At a recent hearing of the House Ways and Means Oversight Subcommittee, lawmakers examined troubling practices among tax-exempt organ procurement organizations (OPOs). The session included personal stories from Americans who experienced problems with the organ donation system, as well as testimony from experts and former OPO employees calling for more oversight.
The hearing followed an ongoing Committee investigation into OPOs that has uncovered clinical failures, misuse of public funds, and questionable financial conduct. According to findings cited at the hearing, 18 out of the 21 most profitable OPOs are ranked in the lowest-performing tiers by the Centers for Medicare & Medicaid Services (CMS).
Federal investigations have found evidence that some OPOs have improperly interfered with determining when a donor is legally dead—a responsibility that belongs to hospitals. Jennifer Erickson, an expert on organ donation policy, explained: “It is the hospital that declares death. One of the things that has come out through the HRSA’s detailed report about Network for Hope and KODA [Kentucky Organ Donor Affiliates] in Kentucky is that often OPO staff get involved in that decision-making process in ways that they should not.”
Testimony also addressed how recent incidents have eroded public trust in organ donation. Nyckolleta Martin, a former Kentucky OPO employee, said: “…I think this has to start from regaining public trust, and the only way to do that is to have transparency and accountability, and for Congress to continue working with other legislative bodies and law enforcement specifically to make sure that these people are held accountability for what they’ve done, so that it doesn’t happen in the future. Then, we can show the public that we see the problems, and we’re working on them. The public should have more informed consent. They should truly understand what they’re signing up for when they sign up to be an organ donor, because organ donation is so important, and we need it so badly. Thousands of people are dying, but also thousands of people are taking their name off the organ donation registry, so we have to fix that.”
One Missouri woman described her mother’s experience receiving a liver transplant infected with cancer due to errors during donor screening. Heather Knuckles recounted: “On October 30, 2022, my mother underwent the liver and kidney transplant at Barnes Hospital in St. Louis with organs procured by Mid-America Transplant…On November 3, transplant surgeons informed us that the donor liver contained high-grade metastatic cancer that was not reported on the donor records from UNOS [United Network for Organ Sharing], but was discovered by the transplant hospital…Our dreams were shattered. Fear and sadness washed over my mother’s face... Following the passing of my mother, we suffered nearly three years as this horrific ordeal was ignored.”
Martin also testified about cases where OPOs attempted organ recovery even after patients showed signs of life or regained consciousness—practices she called breaches of medical standards and ethics. She stated: “In 2021, T.J. Hoover was brought to the hospital in cardiac arrest…T.J. had remained unresponsive for several days, regaining consciousness during his cardiac catheterization... Even more alarming...the family was never informed that T.J. had regained consciousness... Under my former employer’s own protocol at that time, the case should have been halted immediately once neurological function improved..."
Lawmakers raised concerns about taxpayer funding supporting problematic OPO activities through Medicare reimbursements—even covering costs like executive compensation or lobbying expenses not eligible under program rules.
Jennifer Erickson clarified: “The largest single payer is Medicare, so the taxpayer.”
The hearing took place just before a deadline set by the Committee for New Jersey Sharing Network—an OPO under scrutiny—to provide documents and schedule interviews related to its practices.
