NOTA and subsequent regulations mandate that the OPTN prioritize fair patient access to transplantation while relying on objective medical evidence and adapting to advancements in clinical practices and scientific knowledge.

Before the enactment of the National Organ Transplant Act NOTA was put in place, there was no clear jurisdiction on what property rights were for a human corpse.

H. Barry Jacobs, the head of a Virginia company, announced in 1983 a plan to buy and sell human organs on the market.

[7] NOTA prohibited compensating organ donors but allowed payment for other types of donations, such as human plasma, sperm, and egg cells.

In 2009, a public interest law firm (The Institute for Justice) sued to allow donors to be compensated for giving bone marrow.

[9] The firm argued that the development of apheresis meant that donors who gave bone marrow through blood donation should be allowed to receive compensation.

[8][10] Critics argued that allowing compensation could reduce donation, increase the risk of disease, and lead to the exploitation of the poor.

[8][9][11] In December 2011, the Ninth Circuit Court of Appeals unanimously ruled that donors giving bone marrow via apheresis were eligible for compensation.

[8] In November 2013, the federal government proposed a regulation that would change legal definitions to cover bone marrow regardless of how it is obtained.