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General Questions

The National Living Donor Assistance Center (NLDAC) is a federally funded program that helps eligible living organ donors with their travel expenses and lost wages. This program is not intended to promote or encourage donation. Funds are not provided as a gift or reward for being a donor. Funding is only available to donors who cannot receive reimbursement of these costs from any of the following:
  1. the recipient of the organ
  2. any State compensation program, under any insurance policy, or under any Federal or State health benefits program, or
  3. an entity that provides health services on a prepaid basis
NLDAC is funded by a federal grant from 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.

There are two sets of requirements—one for the donor and recipient, and one for the transplant center where the donation occurs.

The donor and recipient must:

  • Be U.S. citizens or lawfully present residents of the U.S. or its territories
  • Have their primary residence in the U.S.
  • Sign the attestation form, indicating they are in 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.”
  • Travel from their primary residence to the transplant center

The transplant center where the donation occurs must:

  • Attest to its status of good standing with the Organ Procurement and Transplantation Network (i.e., it does not have a designation of “Member Not in Good Standing”)
  • Be registered with NLDAC

The recipient’s household income is the primary factor in determining whether a donor qualifies for NLDAC assistance. The recipient’s yearly household income should be no greater than 350% of the HHS Poverty Guidelines, which can be found in the NLDAC Eligibility Screening Tool. The recipient may request a waiver for financial hardship if their income exceeds the guidelines but they could not help their donor. The donor’s household income does not determine eligibility, although it does affect priority for funding. NLDAC gives priority to eligible donors whose household income is within the income guidelines, and depending on available funding, might only be able to approve applications for these donors at certain times. NLDAC will announce if donor income is restricted on our website and in our newsletter.

The eligibility criteria were developed by the National Living Donor Assistance Center Advisory Group and the Health Resources and Services Administration (HRSA).

Donors can apply for two kinds of reimbursement: travel expenses and lost wages. The travel expense reimbursement covers transportation, lodging, and meals for the donor and a support person on evaluation, donation surgery, and follow-up trips to the transplant center for up to 2 years after the donation surgery. Under exceptional circumstances, the transplant center may request NLDAC fund a trip more than 2 years after the donation surgery. The lost wage reimbursement covers up to 3 days for evaluation, up to 4 weeks for recovery from donation surgery, and up to 2 weeks for follow-up trips or rehospitalization due to complications. Many donors take more than 4 weeks off work for their recovery, and so they may have additional lost wages beyond what NLDAC can cover.

Kidney recipients: one donor at a time with a maximum of 3 donors evaluated.
Liver recipients: one donor at a time with a maximum of 5 donors evaluated.
Lung recipients: two donors at a time with a maximum of 6 donors evaluated.

Expenses covered by NLDAC cannot be claimed as donor out-of-pocket expenses, and cannot be deducted on income tax returns. However, many state laws allow the living donor to claim unreimbursed lost wages and medical expenses when filing income tax returns. Certain states allow state employees additional vacation or sick time if they are living donors.

A transplant center professional (usually a living donor advocate, social worker, nurse coordinator, or financial coordinator) will file the application on behalf of the prospective living donor. NLDAC cannot accept applications directly from patients.

Complete information on how to apply is located in the Step by Step Guide. The donor and the recipient must:

  1. Complete the NLDAC application worksheets and sign the NLDAC attestation form.
  2. Attach a copy of their most recent federal income tax return, pay stubs, or other documents to verify their household income.
  3. Donors applying for reimbursement of lost wages must also attach their two most recent pay stubs (or other documentation of their current wages if they are self-employed) and a signed W-9.
  4. Give these documents to their nurse coordinator, social worker, or other transplant professional. The transplant professional will file the web-based NLDAC application.

On the Step by Step Guide. You can also ask NLDAC or your transplant center to send you a paper copy of the application worksheets.

We recommend applying well in advance of any trips you’d like NLDAC’s help with. NLDAC requires 10 business days to process applications where the recipient’s household income is within our guidelines (preference categories 1 and 3), and at least 15 business days to process category 2 and 4 applications, where a financial hardship waiver is requested. 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.

At least two members of the NLDAC operations team review each application, approving or denying them based on the eligibility criteria and preference category. If a waiver for financial hardship is requested, the Health Resources and Services Administration (HRSA) will make the final determination. HRSA’s decision is not subject to appeal.

It is illegal to buy and sell organs in the United States. 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 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). The attestation forms also authorize the transplant center to provide information about the donor and recipient to NLDAC.

For the purposes of NLDAC eligibility, a household is defined as 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 be considered a separate household are spouses living together, parents living with their natural, adopted, or stepchildren, or children living with their natural, adopted, or stepparents, unless the child is 22 years or older.

For the purposes of NLDAC eligibility, 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.

Authorizing legislation mandates that the recipient’s ability to pay must be taken into consideration as part of this program. 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 NLDAC does not change this. 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) and/or lost wages.

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, unemployment benefits, and proof of eligibility for Medicaid, SNAP, WIC, or HUD Section 8. Other documents may also be considered as proof of household income. Please call us at 888-870-5002 if you have questions.

All living kidney, liver, lung, uterus, 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 order of priority: preference category 1, preference category 2, preference category 3, and preference category 4. Categories 2 and 3 describe different requirements that may be in place at a certain time for applicants with a recipient household income within the guidelines and a donor household income above the guidelines.

