# What the Network for Hope Review Found ## What happened On August 5, 2026, the U.S. Department of Health and Human Services began the process of decertifying Network for Hope, the federally designated organ procurement organization for Kentucky and parts of Indiana, Ohio and West Virginia. An organ procurement organization is the nonprofit that coordinates organ donation in its region: it evaluates potential donors, seeks authorization, and arranges recovery. HHS said multiple federal reviews had found persistent patient safety failures, and that the organization had been given repeated chances to correct them. The action followed a review by the Health Resources and Services Administration (HRSA), first announced on July 21, 2025, of cases between 2021 and 2024 where donation was authorized but never completed. ::: stats - **351** cases where organ donation was authorized but not completed. - **103** of them (29.3%) showed concerning features. - **73** patients had neurological signs incompatible with organ donation. - **28** patients, at least, may not have been deceased when organ procurement began. ::: HHS said the problems were worst in smaller and rural hospitals. Its findings pointed to three kinds of failure: ::: cards 1. **Neurological checks.** Evidence pointed to poor neurologic assessments, and 73 patients showed neurological signs incompatible with donation. 2. **Timing after death.** HRSA ordered a root cause analysis of the organization's failure to follow its own protocols, including the five-minute observation rule after a patient's death. 3. **Consent and cause of death.** Evidence also pointed to questionable consent practices, lack of coordination with medical teams, and misclassified causes of death, particularly in overdose cases. ::: HRSA ordered Network for Hope to adopt a procedure letting any staff member halt a donation over a safety concern. It also made a national change: any safety-related stop of a donation, whether called by a family, a hospital or procurement staff, must be reported to regulators. In May 2026, a review by the Centers for Medicare & Medicaid Services found the earlier problems were still surfacing. HRSA and CMS each concluded the organization had not improved enough, and the decertification process began. ### The case behind the review HHS did not name a patient. Its July 2025 release said HRSA had reopened "a disturbing case involving potentially preventable harm to a neurologically injured patient" that an organ network committee had earlier closed without action. News coverage and the patient's family have connected the review to the case of Anthony Thomas "TJ" Hoover II. In October 2021, Hoover was taken to Baptist Health Richmond, in Kentucky, after a cardiac arrest following an overdose. His family says they were told he had no reflexes and no brain activity, and they agreed to withdraw life support and donate his organs. On the walk to the operating room, his family says, his eyes opened and followed them, and staff told them it was reflexes. In the operating room the procedure was stopped because he was showing signs of life. He survived, and his sister has cared for him since. Kentucky's attorney general opened an investigation in 2024. ## Why it matters Every case in the review began the same way: donation had been authorized. Authorization comes either from the person, through a donor registry or a signed gift, or, when the person made no decision, from someone else, usually family, under state law. That second path is the one most people do not know about. Removing your name from a donor registry deletes a yes. It does not record a no. In most states, a signed refusal bars anyone else from authorizing a gift of your body after you die. A few states handle refusals differently, and [your state's page](/states) says which rule applies where you live. A refusal only does that job if it exists and can be found. The review describes hospitals where coordination between the procurement organization and the medical team was weak. A refusal in a drawer at home does not reach that room. ::: stance ### Summary HHS began decertifying Network for Hope on August 5, 2026. A federal review of 351 authorized but incomplete donation cases had found 103 with concerning features, including at least 28 patients who may not have been deceased when procurement began. Every one of those cases started with an authorization. Leaving a donor registry does not stop someone else from giving it. In most states a signed refusal does, if it can be found in time. ::: ## What you can do about it - **Know the difference between leaving a registry and refusing.** [Removing yourself from the donor registry](/organ-donor-registry-removal) is the first step, not the last. - **Make a refusal in the form your state recognizes.** [Your state's page](/states) shows what your state requires and what a refusal does there. - **Make it findable.** Carry it where a hospital will see it, and tell the people who would be asked to decide for you. They are the ones a procurement organization calls. ::: sources ## Sources - HHS, [HHS Finds Systemic Disregard for Sanctity of Life in Organ Transplant System](https://www.hhs.gov/press-room/hrsa-to-reform-organ-transplant-system.html), July 21, 2025. The 351, 103, 73 and 28 figures, and HRSA's corrective actions. - HHS, [HHS Decertifies Kentucky Organ Procurement Organization to Protect Patients, Restore Trust](https://www.hhs.gov/press-room/hhs-decertifies-kentucky-organ-procurement-organization.html), August 5, 2026. The decertification and the May 2026 CMS review. - WKYT, [Kentucky family fights for reform after man wakes up just before organ donor surgery](https://www.wkyt.com/2024/10/18/they-finally-stopped-procedure-because-he-was-showing-too-many-signs-life-family-fights-organ-procurement-organizations-reform/), October 17, 2024. The Hoover family's account. ::: This article summarizes public federal findings and news reporting. It is not legal or medical advice.