“The ability to pay for post-transplant care and lifelong immunosuppression medications is essential to increase the likelihood of a successful transplant and longevity of the transplant recipient,” officials wrote.

In the most pragmatic light, that makes sense. More than 114,000 people are waiting for organs in the United States and fewer than 35,000 organs were transplanted last year, according to the United Network for Organ Sharing, or UNOS. Transplant centers want to make sure donated organs aren’t wasted.

“What people don’t really understand is that it’s important to have the funds on the back end to pay for medications and other costs,” said Kelly Green, executive director of HelpHopeLive, the Pennsylvania organization that Mr. Mannion turned to for assistance in raising the money he needed to afford maintaining his new lungs.

His friends and family rallied, flocking to fund-raisers including hair salon cut-a-thons and golf tournaments, raising more than twice his original goal.

Allowing financial factors to determine who gets a spot on the waiting list strikes many as unfair, Dr. Caplan said.

“It may be a source of anger, because when we’re looking for organs, we don’t like to think that they go to the rich,” he said. “In reality, it’s largely true.”

Nearly half of the patients waiting for organs in the United States have private health insurance, UNOS data shows. The rest are largely covered by the government, including Medicaid, the federal program for the disabled and poor, and Medicare.