The Honor Our Living Donors Act
The Honor Our Living Donors Act is bipartisan legislation designed to remove barriers that prevent or discourage people from becoming living organ donors. The bill recognizes a simple truth: people who step forward to save lives should not face financial obstacles for doing so.
The legislation was developed by Waitlist Zero and advanced in Congress with the invaluable support of the American Society of Nephrology. Their collaboration helped bring national attention to the financial barriers facing living donors and build bipartisan support for reform.
Introduced in the U.S. House of Representatives as H.R. 628, the legislation was led by Jay Obernolte and Suzan DelBene, with companion leadership in the Senate by Ben Ray Luján and John Boozman.
The legislation amends the Public Health Service Act to improve how the federal government reimburses living organ donors for expenses related to donation.
Why the Legislation Was Needed
Living organ donors often incur significant expenses when they donate a kidney or part of their liver. These expenses can include:
Travel to transplant centers
Lodging during evaluation and surgery
Lost wages during recovery
Childcare and other incidental costs
To help address these costs, the federal government operates the National Living Donor Assistance Center, which reimburses certain donation-related expenses.
However, the rules governing this program unintentionally excluded many donors.
Previously, eligibility for reimbursement depended in part on the income of the organ recipient. If the recipient earned more than 350% of the federal poverty guidelines, the donor could be denied reimbursement. In addition, donors could be denied assistance if the program believed the recipient could reasonably pay the donor’s expenses.
These rules created a troubling situation: a person willing to donate an organ could be denied reimbursement for basic costs simply because of the recipient’s income.
The Honor Our Living Donors Act fixes this problem.
What the Law Does
The Honor Our Living Donors Act makes three important changes to federal policy.
1. Removes consideration of the recipient’s income
Under the legislation, reimbursement decisions cannot consider the income of the organ recipient. A donor’s eligibility for reimbursement is now based solely on the donor’s participation in the donation process, not on the financial status of the patient receiving the organ.
2. Eliminates expectations that recipients should pay donor expenses
Previously, donors could be denied reimbursement if the program believed the organ recipient could reasonably pay their expenses. The legislation removes this expectation. Living donors can now receive reimbursement regardless of whether the recipient is able or expected to cover those costs.
3. Requires federal reporting on donor expenses
The law requires the U.S. Department of Health and Human Services to submit an annual report to Congress assessing whether the reimbursement program fully covers the costs donors incur. If donors are not receiving full reimbursement, the report must estimate the funding required to cover all qualifying expenses.
This reporting requirement helps ensure policymakers understand the real financial burdens living donors face.
Why This Matters
Living organ donors save lives. Each living kidney donation allows someone with kidney failure to avoid years of dialysis and dramatically improves survival and quality of life.
Yet many potential donors hesitate because of the financial risks associated with donation.
The Honor Our Living Donors Act helps address this problem by ensuring donors are not denied reimbursement simply because of the financial situation of the person they are helping.
It sends an important message: living donors deserve support, not obstacles.
Part of a Broader Effort
While the Honor Our Living Donors Act removes important barriers, it is only one step toward solving the kidney shortage in the United States.
Organizations like Waitlist Zero continue to work on broader reforms, including the End Kidney Deaths Act, which would create a system capable of generating enough living donors to end the kidney transplant waiting list.
Together, these reforms reflect a growing national commitment to honoring and supporting the people who save lives through living organ donation.