Recent Criticism of Organ and Tissue Donation: "NO!," the Transplant System is NOT ‘in Chaos’!

According to a recent article in the New York Times, there are issues within the U.S. organ transplant system about which you should be aware if you are a person awaiting an organ transplant, or an intended recipient (the NYT article is behind a pay wall, but you can access the article for free in the Virgin Islands Daily News by clicking here).  If one could believe the headline, the "organ transplant system" is  "in chaos."  The headline is clearly exaggerated and untrue.   

Before delving into the specifics of the article, however, these challenges do not regard organ procurement or recovery.  In other words, please do not reconsider a donation!  If anything, the article raises issues that would be resolved by a larger supply of donors and donor organs.  In other words, the criticism does not, and should not, mean that if you are an intended donor, that your gift will not be honored.  

The article focuses on the practices of providing organs to patients on a waitlist.  According to the article, procurement organizations like Lifebanc in Northeast Ohio, and Legacy of Hope in Alabama sometimes provide organs to patients that are not at the top of a waitlist.  The story highlights the plight of Marcus, a man who reportedly was "next in line" for a kidney transplant, but who has been "skipped" multiple times in favor of patients at different hospitals. According to the Times, the practice of directing donations that do not strictly follow the "official waitlist" raises concerns about fairness and transparency in organ allocation, especially since some hospitals appear to benefit more than others.

The broader question raised by the authors is whether the U.S. organ transplant system, controlled by a single national network,  lacks transparency, leading to what some believe are inequities in who receives life-saving organs. Reforms have been proposed to increase accountability and ensure that the "official waitlist" is followed more strictly. Some argue that systemic changes are needed to prevent hospitals from unfairly influencing organ allocation and to ensure that every patient has a fair chance at receiving a transplant.  Of course, the article does not discuss or explore whether deviation from the official waitlist has any explanations or virtues, or whether strict reliance upon a waitlist might be disadvantageous.   

The article admits, for example, that there is already a highly regulated "official waitlist." The Times article doesn't really explain "why" patients like Marcus are skipped.  The Times did commission a survey showing that more organs in such cases go to hospitals with what it characterizes as "close ties" to organ procurement networks. The fact that hospitals with ties to organ procurement organizations receive more organs, however, may just reflect the fact that they conduct more donor recoveries and organ transplants, and are therefore more likely to be able quickly stand up a transplantation surgery reducing risk of loss of a donated organ.  The authors imply that any deviation from the list results from undue and unfair influence, and is therefore suspect, but the authors don't explore alternate explanations.  

The article is replete with strong denunciations by some advocates with little explanation why procurement organizations might "favor" one hospital over another.  Of course, procurement organizations haven't helped themselves, because they have not responded to the criticism.  There is no response from either procurement organizations or hospitalists regarding either the survey findings, or the rationale for anomalies explaining why a person might be "skipped."  I sought a response from two procurement organizations with which I am familiar, sharing the broad outline of my intended article, and I was unable to garner comment or response, but, that may reflect nothing more than a disciplined strategy regarding  public communication.

I am not  a doctor, but I suspect that there may be a variety of reasons, admittedly frustrating to a waitlist patient, that explain such anomalies.  For example, the relative proximity of the patient to the recovered organ (long trips for recovered organs present risks) might explain a skip.  The temporal availability of the patient, transplant teams, and/or operating rooms to make use of the recovered organ might explain anomalies (larger hospitals with large surgical staffs may simply be "ready," and/or one patient may relatively make a better candidate "in the moment" than another, regardless of list placement.  There may also be a variety of risk factors specific to a particular patient, hospital, transplantation, or transport.  Any or all of these seem to be pretty obvious possible explanations for deviating from a list. 

It is also possible that list anomalies occur as a result of the HIV Organ Policy Equity Act (HOPE ACT). What is the Hope Act?  It is the Act which permitted HIV positive individuals to make donations of organs and tissue. Until 2013 it was against federal regulation to transplant organs from someone who was HIV positive into a potential organ recipient, even if the intended organ recipient was also HIV positive. In 2013, these HIV prohibitions were deemed outdated by Congress and lifted. The HOPE Act directed the Health and Human Services (HHS) Secretary to develop guidelines to conduct research relating to HIV positive donors and organ transplantation.

