2024 AKF Living Donor Protection Report Card

How states are graded

The American Kidney Fund (AKF) Living Donor Protection Report Card identifies seven categories of publicly reported legislation enacted by states to protect living organ donors from discrimination and encourage living organ donation. States receive one point for each type of legislation that has been enacted and receive their grade based on their total points.

The AKF Living Donor Protection Report Card assigns a grade of an “A,” “B,” “C,” “D” or “F” on the following scale:

  • A: 5+
  • B: 3-4
  • C: 2 *
  • D: 1
  • F: 0

(this would be the baseline grade for all states if a federal Living Donor Protection Act were passed)

Protection from life, disability or long-term care insurance discrimination

This type of legislation typically prevents life, disability and long-term care insurance companies from discriminating against living organ donors by charging higher premiums or refusing to insure them altogether.

Why it’s important
Only people in excellent health can become living donors. Research has shown that people who donate a kidney live as long as similarly healthy people who have both kidneys. The prospect of being denied insurance or charged higher premiums in the future may deter someone from becoming a living organ donor.

Job-protected leave from private employers

This type of legislation guarantees a period of job-protected leave, which varies by state, and ensures that employees of private employers can take time off for living organ donation without losing their jobs.

Why it’s important
Living organ donors typically need from 2 to 12 weeks for surgery and recovery. Job-protected leave ensures that a living donor can take the time needed to recover adequately from surgery.

Job-protected leave from public employers

This type of legislation guarantees that a living organ donor who works for state or local governments will not be penalized for taking time off from work for surgery and recovery.

Why it’s important
Public employees make up about 15% of the U.S. workforce overall, and in some states it’s as high as 25%. Federal employees enjoy job-protected leave for living organ donation, but not all states offer that benefit to their employees. Job-protected leave ensures that a living organ donor can recover adequately from surgery.

Tax credits for private employers who provide paid leave

This type of legislation reimburses, via a tax credit, some or all of the salary of employees of private companies who become living donors if their company provides paid job-protected leave.

Why it’s important
Not every worker is able to afford to take unpaid leave to become a living organ donor. Legislation that incentivizes private employers to provide paid leave can make it possible for more employees to consider becoming living organ donors.

Direct reimbursements, tax credits or tax deductions for donor expenses

This type of legislation allows a living organ donor to recoup some or all of the expenses they incur by either direct reimbursement, tax deduction or a tax credit. Tax credits provide a more generous benefit than tax deductions, but neither are as inclusive as direct reimbursements. Direct reimbursements of allowable expenses would benefit every living donor, regardless of tax return filing status.

Why it’s important
The transplant recipient’s health insurance typically pays all the medical costs of the surgery for the living donor, but does not necessarily reimburse out-of-pocket expenses such as travel, lodging and prescription medications that may be needed during recovery. Direct reimbursement, tax deductions or tax credits can help to eliminate or lessen this potential financial obstacle for living donors.

Paid leave via state family and medical leave laws

This type of legislation recognizes living organ donation as a serious health condition that qualifies an employee for family and medical paid leave.

Why it’s important
Many working Americans cannot afford to take any time off work without pay. Providing paid leave for living organ donation under a state’s family and medical leave law eliminates the primary financial hurdle—loss of income—that might keep someone from considering becoming a living organ donor. 

Enhanced family and medical leave beyond 60 days

This type of legislation goes above and beyond most family and medical leave laws by extending the eligibility period beyond 60 days (12 work weeks), which is the limit of such laws.

Why it’s important
Though most living organ donors recover and return to work in less than 12 weeks, medical complications may extend the recovery period. Generous family and medical leave laws that extend the leave period beyond 60 work days provide living donors with peace of mind in the event their recovery takes longer than is typical.

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