The public debate about organs is almost always about scarcity — too few, too many waiting. This investigation is about the other thing, the part the system would rather not foreground: how it is governed, where it fails, and who is exposed when it does. OrganWatch assembles 513 source-linked findings, a 51-jurisdiction map of consent law, and a roster of all 57 organ procurement organizations — every item drawn from a government record, court filing, or peer-reviewed study. This is the index to it: the case in one place, and where to read each part.
The shape: a protected monopoly
Each OPO holds a federally granted monopoly over organ recovery in its territory, feeding a national network run for nearly four decades by a single contractor. Now that CMS grades them on objective measures, 20 of the 57 sit in Tier 3 — below the government's own minimum standard. The monopoly cannot be fired by the hospitals it serves, and a third of it is failing. Start with the monopoly & decertification and which OPOs are failing.
The bedside: procurement vs. care
The hardest findings are at the bedside of the dying. A 2025 federal review of 351 cases found concerning features in roughly 29% and concluded a number of patients may not have been deceased when recovery began. The conflict is structural: the entity graded on how aggressively it recovers is present while a prognosis is still being decided. Read how organs are taken from the dying.
The consent gap and the body trade
Beneath transplant sits a far less regulated layer: whole-body and tissue donation. In most states an unclaimed or indigent person's body can be used without next-of-kin consent; a paying market — device makers, the military, training firms — pulls on that supply; and the worst actors end up in court. Read the consent gap, the 50-state map, who buys the dead, and the body trade on trial.
The money
Donation is free; the system around it is not. The largest OPOs are nonprofits reporting nine-figure revenue, and a bipartisan Senate review found the incentives can favor tissue recovery over lifesaving organs. Read the money behind the system.
Accountability, finally arriving
The record is not only of failure but of a system being forced into daylight: the first-ever OPO decertification in 2025, a bipartisan Senate “Operation Transplant” review of 17 named OPOs, repeated congressional hearings, and HHS-OIG and GAO audits. The deep-investigation set in OrganWatch collects these across 18 lines of inquiry, with the prosecutions and the sworn congressional testimony alongside.
How this is built — and the one rule
Every finding links to a primary source and is written at the institution and finding level. One rule governs all of it: no patient, donor, or family is ever named — not their name, age, town, or case. The people this system touches at its most vulnerable are exactly the people a careless exposé would harm a second time. The accountability here is the system's, never theirs. The compilation is openly licensed for journalists, researchers, and agents to reuse with attribution.
The data: OrganWatch — 513 findings, the 51-jurisdiction consent map, and a dossier for each of the 57 OPOs.
The full series: the monopoly, the consent gap, the money, the bedside, the 50-state map, the court record, the demand side, and the failing OPOs.