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“Lives at Stake: Holding Tax-Exempt Organ Procurement Organizations Accountable”

House Ways and Means Oversight Subcommittee

December 2nd, 2025 (recording linked here)

WITNESS & TESTIMONY

• Heather Knuckles: Family Member of Organ Donor

• Nycki Martin: Whistleblower; Former OPO Employee

• Jennifer Erickson: Senior Fellow for Organ Donation Policy, Federation of American Scientists

• Emily Gee: Senior Vice President for Economic Policy and Senior Fellow for Health Policy, American Progress

HEARING HIGHLIGHTS

MEMBER OPENING STATEMENTS

• Chair Schweikert (R-AZ) recognized the vital work of organ procurement organizations. He stated that while their mission saves lives, they must still be subject to oversight and accountability. Schweikert described how the committee began requesting information in April and received troubling whistleblower reports, raising concerns about potential weaknesses at all levels—from hospitals to CMS. He asked witnesses to guide the committee on where further investigation should go and whether reforms such as new scoring models might be needed to improve outcomes.

• Ranking Member Sewell (D-AL) stressed that this issue was about saving lives, not political ideology, and affects over 100,000 Americans waiting for transplants. She cited multiple independent reviews and watchdog reports highlighting that some OPOs perform exceptionally while others have poor recovery rates and mismanagement. Sewell brought forward disturbing examples from Alabama, including lawsuits over missing organs and systemic accountability failures. She emphasized the need for transparency, equity, and reforms, particularly to address racial disparities and the negative impact of recent Republican-led legislation that could weaken access to healthcare for transplant patients.

WITNESS OPENING STATEMENTS

• Ms. Knuckles shared the tragic account of her mother’s liver and kidney transplant, which began with hope but ended in her mother’s death due to a cancerous donor liver. She recounted how post-surgery scans revealed high-grade metastatic cancer not reported in the original donor documentation. Despite her mother's deteriorating condition, the family struggled to get clear answers from the transplant team. Knuckles urged Congress to strengthen donor screening and hold OPOs accountable to prevent other families from enduring similar tragedies.

• Ms. Martin testified that her former OPO employer manipulated metrics to boost Medicare payments, disregarding medical ethics and endangering patients. She detailed a case involving TJ Hoover, a donor who had regained consciousness, but the recovery process continued without full neurological exams or proper consent. Martin described how staff concerns were silenced, records were restricted, and whistleblowers were retaliated against. After she came forward, a federal investigation found over 100 organ donation errors in just 89 days, prompting her call for systemic reform and leadership change within the OPO system.

• Ms. Erickson described a national crisis in organ procurement, stating that OPOs have abused public trust, misused taxpayer money, and in some cases, endangered patients who were still alive. She cited whistleblower accounts of coercion, improper sedation, and manipulation of documentation, along with financial entanglements involving tissue companies and shadow spending. Erickson emphasized that the line between donation and harvesting is consent, and that violations of this boundary have resulted in horrifying abuses. She urged Congress to replace and prosecute any OPOs that have acted unethically and to protect families from corrupt or negligent practices.

• Dr. Gee emphasized the need for rigorous oversight of OPOs alongside the importance of protecting Americans’ access to comprehensive healthcare coverage. She noted that HHS and CMS already have the authority to decertify underperforming OPOs and cited a recent example in South Florida. Dr. Gee warned that ongoing federal policy changes, including cuts to Medicaid and ACA subsidies, could leave millions uninsured, jeopardizing transplant eligibility and post-surgical care. She concluded that health coverage is a vital factor in transplant access and outcomes, and that Congress should act to prevent worsening inequities.

QUESTION AND ANSWER SUMMARY

• Full Committee Chair Smith (R-MO) opened by sharing a personal connection to the transplant system, emphasizing how public trust in organ procurement is vital to ensuring ongoing donor participation. He asked whether Mid-America Transplant acknowledged any failures, to which Ms. Knuckles responded that it had not.

