(B)
In making a determination under subparagraph (A), the Secretary may consider factors that would include, but not be limited to—
(ii)
improvements in quality;
(iii)
whether there has been any change in a hospital’s designated organ procurement agency due to a change made on or after December 28, 1992, in the definitions for metropolitan statistical areas (as established by the Office of Management and Budget); and
(iv)
the length and continuity of a hospital’s relationship with an organ procurement agency other than the hospital’s designated organ procurement agency;
except that nothing in this subparagraph shall be construed to permit the Secretary to grant a waiver that does not meet the requirements of subparagraph (A).