Government-transplant community partnership eases financial burden for donors

Donating an organ to a loved one or friend in need is a personal sacrifice and a life-giving form of altruism. But it can be costly for some donors when insurance doesn't cover the expenses. Enter the National Living Donor Assistance Center.

Since 2007, the NLDAC has been a successful model of a public-private partnership in helping bring donors and recipients together. Based in Arlington, Va., the Center is funded by the federal Healthcare Systems Bureau of the Human Resources Services Administration, and is managed and administered by the University of Michigan in partnership with the American Society of Transplant Surgeons and the Arbor Research Collaborative for Health. In a time of tightening federal dollars and legislative dogfights on how tax dollars should be spent, funding for this program was recently renewed at $3.5 million a year through 2019.

NLDAC provides reimbursement of travel and subsistence expenses for living organ donors to travel to the transplant center to donate an organ. Approved applicants receive a controlled value card, which is like a credit card, to pay for approved transportation, food and lodging expenses up to $6,000.

Getting funds to donors in need

Perhaps it is the effectiveness and track record of the program that has produced a popular fan base in Washington and at HRSA, which must petition for funding in its own budget to keep the doors open for the Center (see box for results).

Accomplishments

Applications processed: close to 6,000 since 2007

Participants/Referrals: 200 transplant centers

Funds paid: $1.8 million (2013) based on 960 applications

But organizers are careful with the funds they get; the program is aimed at helping low income individuals on the transplant wait list, and in accordance with the program authority, the NLDAC cannot provide reimbursement to donors if other possible payers, such as state compensation pro grams, health insurance companies, or the recipient of the organ can pro vide reimbursement. Donor and recipient household incomes are means tested at 300% of the federal poverty guidelines and assigned a preference category.

Priority is given to individuals who cannot otherwise afford the expenses, but the program also provides an exception to the funding thresholds for documented financial hardships "Donors who receive support from NLDAC tell us the program was essential and they would have been unable to be a living donor without the assistance;' said Program Director Akinlolu Ojo, MD, PhD, a professor of medicine at the University of Michigan.

"Living donors usually travel at least three times to the transplant center and are required to stay near the hospital for up to two weeks after the transplant surgery for monitoring. For donors who travel a long distance, these travel costs are prohibitive despite their willingness to donate an organ," adds Robert Merion, MD, President of Arbor Research and NLDAC Program deputy director. With careful screening by the transplant center and ASTS staff, close to 90% of applicants are approved for some level of reimbursement, said Merion.

In addition to helping individuals who want to donate, the NLDAC has been a financial success for the government, notes Merion, a transplant surgeon for three decades. "On aver age, approved applicants spent $2,767 for their travel expenses to the trans plant center. While expenses for the transplant itself in the first year are high, it saves money on providing dialysis long term for these patients with kidney failure. These recipients could be on the waiting list for another 3-4 years if they didn't have a living donor:· That $2,767 to facilitate the trans plant, said Merion, is a positive return on the government's investment in the program.

For more information, visit the National Living Donor Assistance Center website at www.livingdonorassistance.org/ or call the center at 703.414.1600. -by Mark Neumann