US organ donation service decertified after investigation finds serious patient safety failures

A US organ procurement organisation is being decertified after federal investigations identified serious patient safety failures, including cases involving potential donors who showed neurological signs incompatible with organ donation.

The US Department of Health and Human Services (HHS) announced that it had begun the process of decertifying Network for Hope, the organisation responsible for coordinating organ donation across Kentucky and parts of Indiana, Ohio and West Virginia.

The decision follows investigations by federal health authorities into the organisation’s practices. Between 2021 and 2024, the Health Resources and Services Administration reviewed 351 cases in which organ donation had been authorised but was ultimately not completed.

Investigators identified concerning features in 103 of those cases, representing 29.3% of those reviewed. This included 73 patients who displayed neurological signs that authorities said were incompatible with organ donation. The investigation also raised concerns that some potential donors may not have been dead when the organ procurement process began.

One of the cases to attract significant attention involved Kentucky man Anthony Thomas “TJ” Hoover II. Hoover had been taken to hospital following a drug overdose in 2021 and was being prepared for organ donation when he showed signs of life.

The case subsequently prompted investigations into the circumstances surrounding the planned organ retrieval. Reports described Hoover moving and crying during preparations for the procedure, which was ultimately stopped.

The wider federal review identified concerns including inadequate neurological assessments, poor coordination with medical teams, questionable consent practices and problems with the classification of causes of death, particularly in cases involving drug overdoses.

Network for Hope had previously been placed under increased oversight and required to implement corrective measures. However, separate reviews by the Health Resources and Services Administration and the Centers for Medicare & Medicaid Services concluded that the organisation had not demonstrated sufficient improvement.

A CMS review carried out in May 2026 found continuing concerns relating to areas including donor evaluation, the handling of adverse events and administration.

HHS announced the decertification action on 5 August, with CMS also publishing a termination notice for Network for Hope.

The action means the organisation is set to lose its federal certification as an organ procurement organisation, with authorities saying the intervention is intended to protect potential donors and maintain public confidence in the transplant system.

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