In a move that will surprise exactly no one who remembers the 2021 incident, the US Department of Health and Human Services (HHS) has begun proceedings to decertify Network for Hope (NFH), a Kentucky-based organ procurement organization accused of trying to harvest a living man's organs. The decertification, announced Wednesday, would effectively shut down the organization, which serves Kentucky and parts of Indiana, Ohio, and West Virginia. If NFH loses its certification, another organization will be appointed to coordinate donations in the region - presumably one with a better grasp of the 'living' part of 'living donor.'

NFH, unsurprisingly, 'strongly disagrees' with the HHS finding and plans to appeal. The HHS decision stems from two federal investigations that found 'persistent patient safety failures,' despite extensive oversight and opportunities to correct them. The investigations, conducted by the Centers for Medicare & Medicaid Services and the Health Resources and Services Administration (HRSA), examined 351 NFH cases where organ donations were authorized but canceled. In 103 of those cases, investigators found 'concerning features,' including 73 cases where patients had neurological signs that should have made them ineligible for donation. That's a lot of red flags, even for an organization that might argue it was just being thorough.

The scrutiny comes amid a rise in donations after circulatory death (heart stops) rather than brain death. In such cases, families decide to withdraw life support when recovery seems unlikely. Organ procurement organizations can't declare death or be involved in care decisions - but apparently, they can still pressure hospital staff to proceed, as alleged in the 2021 incident involving Anthony Thomas Hoover II. Hoover, a Kentucky man in his 30s, had overdosed and was unresponsive for two days. His family agreed to donate his organs, believing he wouldn't recover. But as surgery approached, he began showing signs of improvement, which allegedly went ignored by organ procurement workers. NFH's predecessor, KODA, allegedly pressured hospital staff to proceed, even as Hoover cried, pulled his knees to his chest, and shook his head while being wheeled into the operating room. Doctors refused to proceed, and the surgery was canceled. Hoover recovered, though with lingering neurological injuries. His sister appeared at the press briefing announcing the decertification efforts.

NFH claims it complies with all federal organ policies and has since implemented a 'pause' process - now state law in Kentucky - allowing anyone involved to pause donation plans if concerns arise. A lovely idea, though one might argue the pause should have happened before the man was wheeled into surgery, not after. Meanwhile, over 103,000 people remain on the US organ transplant waiting list, and there were more than 49,000 transplants last year. Here's hoping the next organization in charge has a better handle on the difference between a donor and a patient.