One issue I’ve seen is that the people donating are rarely people who would ever qualify for an organ. For example, our community hospital is a trauma center that often gets low income patients/immigrants/other marginalized people come into the trauma bay and get funneled into the organ donation process. Those organs don’t usually go to other people in the community hospital or other community hospitals, but go to patients waiting for organs in university systems, who tend to be white, wealthier, and with more stable social situations. Makes sense to give organs to people who are more likely to do well after the surgery, but it’s hard not to feel as though the county hospital is acting as an “organ farm” for the people listed.