Application Process:

Step by Step Diagram of Application and Donation Process

1. NLDAC Overview
   1. What is living organ donation?
   

   Living organ donation is the act of donating a kidney, lobe of a lung, portion of the liver, pancreas, or intestine, to a loved one, friend, or stranger. It is an alternative to waiting on the national transplant waiting list for an organ from a deceased donor.

   2. What is the National Living Donor Assistance Center (NLDAC)?
   

   The National Living Donor Assistance Center (NLDAC) is a federally funded program to assist agreeable, eligible donors with reimbursement of travel and subsistence expenses toward living organ donation. This program is not intended to promote or encourage donation. This program is not being provided as “a gift” for being a donor. This program is to be used as a “payer of last resort” and will provide reimbursement only when travel and subsistence expenses cannot be covered:

   1. by the recipient of the organ;
   2. under any State compensation program, under any insurance policy, or under any Federal or State health benefits program; or
   3. by an entity that provides health services on a prepaid basis

   3. What does “payer of last resort” mean?
   

   It means the NLDAC program can only pay for travel and subsistence expenses for individuals who have no other means to pay for these expenses.

   4. Why is the NLDAC serving as a “payer of last resort?
   

   The United States Congress included this requirement in the law that authorizes the program. Limited funds are available and are required to be used to help those with the greatest need.

   5. How is the National Living Donor Assistance Center (NLDAC) funded?
   

   The NLDAC is funded by a Federal government 4-year grant award by the Health Resource Service Administration (HRSA). It is established to provide greater access to transplantation for persons who want to donate. Priority will be given to those who cannot otherwise afford the travel and subsistence expenses associated with donation.

   6. What is the Health Resources and Services Administration (HRSA)?
   

   HRSA is an agency of the U.S. Department of Health and Human Services. HRSA provides national leadership, program resources and services needed to improve access to culturally competent, quality health care. For more information go to http://www.hrsa.gov/about/default.htm

   7. Who is the American Society of Transplant Surgeons (ASTS)?
   

   The ASTS is a professional society comprised of transplant surgeons, physicians, scientists and allied health professionals from all around the globe. ASTS co-authored the NLDAC grant with the University of Michigan and is providing NLDAC operations. For more information go to http://www.asts.org

   8. Who are the Regents of the University of Michigan?
   

   The University is governed by the Board of Regents, which consists of eight members elected at large in biennial state-wide elections. According to the Michigan Constitution of 1963, the Regents have “general supervision” of the institution and “the control and direction of all expenditures from the institution’s funds.”

   9. What testing does the NLDAC require as part of the pre-evaluation before a prospective donor travels to a transplant center for a full evaluation?
   

   The NLDAC requires the blood type of the living donor candidate to be determined.

   10. What information will the transplant center need to complete a NLDAC application?
   

   • Name
   • DOB
   • Social security number
   • Address of primary residence
   • Contact information (including 2 phone numbers)
   • Relationship to Transplant Candidate
   • Gender
   • Race
   • Organ to be donated
   • Marital status
   • Education
   • Number of miles from donor candidate primary residence to transplant center
   • Select preferred mode of transportation for evaluation, procedure, medical follow-up trips: Air, privately owned vehicle, train, bus
   • Select the number of nights lodging for each potential trip: 1) evaluation, 2) procedure and, 3) medical follow-up
   • If flying, the estimated cost for ground transportation for each trip: 1) evaluation, 2) procedure and, 3) medical follow-up
   • If driving, the estimated costs for parking for each trip: 1) evaluation, 2) procedure and, 3) medical follow-up
   • Income verification: Donor and transplant candidate (recipient) annual income based on federal income tax return for the most recent year or other documentation, such as electronic government assistance transfer card or any document confirming participation in a government assistance program including: HUD section 8 Housing subsidy, Medicaid, Food Stamps Program or WIC program

   11. Does the transplant center need to be registered with the NLDAC before I can apply for NLDAC funds?
   

   Yes.

   12. Who files the application to the NLDAC?
   

   The transplant center will apply online on behalf of the prospective living donor at www.livingdonorassistance.org

   13. Who reviews the applications and makes the awards?
   

   The NLDAC Review committee will review all applications and will approve applications based on eligibility guidelines and criteria. If a waiver is requested, HRSA will make the final determination.

