2024 AKF Living Donor Protection Report Card

Letter From AKF President & CEO, LaVarne A. Burton

We all deserve the best kidney care, no matter where we live or the color of our skin. 

Currently, chronic kidney disease (CKD) affects more than 1 in 7 adults in the U.S. However, kidney failure takes a disproportionate toll on people of color and those living in rural communities, with a higher potential of poor outcomes. Some causes are genetic. However, studies have shown that social drivers of health, structural racism and implicit bias can result in disparate kidney health outcomes. 

In fact, compared to white Americans, Black and Hispanic people are more than four times and more than two times, respectively, as likely to develop kidney failure. Furthermore, evidence shows that rural Americans with kidney failure suffer worse mortality rates than their suburban and urban counterparts.

Without dialysis or a kidney transplant, kidney failure is fatal. 

There are more than 103,000 people on the organ transplant waitlist and of those on the waiting list, the vast majority—nearly 88 percent— are waiting for a kidney.

Receiving a kidney from a living donor is the best option for someone in need of a new kidney. On average, kidneys from living donors last longer than transplants from deceased donors.

However, lack of awareness, health concerns, job insecurity, insurance discrimination and more deter people from becoming living organ donors. For example, living organ donors typically need 2-12 weeks for surgery and recovery, but not everyone has job-protected leave to take this time to recover after saving a life. In some states, persons can also be denied life, disability or long-term care insurance simply because they were a living organ donor, even though research shows people who donate a kidney live as long as similarly healthy people who have both kidneys. 

That’s why we at the American Kidney Fund (AKF) are leading efforts at the state and federal level to advocate for policies to improve living organ donation. The bipartisan Living Donor Protection Act, introduced last April in both the U.S. House of Representatives and Senate (H.R. 2923 and S. 1384), would provide baseline protections nationwide, ensuring that living organ donors have FMLA and anti-discrimination protections. Passage of this legislation would mean that the lowest Report Card grade any state could receive would be a C. Through our Annual State of the States: Living Donor Protection Report Card, we track progress in achieving much-needed policy protections.

In this year’s report, we are proud to announce that 5 new states have passed common sense laws to help protect living organ donors. Since the first report was issued, 32 states have enacted such legislation.

We applaud the progress made thus far, but only 3 states have an A grade—meaning they have enacted at least 5 of the 7 types of legislation that can encourage living donation. 

More progress is desperately needed. We will continue to fight on all fronts until every state has an A grade. To get us there, in 2024 we’re focusing on states across the country with D and F grades. We are working to pass living donor protections in these states and looking at paid and unpaid leave bills in states that have passed living donor protections. This effort includes states where work to improve the number of living organ donors focuses on more rural and medically underserved communities. Simultaneously, we will continue our strong focus on passing the Living Donor Protection Act in Congress.


 LaVarne signature

LaVarne A. Burton

President and Chief Executive Officer



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