By Alan D. Viard and Sally Satel

Last year, the Health Resources and Services Administration (HRSA) modestly expanded federal financial support for living organ donors, who are almost always kidney donors. In a previous post, we welcomed the expansion, but emphasized the need for HRSA and Congress to further ease the financial barriers to organ donation — each day, 13 Americans die while waiting for a kidney transplant. Fortunately, the House has now passed a bill (awaiting Senate action) that envisions tripling federal financial support for donors.

HRSA finances a program, operated by the National Living Donor Assistance Center, that reimburses living organ donors’ non-medical expenses. A donor is eligible for reimbursement from the program if he or she cannot obtain reimbursement from other sources and if the recipient of the donor’s organ has limited financial resources. In September 2020, HRSA expanded the program by making two revisions to its guidelines.

One revision allowed reimbursement for donors’ lost wages and child-care and elder-care costs, in addition to the travel, meal, lodging, and incidental costs that had previously been covered. The revision did not change the $6,000 cap on each donor’s reimbursement. The second revision made a donor eligible for reimbursement if the organ recipient’s income did not exceed 350 percent of the federal poverty level, up from 300 percent under the previous rules. (In 2021, 350 percent of the poverty level is generally $76,860 for a three-person household.) This revision also allowed reimbursement for donors who made undirected donations to the next person on the waiting list, regardless of the recipient’s income.

HRSA’s second revision was less bold than it should have been. The agency set the new ceiling on the organ recipient’s income at 350 percent of the poverty level, although it acknowledged that 68 of the 77 comments submitted during the rulemaking process had supported a higher ceiling. Fifty-one comments had urged HRSA to set the ceiling at or above 500 percent of the poverty level — our comment was among them.

Of course, the program’s scope is limited by the funding that it
receives from Congress. A recent House vote offers hope that Congress will
dramatically increase the program’s budget, enabling HRSA to further ease financial
barriers to organ donation.

On July 29, the House passed an appropriations bill that would fund numerous federal agencies for the fiscal year that begins on October 1. In a July 15 report on the relevant portion of the bill, the House Appropriations Committee recommended that HRSA allocate $18.8 million to the organ donor reimbursement program in the upcoming fiscal year. The new funding level would more than triple the program’s current $6 million budget.

The committee spelled out its ambitious vision for the program:

“The Committee supports the expansion
of this program to reimburse a comprehensive range of living donor expenses for
the greatest possible number of donors, including lost wages, childcare,
eldercare, similar expenses for donor caretakers, and removing other
disincentives to donation. The Committee supports significant expansion of
income eligibility for the program to allow as many donors as possible to qualify.”

If the Senate follows the House’s lead, that vision can be fulfilled.

Alan D. Viard is a senior fellow at the American Enterprise Institute, where he studies federal tax and budget policy. Sally Satel is a senior fellow at the American Enterprise Institute and a practicing psychiatrist and lecturer at the Yale University School of Medicine.

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