Current regulations ensure that an HIV negative recipient does not receive an organ from a HIV positive donor, but HIV positive donors can donate organs and tissues to other HIV positive recipients. The HOPE Act simply gives more people a chance to donate life. Given the limited number of transplantable organs available for the more than 120,000 people who are awaiting transplants, it makes sense to find all possible ways to safely and ethically save as many lives as possible.  But, it also means that any particular organ may not be suitable for the person at the top of the list.  Of course, these details cannot be shared, due to medical privacy (HIPAA).  A doctor can't tell a reporter or a recipient that an organ is positive or negative because that violates the medical privacy of the organ recipient, potentially disclosing a patient's HIV history. I suspect there are similar restrictions for other health attributes, but I am just spit-balling here. The point is that I would be shocked, given such considerations, if every available donor organ went precisely to the next person on the list.

I get a sense when reading the article that at least some critics treat organs like product deliveries from Amazon: "I ordered first, so I should get mine first." The waitlist, however, isn't a "line" at the car wash where the first in line is always, or even should be, served first. 

I formerly taught medico-legal documentation and deposition preparation and conduct "classes" during Grande Rounds at a local teaching hospital.  I considered the opportunity  to work with such amazing minds a privilege and an honor.   I was amazed and impressed at the vast array of variables and considerations medical professionals in a hospital consider and resolve in making even routine decisions.  My strong suspicion is that the article, while certainly well researched, supported, and written, from the standpoint of a layperson, could not begin to report fairly to a lay audience the myriad reasons a simple list is not reflexively adhered to in making such momentous decisions. That does not mean that there may never be some form of corruption in the system, but the mere possibility of corruption extrapolated from a few cases should be considered critically. 

Regardless, if you are a donor awaiting a transplant, you should be aware of the facts, and better, be prepared for possible frustration and/or disappointment.  I would encourage those in positions of responsibility, if they don't already, to explain to patients and families that the waitlist is not a strict line, and manage expectations, frustrations, and disappointment.  Especially for those clinging to last hopes, honestly managing expectations would seem both moral and necessary. 

I also want to be careful that my criticism of the Times article is not woven into the  rhetorical crutch, "fake news." Reporting that raises awareness, asks questions, and challenges, even if by casting circumstances in the worst possible light, should be celebrated.  I am not suggesting that the authors engaged in shoddy reporting; as discussed I believe that the authors cast is probably limited by the fact that they aren't surgeons, hospitalists, or professionals routinely dealing with organ procurement and transplantation questions or concerns.  Professionals understand and appreciate, or should, that these articles, headlines, and narratives may not reflect the "whole story," just like a client's or patient's fears, apprehensions, or concerns, are usually not based upon the "whole story."  To the anxious or frightened layperson, though, these emotions are the only story.  That is why professionals work so hard to cultivate good productive relationships with clients/patients, and where appropriate, their families, so that their decisions and risks can be evaluated carefully, based upon their specific circumstances, thereby leaving them with only appropriate concerns, and realistic expectations.  Reporters, admittedly, are not in that "business."  

Full disclosure: both my wife and I were Ambassadors for Lifebanc.  My clients can attest, though, that I never, professionally "encourage" or "discourage" donation; as a lawyer my  professional responsibility is to see my client's wishes fulfilled.  Most clients have made decisions regarding donation prior to settling an estate plan. I can sometimes play a role in answering questions regarding the procurement and recovery process, and dispel unfounded fears or concerns (the most common being that the family of of a donor bears the cost of organ recovery), but my role as an "advocate "is appropriately left to seminars, public forums, and articles.          

For more information see Bryan M. Rosenthal, Mark Hansen and Jeremy White, "Organ Transplant System ‘in Chaos’ as Waiting Lists Are Ignored," New York Times, March 10, 2025. 

Smart Home Technologies: A Game-Changer for Aging in Place and Elder Care

Imagine a quiet morning in your own kitchen: the coffee brews on a timer, lights gently brighten to ease you awake, and a soft voice reminds you it's time for your daily walk. If you stumble, a sensor quietly alerts a family member on their phone, before you even realize you're shaken. This isn't science fiction; it's the reality of smart home health technologies (SHHTs). A comprehensive review published in the Cochrane Database of Systematic Reviews (January 2024) shows they're transforming how seniors stay safe and independent at home. Drawing from 163 studies spanning 2000 to 2021, the review analyzed feedback from thousands of older adults and caregivers worldwide, revealing SHHTs as powerful allies against frailty, falls, chronic illnesses, and isolation. For readers of the Aging-in-Place Planning and Elderlaw Blog, this isn't just about gadgets; it's about tools that support autonomy, ease family burdens, and prevent the slide into institutional care. As we've repeatedly discussed, integrating tech with legal safeguards like trusts, supported decision-making (SDM), and advance directives creates a robust safety net. This article breaks down the review's insights in plain terms, compares tech to traditional care, and shares everyday examples to help you envision and implement these solutions.