   14. How long will it take before a decision is made after an application is submitted?
   

   10-15 business days, and longer in case of request for waiver.

   15. Are bone marrow donors eligible for funds through the NLDAC grant?
   

   No, the NLDAC is for living solid organ donors only.
2. NLDAC Eligibility
   1. How were the eligibility criteria developed?
   

   The eligibility criteria were developed by the National Living Donor Assistance Advisory group and the HRSA. The NLDAC Advisory group consists of a kidney donor, liver donor, transplant surgeons, transplant physicians, transplant nurse coordinator, transplant social worker, health economist, social scientist, financial administrator and a HRSA representative.

   2. What are the criteria for the NLDAC Donor Reimbursement?
   

   • Donor and recipient of the organ are either U.S. citizens or lawfully admitted residents of the U.S.
   • Donor and recipient have primary residence in the U.S. or its territories.
   • Travel is originating from the donor’s primary residence.
   • Donor and recipient attest to full compliance with section 301 of the National Organ Transplant Act (NOTA), as amended (42 U.S.C. 274e) which stipulated in part “ * * * (i)t shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.”
   • The transplant center where the donation procedure occurs attests to its status of good standing with the Organ Procurement and Transplantation Network (i.e., it is not a Member Not in Good Standing).
   • Any individual who in good faith incurs qualifying expenses toward the intended donation of an organ but with respect to whom, for such reasons as the Secretary determines to be appropriate; no donation of the organ occurs (see Special Provisions).

   
   Special Provisions: Many factors may prevent the intended and willing donor from proceeding with the donation. Circumstances that would prevent the transplant or donation from proceeding include: present health status of the intended donor or recipient, perceived long-term risks to the intended donor, justified circumstances such as acts of God (e.g., major storms or hurricanes), or a circumstance when an intended donor proceeds toward donation in good faith, subject to a case-by-case evaluation by the NLDAC, but then elects not to pursue donation. In such cases, the intended donor and accompanying persons may receive reimbursement for qualified expenses incurred as if the donation had been completed. Under Program policy, a form will be filed with the Internal Revenue Service (IRS) reporting funds disbursed as income for expenses not incurred.

   3. How does the transplant center verify income for the living donor candidate and the transplant candidate (recipient)?
   

   Ability to pay must be considered based on legislative requirements (the law authorizing this program requires it). Income will be verified by transplant centers when filing an application for assistance. Income may be verified in a variety of ways including; recent pay stubs, participation in public assistance programs (i.e. HUD section 8 housing, Medicaid, Food Stamps Program, or the WIC Program), or Federal Income Tax statements.

   4. Why is the recipient’s income counted in the application?
   

   Authorizing legislation mandates that the recipient’s ability to pay must be taken into consideration as part of this program. The NLDAC is to serve as a “payer of last resort.” The National Organ and Transplant Act (NOTA) of 1984 has always provided that the recipient may reimburse the donor for certain expenses associated with donating an organ. The establishment of the NLDAC does not change this. The NLDAC is established to assist donors, priority will be given to individuals who would otherwise not be able to donate because neither the donor nor the transplant candidate (recipient of the organ) can afford the expenses associated with the donor travel ( e.g., airfare, lodging, meals).

   5. If I am participating in a paired exchange program, am I eligible for NLDAC funds?
   

   Yes. The intended transplant candidate (recipient) will be used for income verification.
3. NLDAC Preference Categories
   1. What are the preference categories for the NLDAC?
   

   All live organ donors are eligible for reimbursement of qualifying expenses provided all of the criteria for donor reimbursement are fulfilled. However, subject to availability of funds, preference will be given to donors who are more likely to be otherwise unable to meet the qualifying expenses, in the following proposed order of priority; preference category 1, preference category 2, preference category 3, and preference category 4.

   2. What is preference category 1?
   

   Preference Category 1: Donor income and recipient income are each ≤ 300% of HHS Poverty Guidelines in effect at the time of the eligibility determination in their respective states of primary residence.

