The US health department is working to shut down a Kentucky-based organ procurement organization that made headlines over a 2021 incident in which it was accused of trying to harvest a man’s organs while he was still alive.

In an announcement Wednesday, the Department of Health and Human Services said it had begun the process to decertify the organization, Network for Hope (NFH). Losing its certification would effectively shutter the organization, which serves Kentucky as well as parts of Indiana, Ohio, and West Virginia. If decertified, another organization will be appointed to coordinate donations in the region.

In a statement, NFH said it “strongly disagrees” with the HHS’s finding and will appeal the decertification decision.

HHS said its decision stems from two federal investigations of NFH that found “persistent patient safety failures,” despite extensive oversight and opportunities to correct failures. The two investigations were carried out separately by the HHS’s Centers for Medicare & Medicaid Services and the Health Resources and Services Administration (HRSA).

The HRSA investigation, which concluded last year, examined 351 NFH cases in which organ donations had been authorized but were ultimately canceled. In 103 cases, investigators found “concerning features,” including 73 cases in which patients had neurological signs that should have made them ineligible for organ donation.

The scrutiny over NFH and other organ procurement organizations comes amid increases in donations from people who have had circulatory deaths (their heart stops), rather than those who have been declared brain-dead. Donation after circulatory death often occurs when patients are not expected to make a recovery and a family decides to withdraw life support. Organ procurement organizations cannot declare a person dead and are barred by law from being involved in care decisions. However, deciding when to remove life support is not clear-cut.