US earns a C grade for living organ donor protections in AKF report card
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The American Kidney Fund released its 2023 State of the States: Living Donor Protection Report Card and gave the U.S. an overall grade of a C.
This is an improvement from the 2022 grade of a D.
According to the press release, AKF grades state legislation based on anti-discrimination laws for life, disability or long-term care insurance; job-protected leave from private employers; job-protected leave from public employers; tax credits for employers who provide paid leave; direct reimbursements, tax credits or tax deductions for donor expenses; paid leave via Family and Medical Leave (FMLA) laws; and extended FMLA leave of more than 60 days.
For the 2023 report card, three states (Arkansas, Connecticut and Louisiana) earned an A grade. Nine states (Alabama, Michigan, Montana, Nevada, New Hampshire, South Dakota, Tennessee, Vermont and Wyoming) maintained an F grade due to offering no protections.
“In some of these states, it’s hard for people to reach an agreement on legislature to pass,” Holly Bode, the vice president of government affairs at AKF, told Healio. “There are some states, like Michigan, where there’s a definite interest from the community but they haven’t been able to get any traction from the state legislators. At that point, it’s mostly politics.”
As Healio previously reported, New York passed the first law in the U.S. to provide direct reimbursement to living organ donors. Although New York donors will now have access to up to $10,000 in reimbursements, the state did not improve its grade. For New York to move up to an A grade, legislators would have to enact additional protections, such as job-protected leave from private employers or paid leave via FMLA, according to the AKF.
“We hope New York is not the only state with this legislation, say, in 5 years,” Bode said. “Often it leads the way on some of these things, and it can take other states a while to catch up. It’s a great precedent to set, and we’d love to see it in other states.”
Bode suggested that California may be the next state to offer reimbursement to living donors. Moving forward, AKF intends to continue advocating for The Living Donor Protection Act of 2022, which would provide FMLA and anti-discrimination protections to living donors across the country. Reintroducing and passing this act would bring every state to a C grade.
“Despite our best efforts, that legislation didn’t go anywhere last year, but it will be introduced next week, most likely,” Bode said. “We will keep trying to get it passed until we see the A grade on the horizon.”
The AKF 2023 State of the States: Living Donor Protection Report Card can be found here with a breakdown the grade for each state.
Perspective
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Living donor kidney transplantation is undoubtedly the best treatment option for patients with advanced kidney disease, offering improvement in life expectancy and quality of life while minimizing the time waiting for a transplant.
Living donor kidney transplantation (LDKT) not only helps patients at an individual level, but also offers great benefit to society, such as lowering the overall financial burden of therapy for end-stage kidney disease, particularly when compared to chronic dialysis. However, LDKT is only possible through the selfless act of a living kidney donor who ultimately obtains no medical benefits from donation.
In the United States, only a minority of patients receive a kidney from a living donor. In 2022, among 25,449 kidney transplants performed, only 5,863 (23%) were LDKT. We also see significant disparities in access to LDKT. For example, minorities and patients who have low socioeconomic status have reduced access to LDKT. It is well-recognized that financial disincentives act as a huge barrier to kidney donation and even more so for minorities and donor candidates with low socioeconomic status.
Supporting living donors by removing financial disincentives is key to the much-needed growth of LDKT and will not only benefit the donors themselves, but also recipients and society in general.
In the latest release of the Living Donor Protection Act Report Card published by the American Kidney Fund, some improvements have been noted. Nine states have passed living donor protection laws in the last year. What is glaring, however, is that there are nine states that offer no protection at all for living donors. This means that a kidney donor in Tennessee (where I reside and has a report card grade of F) may be subject to unaffordable premium rates for medical insurance or be denied life insurance after donation.
The living donor may have to shoulder the cost of additional childcare while he or she recovers from surgery and may need to use vacation time to be able to donate. These are just examples of challenges living kidney donors face when there is no legislation to provide a safeguard.
Clearly, passing legislation can be accomplished, as shown by the 34 states that now have a grade of C or higher in the report card. The Living Donor Protection Act of 2022, introduced in both houses of Congress, is an opportunity to reduce these existing geographic disparities in laws that protect living donors.
We owe a huge thanks to the American Kidney Fund and other organizations for all the work that these do to promote and support living kidney donation. Ultimately, continued advocacy and political will is necessary to ensure we protect our living donors.
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