Table 3.

Systemic limitations affecting burdens of living kidney donation

Variability of employee benefits
 Employer-sponsored paid time off
  Not a mandated benefit
  Varying allotments
 Short-term disability benefits
  Not a mandated benefit
  Pays a varying percentage of wage
  Living donation may be excluded as an “unnecessary” procedure
 Family Medical Leave Act
  Provides job security
  Does not cover lost wages
  Employee qualifies after ≥1 yr, full-time, for an employer with >50 employees
  Living donation may be excluded as a voluntary procedure
  11 states and District of Columbia expanded coverage
Variability of transplant center billing practice
 Medicare Organ Acquisition Cost Report for LKD evaluation and care
 Medicare Part B interpretation for postdonation charges
 Private insurance and Medicare Advantage contracting differences
Variability in risk for insurability problems
 Effect of ACA
  Improved access to health insurance generally
  Limits to those expected to benefit from ACA include:
     Those who cannot afford premiums (even with subsidies)
     Those in states that did not participate in expanded Medicaid
     Undocumented immigrants
 Life insurance may be less predictable after living kidney donation
  Eligibility problems
  Premium increases
  • LKD, living kidney donor; ACA, Patient Protection and Affordable Care Act.