  Full Committee Chair Smith then pressed for legislative solutions, and Ms. Knuckles urged Congress to mandate rigorous donor screenings and conduct case-specific investigations.

  Full Committee Chair Smith also questioned about broader reform needs, to which Ms. Erickson and Ms. Martin both stressed the importance of transparency, informed consent, and holding OPOs like Network for Hope and the New Jersey Sharing Network accountable through oversight and law enforcement.

• Ranking Member Sewell (D-AL) referenced reports of OPO-related abuses in Alabama, including unauthorized organ removals from incarcerated individuals. She asked how Congress could ensure patient safety. Ms. Erickson reiterated the urgency of removing dangerous OPOs and emphasized the bipartisan nature of the issue.

  Ranking Member Sewell requested details on the impact of ACA tax credit expirations. Dr. Gee explained that losing those subsidies would increase premiums dramatically, possibly forcing transplant patients off waitlists due to loss of required insurance.

  Ranking Member Sewell asked what single reform could restore public trust, and Ms. Martin proposed a more transparent, family-inclusive consent process.
  

• Rep. Bean (R-FL) asked for an explanation of the loophole that allows OPOs to recover organs without transplanting them. Ms. Erickson explained that CMS’s 2020 rule allowed credit for pancreases recovered for “research,” even though no actual research or transplant occurred.

  Rep. Bean pressed further on the scale of the issue. Ms. Erickson testified that over 7,000 pancreases had been harvested under this loophole since 2020, yet islet cell transplant rates remained flat. She confirmed that New Jersey Sharing Network discarded 100 pancreases in one day during a federal investigation, misleading grieving families and violating their trust.

  Rep. Bean also questioned about OPO misuse of taxpayer funds. Ms. Erickson pointed to inflated executive salaries, perks unrelated to patient care, and CMS payments driven by fraudulent metrics. She confirmed that Medicare is the primary payer in this system—meaning the taxpayer is ultimately footing the bill.

• Rep. Yakym (R-IN) referenced the committee’s letter to the New Jersey Sharing Network, which included allegations ranging from Medicaid fraud to recovering organs from patients who showed signs of life. He asked for parallel examples. Ms. Martin described a recent incident involving an elderly ICU patient in Kentucky whose pancreas was recovered for research despite poor medical suitability. She said whistleblowers are silenced when raising such concerns, and that some practices continue unchecked.

  Rep. Yakym asked about donation after circulatory death (DCD) cases, and Ms. Martin testified that patients were often sedated and paralyzed without sufficient evidence of brain death, calling it a pattern of failing to give patients a real chance.

  Rep. Yakym then asked whether unethical practices were confined to a few OPOs or more widespread. Ms. Erickson responded that while not all OPOs were bad actors, systemic misconduct is occurring at organizations like Network for Hope, New Jersey Sharing Network, and OneLegacy, all funded by taxpayer dollars. She called for federal action and replacement of these OPOs.

• Rep. Chu (D-CA) asked how many transplant patients could be denied life-saving procedures due to loss of health insurance. Dr. Gee stated that over 20 million people currently receive subsidies, and millions could lose coverage if the credits expire, affecting their ability to get or remain on transplant waitlists.

  Rep. Chu then addressed claims by Republicans that patients could shift to cheaper, high-deductible or short-term plans. She asked for clarity on why such plans would endanger transplant recipients. Dr. Gee explained that these plans often exclude coverage for pre-existing conditions, hospital care, prescription drugs, and immunosuppressants. She warned that bare-bones insurance could lead to transplant failure due to delayed care or unaffordable medication.

• Rep. Moran (R-TX) commended the whistleblower and asked what message she had for others in the industry. Ms. Martin urged fellow OPO employees to come forward, saying whistleblowers must be protected so they are not retaliated against or fired for doing the right thing.

