Organ donation contractors have all come under intense scrutiny for their incessant promoting of misinformation — including the United Network for Organ Sharing (UNOS), many organ procurement organizations (OPOs), and the Association of OPOs (AOPO). (For example, see fact-check of AOPO misinformation from the Vice Chair of the OPTN Patient Affairs Committee.)
Bipartisan reforms have been passed by both Congress and the U.S. Department of Health and Human Services (HHS). However, to ensure that these common sense reforms are implemented to help patients and address health inequities, it is important to correct industry misinformation.
Myth: the U.S. is the best organ donation system in the world
Fact check: The U.S. does not have the “best” organ donation system in the world. As a factual matter, it does currently have the highest number of organ donors per capita, a misleading statistic which industry interests hide behind to cover for poor performance. The truth is that high (and increasing) rates of donors per capita in the U.S. result from America’s higher rates of deaths which lend themselves to organ donation, such as opioid overdoses, gun deaths, suicides, and fatal car accidents.
In the simplest terms, imagine that 100 Americans were in one room, and 100 Canadians in another. In the American room, let’s say 15 people die in organ donation eligible ways, and our system successfully converts 2 of them into organ donors; and in the Canadian room, 2 people die in such ways and their system converts 1 of them into an organ donor. It is not statistically reasonable — or intellectually honest — to suggest that this means the U.S. system is twice as good as the Canadian system simply because it had 2 donors per capita instead of 1.
Now consider that the U.S. has 20 to 30 times more opioid deaths than European nations, 25 times as many gun deaths as other development nations, the highest suicides rates, and more than twice as many fatal car accidents. This contextualizes both why the U.S. system — even replete with such breathtaking performance failures — still produces more donors per capita than other countries, as well as why that statistic, in practice, is completely meaningless.
For further information, see a fact-check from DJ Patil, former U.S. Chief Data Scientist.
Myth: recent increases in organ donation means the system is working
Fact check: The recent increases in organ donations every year have resulted entirely from public health trends — such as spikes in opioid and gun deaths — including as a second-order effect of the COVID pandemic. The increases are not — as industry suggests — the result of any OPO performance improvement.
In fact, peer-reviewed data published in JAMA has found that, after controlling for increases in donation outside of OPO control (e.g., public health trends such as the opioid epidemic), donation rates in recent years have not even kept pace with simple population growth. For a data visualization, see here.
For further information, see a fact-check from DJ Patil, former U.S. Chief Data Scientist.
Myth: recent reforms will “privatize” the organ donation system
Fact check: No, the organ donation system is not being “privatized.” This line is simply protectionist fearmongering from the current monopoly contractor, UNOS, which has spent decades lobbying for very narrow restrictions on eligibility for the Organ and Procurement and Transplantation Network (OPTN) contract such that only UNOS would even qualify to bid. (See Forbes and Washington Post.)
Industry interests began this misinformation largely through astroturf campaigns from UNOS board members and affiliates, in response to Congressional reforms which would lift the nonprofit restriction on eligibility to bid on any portion of the OPTN contract. However, this in absolutely no way means that the system will be “privatized”, or that it will somehow become subject to profiteering.
OPTN policy always has been — and, going forward, still will be — made by the OPTN board, which is not a for-profit entity. Additionally, all fees for OPTN activities must be approved by the Health Resources Services Administration (HRSA), and no contractor would be allowed to get a single dollar out of HRSA that another contractor could not, regardless of tax status.
Additionally, the National Organ Transplant Act (NOTA), explicitly prohibits the receipt of “valuable consideration” in exchange for a human organ; what industry is suggesting is simply not allowed under law, nor is it in any way enabled by recent reforms. In fact, such recent reforms actually further strengthen the government’s leverage in holding its contractors accountable, including specifically to combat any inappropriate behavior or profiteering activity.
The industry lobbying line that for-profits will take over policymaking activities and engage in profiteering activities is complete nonsense, and is in no way possible given existing regulatory and statutory constraints which no one has proposed changing. All that will change is that the HRSA now has a larger pool of potential bidders to perform various functions (e.g., data analysis) for HRSA as well as the OPTN board, which helps guard against the vendor lock-in dynamic that entrenched UNOS for decades to the detriment of patients.
Lastly, industry interests have recently begun promoting a conspiracy theory that decertified OPOs will be replaced by for-profit OPOs. That is unequivocally false. By statute, OPOs must be nonprofit, and no one has proposed changing that.
As a related fact-check, Organize, a non-profit patient advocacy organization which contributed to this website, is not involved in any attempts to win any OPTN contracts, nor does Organize financially profit in any way from any organ donation reforms. Repeated industry suggestions to the contrary are categorically false.
For further information about the actual problematic influence of profiteering in the organ donation industry, see bipartisan oversight letters from Senate Finance Committee to 10 OPO CEOs into “Potential Self-Dealing And Financial Conflicts Of Interest”, sent in September 2023.
Myth: criticizing the system will undermine trust in donation
Fact check: A standard industry line to quash criticisms is to suggest that any criticism of the donation system will undermine public trust in the system, and by extension will depress donation rates.
Peer-reviewed research, however, has shown that the exact opposite is true. Rightful criticisms of the industry — as well as specific actors within the industry — actually correlate with increases in donation rates, which researchers attribute to the Hawthorne effect.