Preference Category Recipient Household Income Donor Household Income Financial Hardship Required?
Category 1 Below guidelines Below guidelines No
Category 2 Below guidelines Above guidelines Yes, donor must demonstrate financial hardship
Category 3 Below guidelines Above guidelines No
Category 4 Above guidelines Above or below guidelines Yes, recipient must demonstrate 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. 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 NLDAC, which will notify the transplant center. HRSA’s determination is not subject to appeal.

Yes. You will apply with your originally intended but incompatible recipient.

An anonymous, non-directed donor is someone who donates an organ without choosing their recipient or knowing who the recipient is. In reviewing these donors’ applications, NLDAC does not require or consider any information about the recipient. They are assigned to a preference category based on their household income. Donors whose income is within the income guidelines will receive priority.

No. NLDAC can only help living solid organ donors, such as kidney, liver, lung, intestine, and uterus donors.

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.

NLDAC’s ability to reimburse eligible donors for their travel and lost wages depends on the availability of funding. In the event that there is not enough funding for NLDAC to approve all eligible applicants, priority will be given to donors whose household income is within 350% of the HHS Poverty Guidelines, and those who demonstrate financial hardship. Refer to the NLDAC preference categories for more detailed information on how NLDAC prioritizes funding for applications based on the applicants’ household income. NLDAC will mark eligible applications for which funding is not available at the time of review as deferred. If funding becomes available for applications in a previously deferred preference category, NLDAC will announce this on its website and in the newsletter. At that time, the transplant professional who submitted the application can request NLDAC re-review a deferred application for funding, if the donation surgery has not yet been ruled out or taken place (i.e., the donor is still undergoing evaluation). NLDAC can only approve and fund applications before donation surgery takes place, and NLDAC cannot reimburse expenses that were incurred before the application was approved.

Questions About Travel Assistance

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. All expenses are tracked through reporting software.

Yes. NLDAC can cover up to 2 trips for an accompanying person(s).

NLDAC can cover travel expenses incurred on 3 trips for the donor (evaluation, surgery, and follow-up) and 2 trips for a support person. The transplant center may request funding for additional trips. NLDAC only provides funding for trips that take place after the donor’s application is approved and before surgery takes place.

Questions About Lost Wage Reimbursement

Donors submit their two most recent pay stubs with their lost wages application, and NLDAC calculates and records a daily wage for the donor using a wage calculator. Self-employed donors and independent contractors can submit alternate documentation of their wages (see next question). Donors call NLDAC before each loss of wages (evaluation, surgery, follow-up) to discuss their reimbursement needs, and NLDAC multiplies their daily wage by the number of days they will lose wages, up to the NLDAC maximum. Other factors affecting reimbursement needs, like availability of paid time off or short-term disability, will be considered.

Donors who are self-employed or independent contractors (including gig workers) can submit their most recent:

  • Federal income tax return with Schedule C
  • IRS Form 1099
  • Earnings statement or tax summary from their company (like Uber or Lyft)

NLDAC will use the documents the donor submits to calculate their wage reimbursement. We can only reimburse documented wages. Please call us at 888-870-5002 if you have questions or need help identifying the appropriate documentation of your wages.

No. NLDAC cannot pay wages to donors who are unemployed or furloughed at the time of their donation surgery or other appointment, but we encourage them to apply for help with travel expenses. NLDAC can only reimburse wages a donor would have earned if they did not donate an organ.

No. NLDAC can only reimburse documented, reported wages. We cannot accept letters or bank statements as documentation of wages. Wages paid “under the table” are not reported to the IRS and therefore cannot be reimbursed. Not all cash wages are unreported, though. If a donor is paid cash but also receives pay stubs, NLDAC can accept their pay stubs as documentation of their wages. Please call us at 888-870-5002 if you have questions.

Donors can only request reimbursement of wages that will not be paid by another source, such as paid time off or short-term disability. If a donor will not lose any wages because of their donation, they cannot request reimbursement of lost wages from NLDAC. However, if a donor’s paid time off or short-term disability benefits will not cover all of their normal wages for the NLDAC reimbursement period (4 weeks after donation surgery), they can request reimbursement of the remaining, unreimbursed portion of their wages. NLDAC does not require donors to exhaust their paid time off before requesting wage reimbursement, but donors who choose to save their paid time off must check with their employer to ensure the employer allows them to take an unpaid leave of absence before exhausting their paid time off.

NLDAC makes wage reimbursements around the time of each appointment—evaluation, surgery, and follow-up. The transplant center must confirm the donation surgery is complete before NLDAC can make wage reimbursement for the surgery and 4-week recovery period available.

NLDAC sends approved applicants who requested reimbursement of lost wages a controlled value card. The card looks like a credit card Once NLDAC has made funding available, the donor can swipe the card to make purchases, or take the card to an ATM and withdraw their wage reimbursement as cash.

The American Society of Transplant Surgeons will issue an IRS Form 1099 to all donors who receive lost wage reimbursement. The lost wage reimbursement is income, and may be subject to federal and/or state income tax reporting. It is the donor’s responsibility to contact a qualified tax advisor to determine tax liability. The entities providing reimbursement are not responsible for any tax consequence related to wage reimbursement.

Learn what you need to know before applying for NLDAC assistance by reading our Program Snapshot.

Organ Donor
University of Kansas
Arbor Research Collaborative for Health