For nearly two decades, the organ donation system in the United States has saved tens of thousands of lives annually, but concerns about ethical lapses and mismanagement within the industry have prompted calls for urgent reform. Greg Segal, founder and chief executive of Organize, a nonprofit focused on improving organ donation processes, has brought attention to serious allegations of misconduct among organ procurement organizations (OPOs).
Segal's personal connection to the issue began when his father underwent a heart transplant in 2009 after years of battling a rare genetic heart condition. The family’s experience highlights the life-saving potential of organ transplantation, but Segal points to deeper systemic problems that threaten patient safety and undermine public trust.
Organ procurement organizations are federally contracted nonprofits charged with coordinating the recovery of organs from deceased donors. While they have successfully increased the number of transplants, Segal has documented widespread reports of unethical practices within these organizations. These include accusations of financial fraud—such as billing taxpayers for non-essential expenses like private jet charters—and negligence, including unnecessary medical procedures intended to maximize Medicare reimbursements.
One highly publicized case involved Anthony Thomas Hoover III, a 33-year-old man declared brain-dead after a drug overdose. Despite signs that he regained consciousness during pre-donation evaluation and even resisted the transplant procedure, procurement staff allegedly pressured surgeons to proceed with organ recovery. Hoover survived the ordeal but remains traumatized. His case has become emblematic of broader concerns related to patient safety and ethical violations.
Federal investigations have identified instances of procurement organizations retaliating against whistle-blowers, withholding information from regulators, and manipulating medical records. These actions have led to criminal probes and ongoing scrutiny by law enforcement agencies.
Historically, many OPOs have been criticized for complacency, failing to recover sufficient organs to meet demand. These organizations operate as government-sanctioned monopolies within defined regions, and until recently, faced few consequences for underperformance. In 2020, new federal rules introduced accountability measures allowing for contract termination due to poor results. Since then, transplant rates have improved by approximately 25 percent.
However, some industry members argue that these heightened expectations risk promoting overly aggressive organ recovery efforts, potentially compromising donor safety. Segal and others contend that expanding the volume of recovered organs and safeguarding patient welfare are not mutually exclusive goals, calling instead for stronger enforcement of safety standards.
Centers for Medicare & Medicaid Services (CMS) head Dr. Mehmet Oz has pledged to intensify oversight, describing himself as “a new sheriff in town.” His agency has recently revoked contracts from underperforming organizations in South Florida and initiated action in Kentucky, with New Jersey’s procurement organization facing similar allegations.
Officials urge the White House to prioritize oversight of the organ donation system as part of broader Medicare fraud enforcement. Vice President J.D. Vance, who previously co-sponsored legislation to dismantle the national OPO monopoly, currently leads a White House antitrust task force that could push for expanded Justice Department investigations.
Segal has publicly removed himself from the organ donor registry until systemic reforms restore confidence in the safety and integrity of the organ donation process. He envisions a future where donors and recipients alike can trust the system to operate transparently and ethically.