LEXINGTON, Ky. — Federal health authorities revoked the operating license of Network for Hope, an organ procurement organization covering a four-state region, after a government review found that the network had initiated organ harvest procedures on patients whose deaths had not been properly established, Health and Human Services Secretary Robert F. Kennedy Jr. announced Wednesday.
The revocation strips Network for Hope of its federal certification to recover and distribute organs under government health programs. The network served the procurement region covering Kentucky, Indiana, Ohio, and West Virginia — one of 56 federally designated organ procurement organizations in the United States. Chief executive Barry Massa said the organization would appeal the revocation.
The review was conducted jointly by the Health Resources and Services Administration and the Centers for Medicare and Medicaid Services. Of 351 cases the agencies examined, 103 raised concerns significant enough to warrant closer scrutiny. In 73 of those cases, reviewers concluded that patients had not been neurologically assessed in a manner consistent with established brain-death protocols at the time organ procurement was initiated — a finding the agencies characterized as patients being neurologically incompatible with the death determinations that preceded the procedures.
Kennedy announced the action at a press conference in Lexington, Kentucky, framing the revocation as a federal accountability measure for an organization whose clinical practices had deviated from the legal and medical standards governing organ procurement in the United States. He did not specify what interim arrangement, if any, would govern organ procurement services in the four-state region during the appeals process.
The inquiry was triggered in part by the case of TJ Hoover II, whose sister reported that he opened his eyes during an organ procurement procedure — a detail that attracted congressional attention, including scrutiny from the House Ways and Means Committee, and prompted HRSA and CMS to undertake the broader review of Network for Hope’s case history. The organization has disputed the characterization of the Hoover case. The broader review produced the 73-case finding that the agencies cited in the revocation decision.
Organ procurement organizations are federally certified entities that coordinate the recovery of organs from donors and their distribution to transplant centers. Their clinical authority extends to the determination of donor eligibility, which in practice means their staff participate in or oversee the neurological assessments that establish brain death — the legal and medical threshold for organ procurement. A finding that an organization initiated procurement before that threshold was met is among the most serious clinical failures the federal oversight system recognizes.
The gap Kennedy’s announcement did not address is what happens to the region during the appeal. Kentucky, Indiana, Ohio, and West Virginia have a significant transplant patient population. Organ recovery from deceased donors in those states must continue during the adjudication period, and no interim mechanism was publicly specified Wednesday to ensure that coverage. For patients awaiting transplants in the four states, the practical consequence of the revocation — and of any gap in procurement coverage — is immediate.
The Department of Health and Human Services has authority under 42 CFR Part 486 to decertify organ procurement organizations that fail to meet performance standards. The Network for Hope action is more severe than a performance-based decertification: it involves an allegation of clinical misconduct — initiation of procurement on patients whose brain death had not been established — rather than a failure to meet organ yield or family consent benchmarks. That distinction matters for the appeal, which will require the organization to contest not a performance metric but a clinical process finding.
What the revocation decision does not answer publicly is what happened to the 73 patients the review identified as neurologically incompatible with the death determinations that preceded their procurement procedures. Whether any of those patients survived, and under what circumstances their care was managed once the incompatibility was recognized, was not addressed in Kennedy’s announcement or in the agencies’ public statements Wednesday. That question has been central to advocacy by families connected to the cases, and the revocation — focused on the organization’s certification status — does not resolve it.
Barry Massa’s announced appeal will be the next substantive event in the case. Administrative appeals of federal OPO certification actions typically proceed through an HRSA hearing process before judicial review becomes available. The timeline for that process, and whether Network for Hope’s certification will be maintained or suspended pending appeal, was not specified Wednesday.
