Effective on June 28, 2007, the Centers for Medicare and Medicaid Services (CMS) established a new accountability policy for transplant centers to improve patient quality services and to reduce re-transplantation rates. Nonetheless, the regulation could affect the organ utilization rate and exacerbate the current shortage problem. Although there have been positive responses with slightly higher quality transplants in the periods post regulation, transplant centers have also reacted to the new accountability policy in less than desirable ways. This research uses variations across centers from biannual SRTR reports cards between 2002 and 2009 and UNOS patient registration information between 2003 and 2010, and finds persuasive evidence that the regulation adversely affects patients’ welfare. The estimated decrease in graft failures for low performing centers is negated by a decline in access to transplantation, creating a tradeoff between quality and access in the provision of care. Results suggest a sizeable reduction of about 7 less transplants per 6-month period at low performing centers on both patient survival and graft survival outcomes after the regulation.