For decades, OPOs have operated without any competitive, regulatory, or financial pressures to provide high levels of care to patients. Unless and until the government begins to truly hold them accountable, public criticisms of the system have served as something of a stand-in for such systemized accountability, and serve as a tool for patients and caregivers to receive more value from the donation system.
Myth: the rule will decertify a third of all OPOs
Fact check: In 2020, and again in 2021, the Centers for Medicare and Medicaid Services (CMS) finalized a new rule to hold OPOs accountable to objective data. This was long-overdue, and celebrated by every major patient group on record.
The rule works by placing OPOs in one of three “tiers” based on performance. The tier ranking system uses epidemiological government data held by the Centers for Disease Control and Prevention (CDC) to evaluate how well OPOs perform relative to each other on the same lifesaving functions.
Just because there are three tiers does not mean that OPOs will necessarily be apportioned into them evenly. In fact, as clearly outlined in the OPO rule, all OPOs can be Tier 1 in any given cycle, so long as they are not significantly underperforming their other OPO counterparts:
“Under our methodology, all OPOs have the opportunity to cluster at the top because we generate confidence intervals for their donation and organ transplantation rates… Our methodology allows all OPOs the opportunity to perform as well as the top OPOs.”
Tier 1 OPOs will keep their CMS-assigned DSAs without facing competition; Tier 2 OPOs can compete to keep their CMS-assigned DSAs, while high-performing OPOs are welcome to compete to serve these DSAs; and Tier 3 OPOs will lose their certification due to their failure to perform their lifesaving function, and the DSA that was previously assigned to those OPOs will be open to competition to higher-performing OPOs.
If no OPOs compete for an open DSA, CMS will assign these DSAs to high performing OPOs. Because OPOs are funded on a cost-reimbursement basis, expanded OPOs have access to resources to expand their services without diluting care.
Myth: Decertifying failing OPOs will disrupt donation services
The 2020 CMS Final Rule establishes a process by which all parts of the country are served by high-performing OPOs.
CMS is committed to seamless transitions to ensure that donation is never disrupted. Through any decertification process, no part of the country will ever be left without donation service – an OPO will always be assigned to cover every part of the United States.
Seamless transitions are grounded in decades of historical precedence. In September 2025, HHS announced an OPO decertification in Miami. In January 2026, CMS announced another OPO was assigned to the donation service area (DSA); there was no disruption of service.
The Bridgespan Group conducted a data-driven analysis of OPOs expanding their donation service areas, and found no evidence that OPOs expanding their service areas has ever been disruptive. In fact, typically performance in expanded service areas has improved, which is to be expected as higher-performing OPO leadership replaces lower-performing OPO leadership.
Myth: OPOs are disadvantaged by the transplantation rate
Fact-check: A key responsibility of all OPOs is working with transplant centers to ensure that organs are efficiently matched with patients on the organ waitlist.
As CMS has previously written, “it is the OPO’s responsibility to ensure that placement and transport of organs happen in a fast and effective manner. If the OPO engages in best practices for placement, packaging, and transportation of organs, such as using [radio-frequency identification] RFID tags to track organs in transit and assure that they are not forgotten or diverted, there should not be significant differences in the frequency of zero organ donors among OPOs because the occurrence of unexpected anatomical issues which contraindicate donation that arise after consent is secured are random and not statistically significant in one DSA compared to another.”
In other words, all OPOs serve this function, there is no evidence that OPOs face differential barriers to perform.
Myth: Closing the pancreas loophole will not discourage legitimate research
Fact-check: When the OPO rule was finalized, CMS noted concern submitted by stakeholders that the rule could unintentionally create a loophole by which OPOs are given regulatory credit for recovering pancreases “for research”.
CMS further noted that the expected impact of pancreata for research to be minimal, given that, historically, the number of pancreata for research had been small and had been trending downward, and that CMS would “continue to monitor the trends of pancreata procured for research and will use the survey process to conduct further investigation into any anomalies that such monitoring reveal.”
Given significant increases by some OPOs in pancreata listed “for research” – with no concomitant increase in pancreatic islet cell transplant research that the measure was designed to cover – CMS pledged to close this loophole, in line with bipartisan requests from Congress.
Closing this loophole will help restore public trust and integrity to the organ donation system, and protect donor patients from potential abuse. Additionally, closing this loophole protects meaningful pancreatic islet cell research, rather than discouraging it.
CMS is committed to ensuring that the OPO rule focuses OPOs on activities which best support patient care.
Myth: there is already a study from the National Academy of Sciences, Engineering and Medicine (NASEM) on organ donation, so we don’t need any other reforms
Fact check: The NASEM study is under investigation from both the House Oversight Committee and the Senate Finance Committee for financial conflicts of interest among its committee members. This was reported on in both Kaiser Health News and the Washington Post. (NASEM has also come under scrutiny for being influenced by financial conflicts of interest in other studies as well.)
In fact, the Senate Finance Committee explicitly noted that “we are concerned about the appearance of conflicts of interest among NASEM committee members, particularly those who appear to have a financial stake in the implementation of NASEM’s recommendations… We are concerned that the NASEM report seems to align with the lobbying positions of UNOS and the Association of Organ Procurement Organization