   3. What is preference category 2?
   

   Preference Category 2: Although donor income > 300% of the HHS Poverty Guidelines in effect in the state of primary residence at the time of eligibility determination, the donor demonstrates financial hardship. Recipient income is ≤ 300% of the HHS Poverty Guidelines in the state of primary residence at the time of eligibility determination.

   4. What is preference category 3?
   

   Preference Category 3: Any living organ donor, regardless of income or financial hardship, if the recipient’s income is ≤ 300% of the HHS Poverty Guidelines in effect in the recipient’s state of primary residence at the time of eligibility determination.

   5. What is preference category 4?
   

   Preference Category 4: Any living organ donor, regardless of income or financial hardship, when the recipient’s income is > 300% of the HHS Poverty Guidelines but demonstrates hardship, in effect in the state of primary residence at the time of eligibility determination.

   6. What are the current poverty guidelines?
   

   2007 HHS Poverty Guidelines

   Persons in Family or Household	48 Contiguous States and D.C.	Alaska	Hawaii
   1	$10,210	$12,770	$11,750
   2	13,690	17,120	15,750
   3	17,170	21,470	19,750
   4	20,650	25,820	23,750
   5	24,130	30,170	27,750
   6	27,610	34,520	31,750
   7	31,090	38,870	35,750
   8	34,570	43,220	39,750
   For each additional person, add	3,480	4,350	4,000

   SOURCE: Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148
   For more information go to: http://aspe.hhs.gov/poverty/

   7. How is a preference category assigned?
   

   The living donor candidate and the transplant candidate incomes are determined and verified through documents such as federal income tax return, recent pay stubs, electronic government assistance transfer card or documentation confirming participation in a government assistance program by the transplant center. The corresponding amount in the HHS Poverty Guidelines (based on state of residence and number of persons in household, see question 7) is multiplied by 3 to determine if the donor and/or transplant candidate (recipient) income is greater than, equal to, or less than 300% of the HHS Poverty Guidelines. A Preference Category is assigned based on “greatest need.” For example, if both the donor and the transplant candidate earn less than 300% of the HHS Poverty Guidelines, then the donor application is assigned Preference Category 1. If the transplant candidate earns less than 300% of the HHS Poverty Guidelines, but the donor makes greater than 300% of the HHS Poverty Guidelines and is experiencing financial hardship then the donor application is assigned Preference Category 2 and so forth. If the transplant candidate earns greater than 300% of the HHS Poverty Guidelines and is not experiencing financial hardship, the prospective donor is not eligible for this program. See Guide for Determining Preference Category

   8. How is recipient financial hardship defined?
   

   A transplant social worker, or appropriate transplant center representative, based on a complete recipient evaluation, can provide an official statement, notwithstanding income level, the recipient of the organ would face significant financial hardship if required to pay for the qualifying living organ donor expenses. A recipient’s financial hardship is defined as circumstances in which the recipient’s income exceeds 300 % of the HHS Poverty Guidelines in effect at the time of the eligibility determination, but the individual will have difficulty paying the donor’s expenses due to other significant expenses. Whether or not hardship exists in a particular case requires a fact specific analysis; examples of significant expenses include circumstances such as paying for medical expenses not covered by insurance or providing significant financial support for a family member not living in the household. Waiver requests by the transplant center, on behalf of the donor, shall be made in writing and shall clearly describe the circumstances for the waiver request. The NLDAC will review waiver requests and make a recommendation to HRSA to either approve or deny the request. HRSA will make the final determination and communicate its final determination to the NLDAC. The NDLAC will notify the transplant center of the final determination. HRSA’s determination will not be subject to appeal.

   9. How is donor financial hardship defined?
   

   A donor may be able to demonstrate financial hardship, even if the donor’s income exceeds 300 % of the HHS Poverty Guidelines, if the donor will have difficulty paying the qualifying expenses due to other significant expenses. Although all requests will be reviewed on a case-by-case basis, examples of significant expenses include circumstances such as providing significant financial support for a family member not living in the household (e.g., elderly parent), loss of income due to donation process. Waiver requests by the transplant center, on behalf of the donor, shall be made in writing and shall clearly describe the circumstances for the waiver request. The NLDAC will review waiver requests and make a recommendation to HRSA to either approve or deny the request. HRSA will make the final determination and communicate its final determination to the NLDAC. The NDLAC will notify the transplant center of the final determination. HRSA’s determination will not be subject to appeal.

