[4] Although the original forest ecosystem was destroyed and replaced by shrubland with plants like native ʻilieʻe (Plumbago zeylanica) and introduced flora, Molokaʻi kokiʻo survived initially.

Although this tree was destroyed in a fire in 1978, a branch that was removed earlier was grafted onto the related, and also endangered, Kokia kauaiensis.

[4] Its eventual extinction in wild state of the species seems for a large part due to coextinction with native nectarivorous birds.

The birds, Drepanidinae, were extirpated from dryland forest by Polynesians, and most remaining species entirely succumbed to mosquito-borne diseases like avian malaria (Plasmodium relictum) and fowlpox in the 19th century.

The wide, large flowers of Molokaʻi kokiʻo would have admitted a wide range of potential pollinators (as opposed to e.g. Hibiscadelphus): Of these, the ʻIʻiwi was perhaps the most important, given that the other species are/were all either smallish and short-billed (K. cookei has quite large flowers), or did probably not occur in its habitat in significant numbers.