This Letter Does Not Ask. It Demands.

"I am a transplant recipient who is alive because someone cared for me without compensation, without recognition, and without the support of a single federal or state program designed for their benefit. That person's labor — and the labor of 53 million Americans like her — will no longer be treated as a free resource available for governmental exploitation."

"As Administrator of the Centers for Medicare & Medicaid Services, you hold direct regulatory authority over transplant center certification... The corrective actions demanded herein require no new legislation. They require the exercise of existing regulatory authority that your office has declined to exercise. That declination ends with this correspondence."

"Administrative action within existing authority can begin immediately. No new legislation is required for the initial corrective steps demanded below."

"Less than 3% of NIH chronic disease research funding is directed toward caregiver outcomes — despite peer-reviewed evidence that caregiver burden directly determines recipient mortality, medication adherence, and hospitalization rates. Gold-standard science does not ignore the most consequential unmeasured variable in its primary area of study."

"Florida has enacted no meaningful statutory framework requiring compensation, workforce protections, or standardized respite services for care partners across chronic illness categories. That gap is a policy choice this Legislature has made. It is a policy choice this Legislature must reverse."

"92.8 percent of potential living donors are lost before completing donation... These are not unsolvable problems. They are unfunded solutions." — and on independence: "Fresenius Medical Care and DaVita together control approximately 70 percent of the U.S. dialysis market... Each successful kidney transplant eliminates approximately $145,000 in annual dialysis revenue. That financial stake in transplant underperformance is not incidental to the reform environment. It is constitutive of it."