Regulators plan to decertify lowest-ranked organ donation groups by early next year

Federal regulators are cracking down on the nonprofits that coordinate organ donation. They aim to begin shutting down substandard groups by early next year, Stateline reported Friday ¹.

The Centers for Medicare and Medicaid Services (CMS) will score the nation's 55 organ procurement organizations on donation and transplantation rates. The lowest tier will be decertified, which means their federal contracts are revoked ¹.

How the ranking works

Groups in the top 25% are automatically renewed for four years. Second-tier groups can improve and reapply. Bottom-tier groups are decertified, and other nonprofits then bid to take over their service areas ¹.

CMS first announced the framework in 2020, responding to an executive order from President Donald Trump. Earlier this year it released proposed revisions ¹. A law firm's summary says the proposal, published January 30, 2026, would assign tiers to service areas rather than to whole organizations ².

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CMS has not said which groups will be renewed or dropped. The current four-year contracts expire in January, and CMS has said it will issue extensions as needed so transplants continue ¹.

Why the stakes are high

More than 109,000 people are on waiting lists, according to federal data as of July. Most are waiting for kidneys, and about a dozen patients die each day waiting, on average ¹.

Media reports and research have found problems at some groups, including skipping over some transplant centers and sicker patients. That worsens racial and economic gaps in who gets transplants ¹. The federal government has shut down at least two groups in the past two years ¹.

The nonprofits push back

The Association of Organ Procurement Organizations says nearly 42% of the 55 groups could land in the bottom tier. It warns of disruptions in coordinating donations ¹.

Several lawsuits are pending. A federal district court in Florida recently upheld the rule in a case brought by groups serving California, Florida, Georgia, Iowa, Puerto Rico, Texas and Washington state. Those groups have appealed ¹. A Hawaii nonprofit sued in August ¹.

The plaintiffs argue that outcomes like transplant rates are not within their control ¹². Transplant surgeons are divided. The American Society of Transplant Surgeons supports what it called "long-overdue" changes, but it also raised concerns about grading groups on transplant rates ¹.

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What happens next

CMS said in March the process would begin late this year, but it gave no specific date for releasing decisions ¹. Under the proposal, a group assigned only to bottom-tier service areas would be decertified ².

The pattern is a system that many experts say needs measurable standards. How CMS handles the transition will decide whether patients see better results or disruptions. This analysis is The GOP Files' own.

The Record

1. Jan 1, 2020CMS first announced the new evaluation framework in 2020, responding to an executive order from President Trump ¹.
2. Jan 30, 2026CMS published proposed revisions assigning tiers to service areas; comments were due March 31 ².
3. Aug 1, 2026A Hawaii nonprofit sued in August to block the rule ¹.

Sources

1. Stateline, “Federal regulators crack down on organ donation groups” (2026-10-23). stateline.org/2026/10/23/federal-regulators-crack-down-on-or
2. Crowell & Moring, “What Organ Procurement Organizations Need to Know About CMS's New Proposed Rule” (2026-02-13). crowell.com/en/insights/client-alerts/what-organ-procurement

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