Mission & Background
Who We Are
How to Apply
Learn About Organ Donation
Enrolled Transplant Programs
Lost Wages Demo
Living Donation Survey
For Transplant Centers
How to Submit Applications
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. Funds are not provided as a gift or reward for being a donor. This program is to be used as the payer of last resort, and will provide reimbursement only when travel and subsistence expenses
cannot be covered
by the recipient of the organ;
under any State compensation program, under any insurance policy, or under any Federal or State health benefits program; or
by an entity that provides health services on a prepaid basis
How is the National Living Donor Assistance Center (NLDAC) funded?
The NLDAC is funded by a federal government grant awarded by the Health Resources and Services Administration (HRSA). It was established to provide greater access to transplantation for people who want to donate. Priority is given to those who cannot otherwise afford the travel and subsistence expenses associated with donation.
What are the criteria for NLDAC donor reimbursement?
Donor and recipient of the organ are U.S. citizens or lawfully admitted residents of the U.S.
Donor and recipient have their primary residence in the U.S. or its territories.
Travel originates 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 stipulates 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
: Many factors may prevent an 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.
The recipient’s household income determines whether a donor qualifies for NLDAC assistance. The recipient’s yearly household income should be no greater than 300% of the Federal Poverty Guidelines, which can be found in the
NLDAC Eligibility Screening Tool
. The recipient may request a waiver for financial hardship in certain circumstances. The donor’s household income does not determine eligibility, although it does affect preference for funding.
Who developed the eligibility criteria?
The eligibility criteria were developed by the National Living Donor Assistance Center
and the Health Resources and Services Administration (HRSA).
What 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 2 calendar years of the living donation procedure (or beyond the 2-year period if exceptional circumstances exist).
What is the maximum federal reimbursement for qualifying expenses during the donation process for the donor and accompanying individuals?
Do I need to turn in receipts to be reimbursed?
No. NLDAC will provide a credit card with an approved spending limit to cover the costs of meals, hotel, airfare, and other travel expenses for approved applications. The mileage and meal allowances are based on federal rates. The credit card will have a pre-set limit based on the amount of funds approved. All expenses will be tracked through centralized reports.
Are support person(s) for the living donor allowed to travel?
Yes. Up to two trips may be provided for an accompanying person(s).
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).
What is the maximum number of prospective donors per recipient?
Kidney: One donor at a time with a maximum of three donors evaluated.
Liver: One donor at a time with a maximum of five donors evaluated.
Lung: Two donors at a time with a maximum of six donors evaluated.
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.
allow state employees additional vacation or sick time if they are living donors.
Who submits the application to the NLDAC?
A transplant center professional (usually a living donor advocate, social worker or financial coordinator) will file the application on behalf of the prospective living donor. NLDAC does not accept applications directly from patients.
What is the application process?
Complete information on how to apply is located on the
Step by Step Guide
. The donor and the recipient must:
Complete the NLDAC application worksheets and sign the NLDAC attestation form.
Gather a copy of their most recent federal income tax return, pay stubs, or other documents to verify their household income.
Give these documents to their transplant coordinator, social worker or other transplant professional. The transplant professional will file the web-based NLDAC application.
Where can I find the application worksheets?
. You may also request worksheets from the NLDAC office or your transplant professional.
When does the application need to be submitted?
Applications should be submitted 6 to 8 weeks before travel or surgery. NLDAC requires at least 10 business days to process category 1 and 3 applications, and at least 15 business days to process category 4 applications. If the recipient needs a liver transplant urgently and cannot wait 10-15 business days for surgery, the application can be reviewed and approved or denied in 1-2 business days. NLDAC cannot approve an application after the donor’s surgery has taken place, or reimburse expenses incurred before the application was approved.
Who reviews the applications and makes the awards?
The NLDAC Review Committee reviews all applications, and approves or denies them based on the eligibility guidelines and criteria. If a waiver for financial hardship is requested, HRSA will make the final determination. HRSA’s decision is not subject to appeal.
Why must the living donor and recipient sign NLDAC attestation forms?
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 (NLDAC attestation form) affirming they have been informed of what constitutes “valuable consideration” and that they are in full compliance with
. 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).
How is a household defined for NLDAC?
A household is a person living alone or a group of people living together. They do not have to be related. Under this definition, a person who lives with others but lives independently and shares basic living expenses, like roommates, can be a separate household. People who cannot have a separate household are spouses living together, parents living with their natural, adopted or step children, or children living with their natural, adopted, or stepparents,
the child is 22 years or older.
How is income defined for NLDAC?
Income is defined as adjusted gross income when using a Federal income tax return. Income is defined as gross income when using pay stubs as verification of income.
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 was established to assist donors, and priority is given to individuals who would otherwise not be able to donate because neither the donor nor recipient can afford the expenses associated with the donor’s travel (e.g., airfare, lodging, meals).
How do transplant centers verify income for the NLDAC application?
The donor and the recipient are required to submit documents to verify their household incomes. A variety of documents may be used, including federal income tax returns, pay stubs, Social Security disability statements, and Medicaid. Other documents may also be considered as proof of income. Call NLDAC if you have questions.
What are the preference categories for the NLDAC?
All live kidney, liver, lung lobe, and intestine 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. For more information please see Guide for Determining
How is recipient financial hardship defined?
NLDAC defines financial hardship as a situation in which it would be difficult for the recipient to cover their donor’s travel expenses, despite their household income exceeding 300% of the
Federal Poverty Guidelines
. In assessing financial hardship, NLDAC considers two types of expenses: (1) those related to the recipient’s medical condition, including out-of-pocket insurance premiums; out-of-pocket medical bills; pharmacy, lab and physician co-pays; lost income; and transportation to medical appointments (dialysis, etc.); and (2) financial support of a family member living outside the household, such as child support payments. Normal living expenses like rent, car payments, and utility bills and not considered.
How does the recipient request a waiver for financial hardship?
The recipient must complete a
NLDAC financial hardship waiver worksheet
as part of their application. This worksheet describes the recipient’s out-of-pocket medical expenses, lost income, and other expenses related to their medical condition. For example, if their household income is $5,000 above the income threshold and they have $5,000 in allowable expenses, the application may be approved. The NLDAC will review the request and make a recommendation to HRSA to approve or deny it. HRSA will make the final determination and communicate that determination to the NLDAC, which will notify the transplant center. HRSA’s determination is not subject to appeal.
If I am participating in a paired exchange program, am I eligible for NLDAC funds?
Yes. The originally intended recipient is used for income testing.
If I am non-directed donor, am I eligible for NLDAC funds?
Because eligibility is based on the recipient’s household income, a NLDAC application may be submitted on behalf of a non-directed donor only after the recipient is identified. Transplant center staff can help the donor and recipient submit their application while maintaining their anonymity.
Does the NLDAC assist in reimbursement of lost wages and child care expenses?
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.
Are bone marrow donors eligible for funds through the NLDAC grant?
No. The NLDAC is for living solid organ donors only.
What happens if I use funds from the NLDAC and am unable to donate?
Many factors may prevent an 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 (such as 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.
Learn what you need to know before applying for NLDAC assistance by reading our