The US Department of Health and Human Services has begun decertifying Network for Hope (NFH), a Kentucky-based organ procurement organisation that became infamous after a 2021 case in which a man showed clear signs of life while being wheeled into surgery to have his organs removed. Losing certification would effectively shut down NFH, which coordinates donations across Kentucky, Indiana, Ohio and West Virginia; another organisation would then be appointed to take over the region. NFH says it "strongly disagrees" with the finding and plans to appeal, while the case has renewed scrutiny of organ procurement practices nationally, particularly around donations following circulatory death rather than brain death.

Two separate federal investigations found "persistent patient safety failures" at NFH despite years of oversight. One probe, by the Health Resources and Services Administration, examined 351 cases where authorised donations were later cancelled and found "concerning features" in 103 of them, including 73 involving patients with neurological signs that should have ruled out donation. The 2021 incident involved Anthony Thomas Hoover II, who had overdosed and was believed unlikely to recover, but began crying and reacting as he was taken into theatre; the retrieval was halted and he survived, though with lasting neurological injuries. NFH's predecessor, KODA, allegedly pressured staff to proceed regardless. NFH says it has since introduced a "pause" process, now enshrined in Kentucky law, letting anyone involved halt a donation if concerns arise. More than 103,000 Americans remain on the transplant waiting list, with over 49,000 transplants performed last year.