breathing. The physician then gave 500 micrograms of fentanyl. Hartman weighed 21 kilograms and had never had opioids. He was pronounced dead at 11:03 a.m.
The dose never went into the medication record. It was handwritten on a slip of paper and scanned into the chart. Bertone subpoenaed the pharmacy logs. One vial of 250 micrograms had been checked out for him. The source of the second was never established.
Then the toxicology, which is the part that makes the case. Blood drawn in the operating room was couriered to the coroner by OneLegacy. It showed morphine and no fentanyl. Bertone asked the pathologist to also draw blood from the body at autopsy. That sample sat untested for 7 months. When it was finally run, in March 2014, it showed morphine and a lethal level of fentanyl.
The case was first closed in October 2013 as the sequelae of a near drowning, with the manner of death undetermined. It was reopened in November 2016. A pediatric toxicologist found the fentanyl inconsistent with a therapeutic dose, and the death certificate was amended to add fentanyl toxicity. In June 2017, the chief of anesthesiology at USC reviewed the records. He found the dose 250 to 300 micrograms above what was safe. The manner of death was changed to homicide.
That is a finding about how a death came about. It says nothing about intent, and it brings no charge on its own. No charge followed. The deputy district attorney assigned to the case never issued the written rejection notice explaining why the prosecution was declined. Bertone says the family was told it was comfort care. UCLA Health declined to comment, citing privacy law. It said that “potential organ and tissue donations are not a consideration in decisions about life-sustaining care.”
Then the money. Bertone sued the county, saying she was pushed out for pursuing the case. Dr. Lakshmanan Sathyavagiswaran, the chief medical examiner, testified at that trial. He said the coroner's office took in $140,000 to $150,000 a year from OneLegacy, depending on the year. He called it cost recovery, approved in the contract, for organ and tissue procurement and for the time his staff spent on it. He said the office ran on about $40 million a year. He also acknowledged serving on OneLegacy's board for a period, before he came back as interim chief. He denied that anyone retaliated against Bertone. She says OneLegacy also helped his son-in-law get a job. On December 17, 2021, after 90 minutes of deliberation, the jury found for her.
OneLegacy told me California law requires its agreement with the medical examiner. It has the same arrangement in all 7 counties it serves. “The Medical Examiner independently reviews, releases, and/or restricts the recovery of organ, eye, and tissue,” said Shaan M. Johri, director of communications for OneLegacy.
I asked Bertone what changed after the trial. “I was really surprised that after the trial, nothing happened,” she said. “Absolutely nothing.”
Can you actually refuse to be an organ donor?
Rita Hollingsworth and her husband took themselves off the donor list at the California DMV in June 2023. Jeff Hollingsworth told me they did it after reading about investigations into OneLegacy. That organization would have handled both her donation and the kidney transplant she was herself waiting for.
That November she had a brain hemorrhage. The OPO was in the hospital anyway. Jeff says the staff wore scrubs though they weren’t on her medical team. He told the charge nurse he wanted them out of her care. The process kept advancing. He describes her bed kept unusually warm. Rita’s potassium and glucose were checked over and over. Jeff says basic comfort care was neglected. Relatives were turned away. When he got back into her room, he found more than a dozen people around her. A man was performing chest compressions. “Rita was dying,” Jeff told me. “She did not want this.”
OneLegacy sent me a written response to explain the legal position. Registering as a donor in California is called First Person Authorization. It’s legally binding. State law requires OneLegacy to carry it out. The DMV isn’t the controlling registry. You have to contact Donate Life California yourself. “A review of this registrant’s record found no disenrollment,” a OneLegacy spokesperson said. They added that staff are identified by badges and logos, and that when a family says a patient revoked, the record is re-reviewed and donation doesn’t proceed until status is confirmed. The registry is now working with the DMV on a way to remove yourself there.
Raven Kinser died in Newport News, Virginia, in January 2025. The 911 call came at 4:30 p.m. She reached the emergency room at 4:48 p.m. Her parents, in Michigan, weren’t called until 7 p.m. By then there were no flights, and they drove 12 hours. “DNR” was written on her right thigh, where first responders would see it.
