In a groundbreaking move, Health Secretary Robert F. Kennedy Jr. announced Thursday that federal officials are taking the unprecedented step of terminating the contract of one of the organizations tasked with coordinating organ donations across the United States. This decision marks a significant escalation in the government’s ongoing campaign to rectify the national transplant system, which has been plagued by allegations of unsafe procedures and inequitable practices.
The organization in question, the Life Alliance Organ Recovery Agency in South Florida, is one of 55 non-profit entities nationwide holding federal contracts to facilitate organ transplants. Mr. Kennedy explicitly stated that severing ties with Life Alliance, which will effectively lead to its closure, is intended as a clear message to all other procurement groups: drastically improve operations or risk similar decisive action.
Beyond this immediate action, Secretary Kennedy has mandated that all organ procurement organizations (OPOs) implement critical reforms. These include the appointment of dedicated patient safety officers to enhance donor protection and guarantee impartiality in the vital process of organ allocation.
These federal interventions follow extensive investigative reporting that brought to light systemic issues throughout the transplant network.
“We are taking bold and historic action to restore public trust in the organ procurement process,” Kennedy affirmed.
Kennedy highlighted Life Alliance’s “long record of deficiencies directly tied to patient harms,” detailing various citations for issues such as inadequate staffing, insufficient training, and critical paperwork errors.
While the University of Miami-based organization retains the right to appeal the health department’s decision and will continue operations during this interim period, if their appeal is unsuccessful, the federal contract will be reassigned to another qualified procurement organization.
The South Florida organization has not yet responded to requests for comment regarding these developments.
Many of the underlying issues within the system are linked to the growing reliance on “donation after circulatory death” (DCD), a complex and increasingly common practice.
Unlike traditional organ donations from individuals declared brain-dead, DCD involves potential donors who still exhibit brain function. These patients are typically on life support, often in a comatose state, with no expectation of recovery. Should donation be authorized by their families, medical professionals will withdraw life support, allow the patient’s heart to cease beating, and then proceed with organ retrieval.
Previous reports documented numerous instances where patients undergoing DCD procedures experienced premature or mishandled organ retrieval attempts. In several cases, hospitals, despite their duty to care for potential donors, incorrectly concluded that patients had no chance of recovery. Disturbingly, some procurement organizations reportedly disregarded clear signs of alertness in patients who were being prepared for donation.
A particularly troubling incident cited involved the Miami organization in 2023. According to two Life Alliance employees, doctors at a Florida hospital removed life support from a patient who was reportedly crying and biting his breathing tube. The patient subsequently died, and his organs were harvested. Life Alliance declined to comment on this specific case, citing patient privacy regulations.
The Association of Organ Procurement Organizations, a prominent national trade group, maintains that such errors are infrequent, emphasizing that organ donations collectively save thousands of lives annually.
Further compounding the issues, many procurement organizations have been found in violation of federal regulations by increasingly sidestepping patients on official transplant waiting lists. Instead, organs were allocated to recipients who were less critically ill and had not waited as long. Data reveals that nationwide, organizations bypassed eligible patients in almost 20% of transplants last year, a six-fold increase from just a few years prior.
This concerning practice was also observed in cases linked to the Life Alliance Organ Recovery Agency. The group’s former executive director, while expressing personal disapproval of bypassing patients, justified the practice by claiming it improved efficiency and reduced organizational costs.
For many years, federal officials largely failed to adequately address these issues of patient bypassing and other systemic flaws. Although the government previously threatened to not renew a contract with a New York City procurement organization in 2018, it ultimately did not follow through. Thursday’s announcement, therefore, marks the first time the agency has actively moved to decertify an organization in the middle of its contract term.
Increased federal oversight of the transplant system was prompted last year after a House committee heard harrowing testimony about a Kentucky man whose organs were sought for donation even as he physically reacted, shaking his head and pulling his knees to his chest. A subsequent federal investigation revealed that the Kentucky procurement organization had repeatedly ignored similar signs of brain activity in dozens of other patients prepared for circulatory death donation.
The House committee convened a hearing in July and last week issued a bipartisan request to the agency, seeking further details on patient safety within the system. Concurrently, another committee penned a separate letter specifically highlighting concerns related to Life Alliance.
In response, the health department mandated reforms for the Kentucky procurement organization and unveiled broader systemic changes. Currently, working groups are developing new policies for circulatory death donation and organ allocation. Additionally, a public website now actively monitors how frequently organizations bypass patients, and federal officials are actively investigating other procurement organizations.
Secretary Kennedy proudly announced that this year’s intensified efforts to curb ‘line-skipping’ practices have already resulted in organs being directed to an estimated 289 patients who might otherwise have been unfairly overlooked.
Kennedy also shared a personal connection, speaking with pride about a nephew who had been an organ donor. He and other officials reiterated that these reforms are fundamentally aimed at safeguarding the profound gift of organ donation and reinforcing the crucial trust families place in the system.
“If families lose trust, fewer will choose donation,” emphasized Thomas J. Engels, who leads the division overseeing the transplant system. “That outcome is simply unacceptable, and we are committed to fixing these issues.”