What Are Smart Home Health Technologies? A Simple BreakdownThink of SHHTs as your home turning into a thoughtful companion, not a babysitter. Unlike standalone devices (like a single blood pressure cuff), SHHTs create an interconnected "ecosystem" of sensors, apps, and gadgets that work together via the Internet of Things (IoT).  You’re likely familiar with the Internet, the global network that lets you email grandkids, stream shows, or shop online. But IoT, or the Internet of Things, is a special layer on top of the Internet that connects everyday objects in your home, not just computers, to each other and to you. Think of it as giving your home a nervous system: devices "talk" to sense, react, and keep you safe without you lifting a finger.
  The review identifies six main types, each tackling a piece of aging's challenges:

• Physiological monitoring: Tracks vital signs like heart rate or blood pressure, spotting issues before they escalate, and tailored to your specific condition or situation.
• Functional monitoring: Watches daily activities, like movement or sleep patterns, to catch signs of decline or improvement.
• Safety monitoring: Automatic lights, fall detectors, or wandering alerts to prevent accidents.
• Security monitoring: Cameras or locks to ward off intruders or unauthorized visitors.
• Social interaction tools: Video calls or companion applications for virtual chats, combating loneliness and isolation.
• Cognitive/sensory assistance: Reminders for meds, meals, or appointments, easing memory lapses and supporting good memory habits.

Picture it like this: In a traditional setup, a senior might forget a pill, slip in a dark hallway, or feel isolated after a family visit ends. With SHHTs, a sensor notices the missed dose and chimes a gentle reminder; lights flicker on as you approach the hallway; and an application initiates communication between you and family or friends, or alternately,  "chats" with you, sharing stories until your granddaughter calls via screen. It's proactive care that feels personal, not intrusive.The Evidence: How SHHTs Outshine Traditional CareThe review sifted through real-world feedback from older adults (over 65) and caregivers, comparing tech-assisted homes to those without. The results? SHHTs excel in promoting independence and safety, often achieving more with less human effort than traditional methods.
Continuous monitoring is praised in over 70% of studies. Without tech, caregivers might check in daily, but delays could mean a fall goes unnoticed for hours, leading to physical injury, psychological or emotional trauma,  or hospital stays. With SHHTs, sensors "watch" 24/7—think of a bedroom mat that detects if you get up at night and alerts your phone if you're down too long. One study compared this to manual checks: tech users had 20% fewer undetected falls, giving families peace of mind without constant worry. It's like having an invisible guardian angel, not a hovering one.
Social interaction tools offer another win. Loneliness hits hard in aging, worsening memory and mood like a slow-burning fire. Traditional fixes? Scheduled calls or visits, but life gets busy. Enter tech companions: a fluffy seal or cat that "listens" and responds with purrs or stories, or a screen robot that joins family dinners virtually. In trials, seniors with robots reported feeling "connected" 30% more often than those relying on phone calls alone.  Imagine your grandkid "visiting" via a tablet that follows you around the house, turning solitude into shared moments without the drive.
For promoting independence, consider exercise and routine aids. Without tech, a senior might skip walks due to fear of falls, leading to weakness and more isolation. SHHTs change that: a robotic tutor guides chair yoga or balance drills, adapting to your pace, while sensors track progress and celebrate small wins. Compared to group classes (hard if mobility's an issue), this lets you "train" alone or with a virtual coach, building confidence at your own rhythm. One example: A motion-detecting mat in the living room "nudge" you to stretch after sitting too long, turning passive monitoring into active encouragement.
Even cognitive assistance beats paper lists. Med reminders via voice assistants (like Alexa) ping softly, while apps log moods or habits for doctor chats. Versus sticky notes that fade or get lost, this creates a digital diary your family can review together, spotting patterns early, like sleep dips signaling depression, without invading space.
The review isn't all rosy; barriers like clunky designs or costs exist, but solutions abound, many devices start under $100, and Medicare often covers wearables.Why This Matters for You: Everyday Wins for Aging in PlaceFor seniors, SHHTs mean staying put amid health hiccups, dodging the pitfalls of assisted living where understaffing leads to falls or neglect, or nursing homes where seniors are exposed to a myriad of risks threatening the health, safety, and life of seniors, nearly one-third of whom are injured or killed within the first thirty days of care as a result of mistakes and neglect. 
 Families gain breathing room: remote alerts cut worry hours, preventing burnout that ends in institutionalization or guardianship battles. Picture a daughter in another state sleeping soundly, knowing her mom's fall sensor is vigilant, versus the old dread of "What if she's hurt and I don't know?"
Legally, weave tech into your plan: Add to your advance directives, trusts,  power of attorney,  and supported decision-making directives, "Fund SHHTs for safety and independence," or nominate supporters in SDM agreements to manage devices. Trusts can earmark gifting for gadgets, shielding Medicaid eligibility while funding freedom.Conclusion: From Tools to TransformationSHHTs aren't a cure-all, but as the review shows, they're a bridge to dignity, turning homes into havens of proactive care. By comparing their gentle nudges to the isolation of unchecked decline, we see their true power: not replacing life, but enriching it. While this article has provided a thorough overview of SHHTs for aging in place, it is by no means comprehensive. The landscape of technology and care evolves rapidly, influenced by new innovations and personal needs. Therefore, readers must remain vigilant, consulting reliable sources like Cochrane reviews, AARP, and local elder law attorneys, while evaluating their situations to identify risks. By combining awareness with legal tools, seniors and families can safeguard independence and thrive while aging in place. For ongoing support, consult a professional and stay informed.  Your security depends on proactive engagement.