  Rep. Moran asked what consequences should be applied. Ms. Erickson argued that Medicare fraud and lying to families are crimes and that executives at bad OPOs should be removed and prosecuted.

  Rep. Moran asked how Congress could support whistleblower protections and assist law enforcement. Ms. Erickson pointed to UNOS as a federal contractor that had retaliated against whistleblowers and patient advocates, and said that taxpayers should not be funding organizations that obstruct investigations. She urged the committee to work with DOJ and HHS to hold both OPOs and federal contractors accountable.

• Rep. DelBene (D-WA) asked what HHS, CMS, and HRSA should do to address fraud and waste. Dr. Gee urged the agencies to increase transparency, enforce compliance, and replace underperforming OPOs.

  Rep. DelBene noted the racial disparities in kidney transplantation and the high rate of discarded kidneys. She asked how to improve acceptance rates. Ms. Erickson emphasized the importance of public access to OPO data so that disparities and delays in family outreach can be identified and corrected.

  Rep. DelBene then raised concerns about how loss of preventive care due to insurance gaps could increase transplant demand. Dr. Gee predicted that a rise in uninsurance could reverse the gains seen under ACA expansions, leading to fewer patients being listed for transplant and worse outcomes, particularly among lower-income populations.

• Rep. Suozzi (D-NY) shared a story of a constituent who had been waiting nine years for a kidney and expressed concern that current incentives reward organ recovery but not successful transplantation. Ms. Erickson confirmed that CMS can and should remove OPOs like those in Kentucky and New Jersey that have failed to meet ethical and clinical standards.

  Rep. Suozzi asked whether other OPOs warranted attention. Ms. Erickson identified OneLegacy in Los Angeles and the Oklahoma OPO, both of which are under scrutiny for potential fraud and self-dealing.

  Rep. Suozzi also asked how to prevent OPOs from inflating kidney counts for financial gain. Ms. Erickson urged Congress to eliminate “financial counts” and focus solely on clinical outcomes, as counting unused organs amounts to Medicare fraud.

• Rep. Beyer (D-VA) expressed support for whistleblowers and asked what Congress could do to protect them. Ms. Erickson called on HHS to immediately terminate contracts with any OPOs or federal contractors, including UNOS, that retaliate against whistleblowers. She cited reports from Virginia showing taxpayer funds being used to silence patient advocates and even congressional witnesses.

  Rep. Beyer then asked about allegations that OPOs used sedatives to hasten death in order to recover organs. Ms. Erickson confirmed that such practices are criminal and are under investigation by the Kentucky Attorney General.

  Rep. Beyer questioned the practice of OPOs transferring hundreds of millions of dollars to “related organizations.” Ms. Erickson cited OneLegacy’s use of such arrangements to move money outside of Medicare oversight and emphasized the need for CMS to investigate and shut down these financial channels.

  Rep. Beyer asked about coercion in consent procedures. Ms. Erickson explained that whistleblowers in New Jersey reported racial and socioeconomic profiling in donor recruitment, with aggressive tactics used on marginalized families. She called for DOJ-level resources and cross-agency action to address what she described as a national crisis.

• Chair Schweikert (R-AZ) asked whether scoring systems differed among organ types and how CMS tracked OPO performance. Ms. Erickson noted that kidneys are treated differently in Medicare reimbursement, and that the system is prone to fraud due to how CMS metrics are used.

  Chair Schweikert inquired about how death is determined in donation cases. Ms. Erickson and Ms. Martin explained the distinction between brain death and circulatory death (DCD), detailing hospital protocols, wait times, and declaration procedures. They also described a disturbing case in Mississippi where a woman was mistakenly declared brain dead and then found to be alive during organ biopsy — but the OPO failed to alert medical staff or her family for 19 hours.

  Chair Schweikert discussed the need for CMS and HHS to prepare for coming advances such as cryopreservation, genetically modified organs, and Hepatitis C treatment breakthroughs.