America’s leadership in organ donation, which began in 1954 with the first successful whole-organ transplant, is under strain. More than a million people have received the gift of life in the decades since, and last year alone, more than 49,000 transplants were performed. Yet the long-term success of this system depends on public trust — and that trust has been damaged.

Recent federal findings make the problem clear. On Aug. 5, the Department of Health and Human Services began the process of decertifying Network for Hope, the organ procurement organization serving Kentucky and parts of three neighboring states. Federal reviewers found serious problems in nearly 30% of the cases they examined, including ones in which preparations for organ donation continued even though patients still showed signs of brain function. These failures have left families questioning whether their loved ones were truly dead when the decision to proceed was made, and they have undermined confidence in a system that more than 100,000 people on the national waiting list rely upon every day.