Trump Administration Removes Burdens and Threats of the Corporate Transparency Act (CTA)

The following is from a Treasury Department Announcement issued March 2, 2025:

The Treasury Department is announcing today that, with respect to the Corporate Transparency Act ("CTA"), not only will it not enforce any penalties or fines associated with the beneficial ownership information reporting rule under the existing regulatory deadlines, but it will further not enforce any penalties or fines against U.S. citizens or domestic reporting companies or their beneficial owners after the forthcoming rule changes take effect either. The Treasury Department will further be issuing a proposed rulemaking that will narrow the scope of the rule to foreign reporting companies only. Treasury takes this step in the interest of supporting hard-working American taxpayers and small businesses and ensuring that the rule is appropriately tailored to advance the public interest.

U.S. Secretary of the Treasury Scott Bessent issued the following statement:

"This is a victory for common sense.  Today’s action is part of President Trump’s bold agenda to unleash American prosperity by reining in burdensome regulations, in particular for small businesses that are the backbone of the American economy."

Prior to this announcement, there was a great deal of uncertainty regarding the risk of non-compliance with the Act's reporting requirements.  There were several lawsuits seeking to block implementation of the Act.  On January 7, 2025, the U.S. District Court for the Eastern District of Texas issued an order staying FinCEN’s regulations implementing the BOI reporting requirements, precluding FinCEN from requiring BOI reporting or otherwise enforcing the CTA’s requirements. On February 5, 2025, the U.S. Department of Justice—on behalf of Treasury—filed a notice of appeal of the district court’s order and, in parallel, requested a stay of the order during the appeal.

On February 18, 2025, the court agreed to stay its January 7, 2025, order until the appeal is completed. Given this decision, FinCEN’s regulations implementing the BOI reporting requirements of the CTA were no longer stayed. Thus, subject to any applicable court orders, BOI reporting was finally mandatory, but FinCEN notified the courts and the public that it would be providing additional time for companies to report.

The United States Corporate Transparency Act (the “CTA”) became effective at the start of 2024. Under the CTA, your company may have been be required to report its “beneficial owners” to the Financial Crimes Enforcement Network (“FinCEN”), a bureau of the Treasury Department charged with protecting the US financial system from illicit use, fighting money laundering and promoting national security. Failure to report risked significant fines and penalties for both companies and for their beneficial owners.  The law also exempted large and publicly traded companies. focusing instead on smaller entities, like small limited liability companies, corporations, and partnerships. 

The CTA requires non-exempt existing companies to file a report with FinCEN before the end of the 2024 calendar year and requires companies that are newly created or registered to file a more detailed report within 90 days after the company is first organized or registered in the US. The CTA also requires companies to update these filings within 30 days of any change in previously filed information.

The CTA only applies to organizations that either(a) are formed by making a filing with a state’s Secretary of State (or other office charged with forming entities) or (b) are foreign companies that have registered to do business in the United States by making a filing with a state Secretary of State (or other office). So, the CTA does not apply to sole proprietorships, general partnerships or (depending on state) unincorporated nonprofit associations, or trusts.

The CTA contains 23 exemptions for various types of companies. Most of these exemptions are for companies which are already subject to a high amount of regulation, such as public companies, banks, insurance companies, other types of financial firms and utilities. There are also exemptions for certain types of entities where either Congress or FinCEN believed the burden of reporting would be inappropriate or unnecessary. These include tax-exempt entities, including most charities, and certain inactive entities. Importantly, The CTA also has an exemption for larger companies who meet certain employment and income thresholds and which also have operating offices in the U.S.