Organ donation is a noble act and a powerful reflection of the kind of country we live in, where people (or their families) willingly choose to give the gift of life to a stranger, with no compensation, before meeting their Maker. But most people, myself included until recently, have no idea how the system actually works. In the name of transparency, we deserve to know what we are signing up for and who else benefits from this process beyond the patient receiving the organ.
When I was just eight years old, my mom became mysteriously and terrifyingly ill. She could not sleep at night. Anxiety attacks came in waves so intense that she could barely function, let alone take care of her children. I became a second mother to my infant sister, often allowing her to sleep next to me so my mom could get a few moments of rest.
One night, I had to call 911 and watch the paramedics rush her away in an ambulance. Something no child should ever have to do. For years, doctor after doctor dismissed her symptoms. It was not until she reached a breaking point that someone finally took her seriously. She was diagnosed with a grossly enlarged, non-functioning kidney that was swollen six times its normal size and pressing against her adrenal glands.
At just 13, I sat in a hospital waiting room while my mother underwent major surgery to have that kidney removed. Her remaining kidney, her doctor warned, might one day fail as well. I remember telling her that if she ever needed another kidney, I would give her mine. So when I got my driver’s license at 16, I checked the organ donor box without hesitation. I knew what it meant. I knew how desperately some people hope for that phone call that a match has been found, that a life might be saved.
One patient was crying and moving while being prepped for extraction, a moment that Congressman Neal Dunn (R-FL) described as “more fitting for a horror movie than a congressional hearing, frankly.”
In the United States, organ donations are handled through a network of regional nonprofits called Organ Procurement Organizations, or OPOs. Each one has a monopoly over a specific geographic area. When someone dies or is nearing death, hospitals are required to notify the OPO, which then determines whether the patient is eligible to be a donor. The OPO approaches the family for consent, coordinates the removal of the organs, and matches them with recipients through the national transplant system. Families agree to organ donation, believing their loved one has been properly declared dead, and consent must be clear.
This system only works when that trust is unshakable, which brings us to the current crisis.
Network for Hope, the federally chartered OPO serving parts of Kentucky, Ohio, and West Virginia, is now at the center of a scandal that has shaken public faith in the entire transplant system. A federal investigation found that Network for Hope approved organ retrieval from dozens of patients who still showed signs of life. Out of 351 incomplete approvals, seventy-three patients displayed neurological activity that should have disqualified them. At least twenty-eight may not have been legally dead when the organ retrieval process began. One patient was crying and moving while being prepped for extraction, a moment that Congressman Neal Dunn (R-FL) described as “more fitting for a horror movie than a congressional hearing, frankly.” That patient survived.
HHS investigators uncovered systemic problems: faulty neurological assessments, unclear or questionable consent, misclassifications of death, and direct pressure on doctors to proceed with donations despite warning signs. Many of these cases fell under the category of “donation after circulatory death,” in which the patient’s heart has stopped but the brain may still show activity. That type of donation has doubled nationwide since 2021, creating a larger risk of these very abuses.
The fallout has been swift. Thousands of Americans have removed their names from state donor registries, unwilling to risk having their organs taken too soon. Social media is full of personal testimonies from people who say they once supported organ donation but now will not allow it. Their fear is logical: if the system cannot guarantee that the donor is truly dead, then no one is safe.
HHS Secretary Robert F. Kennedy Jr. has threatened to decertify Network for Hope unless they implement strict reforms, including clear donor eligibility rules, comprehensive root-cause reviews for every failure, and a “stop-the-line” policy allowing any staff member to halt a procedure. The National Organ Procurement and Transplantation Network must now track and report every time a procedure is stopped due to safety concerns.
But instead of accepting these reforms as necessary, a coalition of OPOs has sued the federal government to block the new rules, claiming they are unlawful and would lead to widespread decertification. In other words, the organizations responsible for restoring public trust are instead fighting to keep the status quo. Probably not the best strategy for restoring public confidence.
Financially, Network for Hope is not hurting. Its 2023 Form 990 shows $52.65 million in revenue, $51.23 million in expenses, and a $1.42 million surplus. The organization holds $47.45 million in total assets against $21.95 million in liabilities, with $25.5 million in net assets. Executive pay totaled $1.45 million. These are not the numbers of a nonprofit scrambling to survive. This is an organization with the resources to fix its problems, but simply refuses to do so.
This is a dangerous moment for the transplant system. More than 100,000 Americans are currently waiting for an organ, and dozens die each day without one. But every scandal like this drives more people away from registering as donors. Fewer registered donors mean fewer available organs, which means more people dying on the waiting list. Unless OPOs act swiftly to restore public confidence through transparency, strict adherence to medical and ethical standards, and genuine accountability, the damage could last for years.
Those waiting for a healthy organ don’t have that kind of time.
