Table 2.

Recommendations to achieve financial neutrality for living kidney donors

1. Allocate resources for standardized system of reimbursement for LKDs' lost wages and incidentals
 a. Expand National Living Donor Assistance Center program
 b. Remove means testing
 c. Expand coverage to offer standard subsidy for lost wages
2. Develop and pass legislation to standardize LKDs' employment and insurability protections
 a. Transition tax deductions to tax credits to increase effectiveness
 b. Expand and standardize tax relief legislation on the state and federal levels
 c. Develop and pass legislation that prohibits denial of coverage or increase in premiums for health, life, and disability insurance for LKDs
 d. Develop and pass legislation supporting LKDs' use of paid medical leave for donation
 e. Develop and pass legislation that expands use of FMLA protections for LKDs
3. Create an LKD financial tool kit
 a. Summarize known financial risks
 b. Create an equation model for helping living LKDs estimate direct and indirect costs
 c. Provide NLDAC service linkage
 d. List nonprofit sources of financial assistance for LKDs
 e. Develop strategy for discussion with employers of LKD support during recovery
 f. Describe state and federal laws directed at LKDs
 g. Provide uniform guidance to transplant centers in relation to billing options to maximize resources available to LKDs:
  i. Medicare Organ Acquisition Cost Report
  ii. Medicare Part B
  iii. Private insurance
 h. Uniform guidance to payers on coverage for LKD care
4. Research agenda
 a. Capture granular, systems-wide data on the financial effect on LKDs
  i. Indirect costs
  ii. Short- and long-term medical costs
   1. Evaluation process
   2. Routine follow-up
   3. Coverage for complications
  iii. Insurability effect: coverage and rates
  iv. Effect on employment
 b. Determine effect on supports
 c. Capture data about variability in transplant center billing practices
 d. Characterize effect of financial and systemic barriers on potential LKD decision making and rate of LDKT
 e. Characterize effect of financial effect on LKD satisfaction
  • LKD, living kindey donor; FMLA, Family and Medical Leave Act; NLDAC, National Living Donor Assistance Center; LDKT, living-donor kidney transplantation.