She had signed a Virginia DMV form marked “Organ Donor: N” on July 16, 2024. A DMV clerk stamped it. Her license said the same thing. Her mother, Jamie Kinser, told me a LifeNet representative said the Michigan registration “was her living will, and we had to abide by it.” The family found the DMV paperwork six weeks later in a box of her belongings that a detective had mailed back. LifeNet had used an older Michigan registration instead. Jamie says nobody told the family that.
Jamie learned the registry only runs one way. You can register “yes,” and your family legally can’t overturn it. The other option is “not at this time,” which your family can still override after you die. There is no binding way to register “no.”
LifeNet Health told me that federal and state law bar it from confirming or denying whether any specific person was a donor, was referred to them, or was in their system at all. It said it follows the Uniform Anatomical Gift Act, that a valid authorization stays legally enforceable, and that it trains staff on disputes over donor status.
How do organ procurement organizations make money?
Almost everything else in Medicare is paid a fixed price set in advance. OPOs are not. They spend what they spend, report it, and Medicare reimburses the cost. So the way to earn more is to spend more. Medicare pays the OPO directly for kidneys. For a liver, a heart, or a lung, nobody pays the OPO up front. It sends a bill to the hospital that accepts the organ, and it sets that price itself. So an OPO has two ways to raise money. It can charge hospitals more for the organs it sells them. And it can book its shared overhead against kidneys, with the government reimbursing whatever it spent.
In August 2023, the Department of Health and Human Services inspector general audited that arrangement and said the structure itself invites abuse. Its words were that "opportunities and incentives exist for OPOs to: (1) inflate their [standard acquisition costs] SACs for nonkidney organs, (2) misallocate overhead costs between reimbursable and nonreimbursable costs, and (3) not work actively to recover all available organs." In plain terms: charge hospitals more, move overhead onto the government's ledger, and leave organs where they are. A bipartisan Senate Finance letter followed. Nothing about the payment structure has changed since September 2023.
The scorecard has a loophole of its own. It is the pancreas. The 2020 rule credits an OPO only for organs that actually get transplanted. There's one exception. A pancreas taken for research counts as a donor even when nothing is transplanted. CMS never defined research. Recoveries climbed anyway. Senators Ron Wyden (D-OR), Chuck Grassley (R-IA), Ben Cardin (D-MD), and Todd Young (R-IN) wrote to CMS in June 2024 with the numbers. In 2018, OPOs recovered 169 pancreata for research. In 2022, they recovered 1,606. Over the same four years, the share actually used for islet cell research fell from 88% to 48%. CMS has now proposed a rule to strip those out of the count.
New Jersey is where the alleged mechanics are clearest. The House Ways and Means Committee wrote in November 2025 about a patient at Virtua Our Lady of Lourdes in Camden, New Jersey. The patient “reanimated” after life support was withdrawn. The letter says leadership told staff to continue the recovery until hospital staff intervened. It describes 100 pancreases, processed for research, discarded on a single day in March 2024. In an earlier letter, the committee asked Carolyn Welsh, president and chief executive of the New Jersey Organ and Tissue Sharing Network, about kidneys coded "intent to transplant" that no transplant center would take. Michael Symons, a spokesperson for New Jersey's attorney general, confirmed to me: "We are investigating these allegations."
On the day the government moved against Network for Hope, the House Ways and Means Committee charged it with seeking out organs that couldn't be transplanted in order to sell tissue for profit. Chairman Jason Smith (R-MO) called the decertification "a direct result of our investigation." HHS cites a review its own investigators finished in May. Sen. Smith said the committee is still digging into what he called a pattern of misconduct at that group and others like it. Donors and families, he said, "deserve a system they can trust."
The problem goes beyond any one OPO. Erickson testified that tax filings show OPOs have transferred more than half a billion dollars to "related organizations," and that several hold opaque financial interests in tissue processing companies, including some doing business internationally and in the Middle East.
What is distrust costing the organ transplant system?
