When Raven Kinser went to a Virginia Department of Motor Vehicles office two summers ago she left the organ-donor box on the license application unchecked to reflect a decision to revoke an earlier registration. Six months later, after she was declared dead at Riverside Regional Medical Center in Newport News, her parents say they learned that her decision had not stopped organ recovery.
Her case highlights a little-known gap in U.S. organ donation: there is no single, nationally binding way to opt out, or to ensure a later “no” in one state overrides an earlier “yes” in another. That fragmentation, along with other concerns about organ procurement organizations’ consent practices, has drawn bipartisan attention in Congress. A House Ways and Means subcommittee hearing late last year examined alleged consent failures and called for greater accountability.
Raven’s parents drove from Michigan to Virginia and learned the hospital had referred her to LifeNet Health, the federally designated organ procurement organization (OPO) for the region. OPOs are private nonprofit entities with exclusive federal contracts to recover organs in defined regions. Hospitals must refer deaths and imminent deaths to OPOs, which handle donation discussions and decisions. OPOs are regulated by the Centers for Medicare & Medicaid Services and overseen by the Health Resources and Services Administration, but oversight is mainly through certification standards, performance metrics, audits and guidance rather than routine public disclosure.
The Kinsers say LifeNet told them Raven was a registered donor based on an older Michigan license. They contend Raven’s Virginia license, which bore no donor designation, was not turned over to them in time to challenge the OPO’s determination. A LifeNet official said the organization follows federal law, queries state registries, and relies on timestamps and governing law to determine the most recent legally valid expression of intent; a prior authorization can remain enforceable unless a valid revocation is recorded in the regional registry. Privacy laws prevented LifeNet from commenting on specific cases.
Virginia’s registry manager, Donate Life Virginia, said changes made during a Virginia DMV transaction are sent to the registry and updated daily, and that the state registry retains records only for people who have affirmatively said “yes.” The Kinsers say they were never told why Raven’s Virginia DMV record was considered insufficient or how an older “yes” could outweigh a newer “no.”
Families in Raven’s position face an uphill battle. OPOs are intended to separate bedside care from organ procurement decisions to avoid conflicts of interest, but the system can leave families unsure who controls the process when records conflict. The Kinsers asked federal regulators to investigate LifeNet and to require OPOs to provide families documented proof of a donor’s current status at the time of referral. They also urged that OPOs, which function as regional monopolies, be subject to public records laws.
The fragmentation stems from the state-based system for recording donation intentions, primarily through DMV transactions, governed by 50 sets of state laws. States differ on when a registration takes effect, what it covers (transplantation, research, tissue), and how it can be revoked. Under state-adopted versions of the Uniform Anatomical Gift Act, a donor’s most recent legally valid expression of intent should control, but states vary on how revocations must be recorded and which registry is authoritative for people who have lived in multiple states. Those inconsistencies create uncertainty when records conflict across jurisdictions.
Examples of variation: Michigan updates a person’s donor status immediately in the secretary of state system but retains only affirmative “yes” registrations in the public registry, with removals remaining in internal motor vehicle records. Virginia’s registry lists only affirmative donors. New Mexico updates driver records in real time but does not transmit status changes to its donor registry; OPOs receive restricted search access. States report widely differing volumes of removals and registrations: Florida reported hundreds of thousands to more than a million removals in various years, Kentucky processed hundreds of thousands of registrations but far fewer registry withdrawals, and Texas added more than half a million donors in 2025 while tens of thousands requested removal. Those numbers reflect differing practices for recording and transmitting changes.
OPOs have lobbied states on how consent and authorization are defined, whether statuses must be renewed, and how easy it is to opt out. Advocates for stronger registries say better interoperability would help ensure an individual’s documented decision is honored. OPOs counter that strong, durable consent prevents families from overriding a loved one’s “yes” in grief and reduces missed donations, which saves lives.
The Kinser family asked regulators to prevent OPOs from relying on older registry entries when a more recent DMV record exists and to consider criminal penalties for knowingly misrepresenting consent. Federal regulators have not signaled whether they will pursue those proposals.
Congressional and federal activity is underway. Sen. Ron Wyden proposed legislation to create federal standards for patient safety, transparency and oversight in organ transplants, including authority to pause organ recovery if there’s any clinical sign of life. HHS has said it is committed to holding OPOs accountable, and CMS issued guidance in March aimed at strengthening protections and accountability, though critics say it doesn’t address the Kinser family’s core concern.
HRSA has launched a major modernization of the Organ Procurement and Transplantation Network (OPTN), the national system governing organ allocation and transplant policy. Officials describe the overhaul as the most significant restructuring in decades, intended to break up a contractor monopoly, strengthen patient-safety oversight, and replace aging technology. Modernizing OPTN’s data systems could improve interoperability, create clearer audit trails, and make it easier to trace which registry was queried, what timestamp controlled, and how a consent determination was reached in multi-state disputes. But a new federal data architecture would not by itself change the underlying state-by-state legal framework that determines what constitutes a valid “no.”
Donate Life America operates a National Donate Life Registry that lets people sign up directly, view, update or remove registrations, and print proof of their choice. The group is working on a project to let participating states send registrations into the national system, creating a central place to track sign-ups and removals across state lines. Advocates and OPOs note trade-offs: adding more data without auditing and verification may not resolve conflicts unless systems are designed to check and reconcile records.
Ethicists emphasize that consent must be more than a checkbox and must respect autonomy. Medical societies say clinicians’ primary duty is to the patient in their care and that trust requires transparency and safeguards to prevent conflicts from blurring that duty. Families like the Kinsers say they are not opposed to organ donation — Raven’s obituary acknowledged her gift — but they object to decisions they believe were made without proper proof of her wishes.
KFF Health News is a national newsroom that produces in-depth reporting on health issues and is part of KFF, an independent source for health policy research, polling and journalism.
Editor’s note: This story has been updated to clarify the wording on Virginia’s driver’s license applications.