   10. Why is the recipient’s income counted in the application?
   

   Authorizing legislation mandates that the recipient’s ability to pay must be taken into consideration as part of this program. The NLDAC is to serve as a “payer of last resort.” The National Organ and Transplant Act (NOTA) has always provided that the recipient may reimburse the donor for medical and non-medical expenses associated with donating an organ. The establishment of the NLDAC does not change this. The NLDAC is established to assist donors who would otherwise not be able to donate because neither the donor nor the transplant candidate (recipient of the organ) can afford the expenses associated with the donor travel ( e.g., airfare, lodging, meals) to the transplant center for evaluation, surgical procedure and follow up visit without experiencing financial hardship.
4. NLDAC Allowances
   1. What qualifying expenses are covered by the NLDAC?
   

   Travel, lodging, meals and incidental expenses incurred by the donor and/or accompanying person(s) as part of:
   Donor evaluation clinic visit or hospitalization; Hospitalization for the living donor surgical procedure; and/or Medical or surgical follow-up clinic visit or hospitalization within 90 days after the living donation procedure.

   2. Do I need to turn in receipts to be reimbursed?
   

   No receipts are required to be submitted by the prospective donors. The NLDAC will provide a credit card with an approved spending limit to cover the costs of meals, hotel and other travel expenses for approved applications. The meal allowances and mileage are based on federal rates. Hotel expenses, airfare, train fare and etcetera will be provided through a reporting system by the travel agency. The credit card will have a pre-set limit based on the amount of funds approved; all expenses will be tracked through centralized reports.

   3. How many trips are allowed per donation or intended donation?
   

   Five. Three of these trips may be for the potential living donor and up to two trips may be for an accompanying person(s).

   4. How much will the NLDAC pay for meals and incidental expenses?
   

   The NLDAC uses federal per diem rates. The rates vary in cities across the U.S. For more information go to: http://www.gsa.gov

   5. How much will the NLDAC reimburse for hotel expenses?
   

   The NLDAC will pay for the actual lodging expenses up to 150% of federal lodging costs. Lodging rates vary in cities across the U.S. For more information go to: http://www.gsa.gov. The travel agency working with the NLDAC will reserve hotel rooms. NLDAC will use hotels which have established relationships with transplant centers.

   6. How much will the NLDAC reimburse for mileage?
   

   The NLDAC will reimburse privately owned vehicle mileage at federal reimbursement rates, currently 0.485/mile. For more information go to: http://www.gsa.gov

   7. How are parking costs calculated?
   

   The transplant center will estimate parking costs.

   8. How are ground transportation costs calculated?
   

   The transplant center will estimate ground transportation costs.
5. NLDAC Limits
   1. What does “payer of last resort” mean?
   

   It means the NLDAC program is intended to provide reimbursement only in those circumstances when payment cannot reasaonably be covered by other sources of reimbursement.

   2. Does the NLDAC assist in reimbursement for lost wages and child care?
   

   No. The NLDAC is only allowed to reimburse travel and subsistence expenses toward living donation. The authorizing legislation allows for reimbursement of travel and subsistence expenses without further regulation by the Secretary of HHS. The legislation allows the Secretary to approve other non medical expenses by regulation. Currently no other expenses have been approved by the Secretary.

   3. What are the current poverty guidelines?
   

   2007 HHS Poverty Guidelines

   Persons in Family or Household	48 Contiguous States and D.C.	Alaska	Hawaii
   1	$10,210	$12,770	$11,750
   2	13,690	17,120	15,750
   3	17,170	21,470	19,750
   4	20,650	25,820	23,750
   5	24,130	30,170	27,750
   6	27,610	34,520	31,750
   7	31,090	38,870	35,750
   8	34,570	43,220	39,750
   For each additional person, add	3,480	4,350	4,000

   SOURCE: Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148
   For more information go to: http://aspe.hhs.gov/poverty/

   4. Are support person(s) for the living donor allowed to travel?
   

   Yes. Up to two trips may be for an accompanying person(s).

   5. How many trips are allowed per donation or intended donation?
   

   Five. Three of these trips may be for the potential living donor and up to two trips may be for an accompanying person(s).

