Section 3 of
the Organ Donation and Recovery Improvement Act (ODRIA), 42 U.S.C. 274f, establishes the authority
and legislative parameters to provide reimbursement for travel and subsistence
expenses incurred towards living organ donation. HRSA has awarded a cooperative agreement to the University of Arizona,
which has partnered with the American Society of Transplant Surgeons (ASTS),
to establish the National Living Donor Assistance Center (NLDAC) to operate this Program.
As provided for in the statutory authorization, this Program is intended to
provide reimbursement only in those circumstances when payment cannot
reasonably be covered by other sources of reimbursement. The NLDAC, under
Federal law, cannot provide reimbursement to any living organ donor for travel
and other qualifying expenses if the donor can receive reimbursement for these
expenses from any of the following sources:
In response to public solicitation of comments, a threshold of income eligibility
for the recipient of the organ is 300 percent of the Department of Health and
Human Services (HHS) Poverty Guidelines in effect at the time of the
eligibility determination. The Program assumes that recipients whose income
exceeds this level will have the ability to reimburse the living organ donor
for the travel and subsistence expenses and any other qualifying expenses that
can be authorized by the Secretary of HHS. The Program provides an exception
to this rule for financial hardships. A transplant social worker, or
appropriate transplant center representative, based on a complete recipient
evaluation, can provide an official statement, notwithstanding the recipient’s income
level, that 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 percent 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 (e.g., elderly
parent). 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.
All persons who wish to become living organ donors are eligible to receive reimbursement
for their travel and qualified expenses if they cannot receive reimbursement
from the sources outlined above and if all the requirements outlined in the Criteria
for Donor Reimbursement Section are satisfied. However, because of the
limited funds available, prospective living donors who are most likely not able
to cover these expenses will receive priority.
The ability to cover these expenses is determined based on an evaluation of (1) the
donor and recipient’s income, in relation to the HHS Poverty Guidelines
(described in Table 1.1 below), and (2) financial hardship. As a general
matter, income refers to the donor or recipient’s total household income. A
donor may be able to demonstrate financial hardship, even if the donor’s income
exceeds 300 percent 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
Donors will be given preference in the following order of priority:
View 300% of the HHS Poverty Guidelines with the
NLDAC Eligibility Screening Tool to help determine program eligibility.
HRSA reserves the right to prioritize
those most in financial need (based on income or other specified factors) if it
receives large numbers of applications concerning donors meeting preference
The following figures are the 2017 HHS poverty guidelines which are scheduled to be published in the Federal Register.
States and D.C.
families/ households with more than 8 persons add,
$4,180 for each additional person
$5,230 for each additional person
$4,810 for each additional person
300% HHS Federal Poverty Guidelines
$12,540 for each additional person
$15,690 for each additional person
$14,430 for each additional person
Criteria for Donor Reimbursement
For the purposes of the Reimbursement of Travel and Subsistence Expenses toward Living
Organ Donation Program, qualifying expenses presently include only travel,
lodging, and meals and incidental expenses incurred by the donor and/or
his/her accompanying person(s) as part of:
The Program will pay for a total of up
to five trips; three for the donor and two
for accompanying persons. However, in
cases in which the transplant center
requests the donor to return to the
transplant center for additional visits as
a result of donor complications or other
health related issues, NLDAC may
provide reimbursement for the
additional visit(s) for the donor and an
accompanying person. The
accompanying persons need not be the
same in each trip.
The total Federal reimbursement for
qualified expenses during the donation
process for the donor and accompanying
individuals shall not exceed $6,000.00.
Reimbursement for qualifying expenses
shall be provided at the Federal perdiem
rate, except for hotel
accommodation, which shall be
reimbursed at no more than 150 percent
of the Federal per diem rate.
For donor and recipient pairs
participating in a paired exchange
program, the applicable eligibility
criteria for the originally intended
recipient shall be considered for the
purpose of reimbursement of qualifying
donor expenses even though the final
recipient of the donated organ may not
be the recipient identified in the
original donor-recipient pair.
Maximum Number of Prospective Donors per Recipient
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
If you are considering organ donation, NLDAC may be able to lessen the burden of travel expenses. View the NLDAC Eligibility Screening Tool for NLDAC household income requirements.
To learn more about the application process, read the NLDAC brochure "How to Apply" in English or Spanish.
Join NLDAC in its mission to reduce financial disincentives to living donation. Please print a NLDAC poster and place it in your kidney transplant clinic or your local dialysis clinic. If you would like us to mail you posters or brochures, please complete this request form. If you would like to learn about the application process, click on the link below.