CMS issued new guidelines in March 2026 to strengthen patient protections in the US organ donation system.[2][4] The guidelines prohibit organ procurement organizations (OPOs) from influencing the timing of disconnection of support systems or the declaration of death and require that death be declared according to accepted medical standards before organ removal begins.[4] The measure responds to reports that some OPOs were speeding up the donation process and pressuring families to make decisions during grief.[4] The guidelines also reinforce the role of hospitals in providing full health care to patients, regardless of their potential to be donors, and emphasize the need for discretion and sensitivity when communicating with patients and families.[2] CMS is implementing stricter oversight, including a requirement to cite violations of the standards even after they have been corrected, a significant shift in accountability.[4] The agency plans to issue final rules on OPO certification conditions in late 2026 and then initiate recertification or decertification procedures for lower-performing OPOs.[4]