   6. What is the maximum Federal reimbursement for qualified expenses during the donation process for the donor and accompanying individuals?
   

   $6,000.00

   7. What is the maximum number of prospective kidney donors per recipient?
   

   Kidney: One donor at a time with a maximum of three donors evaluated.

   8. What is the maximum number of prospective liver donors per recipient?
   

   Liver: One donor at a time with a maximum of five donors evaluated.

   9. What is the maximum number of prospective lung donors per recipient?
   

   Lung: Two donors at a time with a maximum of six donors evaluated.

   10. If my state has a law to allow for a tax credit or deduction and I am awarded travel and subsistence funds from the NLDAC, may I also use a tax deduction on my state income tax?
   

   Funds awarded by the NLDAC cannot be claimed as an expense and cannot be deducted on state income tax. However, many state laws allow the living donor to claim lost wages and unreimbursed medical expenses when filing income tax returns. Certain states allow state employees additional vacation or sick time if they are living donors. Call your state legislature for more information.
6. NLDAC Authorizations and Regulations
   1. What is the Organ Donation and Recovery Improvement Act?
   

   It is an act passed by the 108th Congress (S573) signed into law by the United States President in April 2004. Its purpose was to amend the Public Health Service Act to promote organ donation, and for other purposes. This act provides the legal framework for award grants to be made for the reimbursement of travel and subsistence expenses incurred by individuals toward making living donations of their organs.
   Organ Donation and Recovery Improvement Act

   2. Why must the living donor and recipient attest to full compliance of the National Organ Transplant Act (NOTA) of 1984?
   

   It is illegal to buy and sell organs in the United States. The NLDAC requires the living donor and transplant candidate (recipient) sign a statement stating they have been informed of what constitutes “valuable consideration” and that they are in full compliance with NOTA.
   
   Section 301 of the National Organ Transplant Act of 1984 (“NOTA” or “Act”), entitled “Prohibition of organ purchases,” imposes criminal penalties of up to $50,000 and five years in prison on any person who “knowingly acquire(s), receive(s), or otherwise transfer(s) any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.” 42 U.S.C.§ 274e (2000).

   3. What happens if I use funds from the NLDAC and am unable to donate?
   

   Many factors may prevent the intended and willing donor from proceeding with the donation. Such circumstances include present health status of the intended donor or recipient that would prevent the transplant or donation from proceeding, perceived long-term risks to the intended donor, circumstances such as acts of God (e.g., major storms or hurricanes) or other unforeseen events outside the intended donor’s control. In such cases, the intended donor and accompanying persons may receive reimbursement for the qualified expenses incurred.

   4. What happens if I use funds from the NLDAC and then no longer wish to donate?
   

   In the case that a potential donor no longer wishes to donate, he or she may receive reimbursement for qualified expenses incurred. However, payments received for expenses that were not incurred by the intended donor and accompanying persons must be refunded. Otherwise, such payment will be treated as income to the intended donor, and in accordance with Internal Revenue Service (IRS) regulations, the Regents of the University of Michigan shall notify the IRS (Form 1099) that a payment has been made to the intended donor in the amount equivalent to the unexpended payment.

   5. Why is the recipient’s income counted in the application?
   

   Authorizing legislation mandates that the recipient’s ability to pay must be taken into consideration as part of this program. The NLDAC is to serve as a "payer of last resort".
7. Other Sources of Financial Support
   1. Do some states allow for a tax deduction if you are a living donor?
   

   Yes, some states have passed laws allowing for a state income tax deduction for lost wages, travel expenses and meals for living donors. Some state employees are given additional sick or vacation time to allow time away from work while recovering from living donation.

   2. Which states have existing laws in place offering state income tax deductions or donor leave laws for living donors?
   

   For current information regarding your state laws, contact your state legislature. The United Network for Organ Sharing (UNOS) Transplant Living website provides some information at: http://www.transplantliving.org/livingdonation/financialaspects/statetax.aspx

   3. Which states are considering similar legislation?
   

   For current information, contact your state legislature. The United Network for Organ Sharing (UNOS) Transplant Living website provides some information at: http://www.transplantliving.org/livingdonation/financialaspects/legislation.aspx