Transplant teams often reject organs offered to their patients for a variety of reasons, including the assessment that the qualities of the organs are too low. Rejections add to cold ischemic time, which makes low-quality organs even less desirable and thus increases the risk of nonuse. Recent changes by the Centers for Medicare & Medicaid Services (CMS) in the way it assesses organ procurement organizations (OPOs) and the more credible threat these changes pose to their local monopolies have incentivized the recovery of more low-quality organs. A change in the organizational report card for transplant centers has incentivized lower-volume transplant centers to reject more low-quality organs despite risk adjustment. The OPTN has developed several policies, such as offer filters, that attempt to reduce the number of organ offers transplant centers receive that they are unlikely to accept. The increasing rates of organ nonuse and the recognition that continuous distribution (CD) could help address it or make it worse led to the Expeditious Task Force and the postponement of the finalization of CD proposals for kidneys and pancreases.