The industry has an answer. The number of people who donated organs after death fell in 2025 for the first time in more than a decade. Kidney donors dropped by 4%, and more recovered kidneys were discarded. The Association of Organ Procurement Organizations (AOPO) ties the decline to renewed scrutiny of the system and to people leaving donor registries. "This reversal will cost lives," it told Axios in January. Fewer donated organs, it said, mean fewer lifesaving transplants.
In Kentucky, more than 2,100 people took their names off the state donor registry between September and December 2024, more than 1,000 of them in October alone. Massa reported those numbers to Congress himself. Nobody has shown that the news reporting caused the drop. Mark Johnson, the interim CEO of UNOS, which runs the national waiting list, said that the decrease "needs to be better understood." He added that the system "is built on trust."
The AOPO also argues the real emergency is elsewhere. Thousands of usable organs are discarded every year. Attention spent on procurement conduct, it says, is attention not spent on that waste. UNOS, the contractor that runs the national waiting list, makes a narrower defense. It answered the December hearing point by point. It says it can't make clinical decisions or oversee hospitals, because doctors and transplant teams make the clinical calls and CMS and HRSA regulate the hospitals. On retaliation, UNOS says the whistleblowers "are not able to produce evidence of retaliation, because it does not exist."
In contrast, the American Society of Transplant Surgeons has backed the federal actions and offered to help.
Why aren’t these groups regulated as healthcare?
Almost none of this is about a lack of regulations. KODA’s protocol required an immediate halt if a patient’s neurological status changed. California requires a family notification form. Mississippi doesn’t permit treating patients in an unlicensed facility.
What was missing was enforcement and penalties for those who didn’t comply with regulations. Martin testified that staff wanted to report the Hoover case. Their access to his records was cut off, and they were told KODA would handle it internally.
In the 1980s, CMS determined that OPOs aren’t healthcare providers. So the people at a dying patient’s bedside don’t have to hold a clinical license, and whistleblower protections that cover nurses and doctors don’t cover OPO staff. Martin told me her clinical supervisor was hired out of a Jimmy John’s. Greg Segal, a co-founder of Organize, a non-profit patient advocacy organization focused on reforms to increase the supply of transplantable organs, told Congress that a Los Angeles Uber driver once mentioned doing organ recoveries for the local group as a side gig.
The consequences fall unevenly. In Alabama, families of men who died in state custody say their bodies came back without a heart or a brain. A state judge let their lawsuit proceed last year. Attorneys general in Kentucky, New Jersey, and New Mexico have all confirmed inquiries of their own. Mississippi declined to comment. California says it’s aware.
What CMS and Congress haven't done.
Some things have. Federal regulators have ordered every OPO to designate a patient safety officer with around-the-clock coverage. The job is to investigate complaints in real time and serve as a contact for families. Regulators also directed the Organ Procurement and Transplantation Network to build a formal way to pause organ recovery. They also ordered a gap closed in the federal data. Records of people authorized as donors whose organs were never recovered had been dropping out. They now have to stay in. In March 2026, CMS issued guidance after reports that some groups had rushed families.
What hasn’t changed is the structure underlying the nation’s organ donation system. Payment is still on cost. OPOs still fall outside hospital licensing requirements under a 40-year-old healthcare regulation.
Every one of the fifty-five federal agreements expires on January 31, 2027. Decertification actions for the failing tiers begin 60 days after that. But only the lower tiers face competition. Thirty of the fifty-five were top-tier in the most recent report. It’s also the wrong lever for these harms. Tier standing rests on the two measures: how many donors and how many organs transplanted. Neither asks whether a family was rushed, whether a revocation was honored, or whether a patient was alive. OPOs that push harder score higher. Nothing on that scorecard would have caught a single case in this article. The pancreas exception is part of the same problem. It lets a group add donors whose organs nobody transplanted.
The two groups the government did move against were caught differently, through the health and safety rules CMS can enforce at any time. But it took 40 years to use it once.
CMS wrote that classification in the 1980s and can rewrite it. Congress can change the payment structure and the immunity. Neither has.
Life Alliance, the Miami OPO, lost its federal contract in March. Network for Hope is appealing, meaning it continues operating while the appeal proceeds.