This nonprofit just took a big step to make kidney donation in the US easier

Reducing deaths from kidney disease is a crucially important public health goal.

I’m biased, as someone who’s donated a kidney, but the numbers are pretty clear: About 40,000 people die every year in the US for lack of a kidney transplant, more than die from major killers like Parkinson’s, HIV, or homicide.

For a long time, the National Kidney Registry, a nonprofit organization that facilitates kidney pairs and chains (which enable more donations by matching donors with recipients who have compatible blood types and antibodies), and is responsible for about a sixth of all kidney donations and about two-thirds of kidney pair donations, has been trying to cut the number of kidney disease fatalities, and a new policy they’ve adopted is especially ambitious.

On Wednesday, NKR announced that all donors giving through swaps NKR puts together will now be eligible for Donor Shield, a program where donors can get reimbursed for major expenses like lost wages, transportation costs, and lodging expenses for their caregivers.

Let’s say you donate a kidney to a stranger, either in exchange for a kidney for a loved one as part of a swap, or as a “Good Samaritan” donor, at one of NKR’s 90-odd centers across the country (there’s at least one in most major metro areas). You need to take two to four weeks off work to recover, and make under $62,000 a year, then your lost wages will be reimbursed. The hotel room your mom or dad or wife or husband or partner stays in while you’re in the hospital? That will be covered too, up to $2,000. Same with your flights if you’re coming from far away. A huge share of the costs associated with donating your kidney are gone.

That is a huge deal. A study just released in the Journal of the American Society of Nephrology estimates that for the typical donor, travel and lost wages amount to a disincentive of over $8,000. And past programs, including internationally, that provide reimbursement for disincentives have reliably been accompanied by increases in donations.

The money comes from a mixture of the transplant centers and the NKR itself, coming out of funds provided by financial donors.

If you’ve ever considered donating your kidney — and if you’re a healthy adult, you should — and have an NKR transplant center nearby, the case for you donating just got a lot better. You can find out more and sign up for an evaluation to see if you’re eligible to donate here.

Donor Shield had previously been adopted at some but not all NKR centers, and a subset of those — Georgetown in DC, Rush in Chicago, Allegheny in Western Pennsylvania (including Pittsburgh), University of Wisconsin in Madison, and Avera in Sioux Falls, South Dakota — provide the benefit to all their donors. That is, even people donating directly to loved ones, not through a swap program like NKR’s, are eligible.

That group, the majority of kidney donors who give to a relative, also have a government-funded program that can help out: the National Living Donor Assistance Center, or NLDAC. Financed by the federal Department of Health and Human Services, NLDAC offers support for transportation and lodging costs, and due to an executive order recently signed by President Donald Trump, will soon be covering lost wages and child care expenses as well.

But NLDAC means-tests both the recipient to make sure they’re low-income. That creates a problem for swap or chain donations. I gave my kidney to a stranger, so I had no idea what his income was or if it was above or below the NLDAC limit. Same goes for people donating to strangers as part of swaps in which their loved one got a kidney in exchange. That benefit stream is effectively cut off from paired exchange and Good Samaritan donors of the kind NKR exists to help.

That’s where NKR and Donor Shield come in. While Donor Shield is means-tested for donors — only people making $62,000 or less get lost wage reimbursement — it is not for recipients. You could donate to a millionaire, and still get reimbursement if you need it. That’s the way it should work, if there’s going to be any means-testing; it’s not clear why the donor’s reimbursement should be affected by the finances of the person they’re donating to. Meanwhile, NKR assures donors that they will be on the top of the list for a kidney themselves if they need one later in life, assuaging another important disincentive.

In the future, Garet Hil, the founder and president of NKR, tells me that he’d love to remove the income cap and the cap on travel expenses, and start reimbursing for child care as well. But currently the hospitals functioning as transplant centers and NKR are sharing the financial cost of the program, which limits how much support they can provide.

The holy grail would be for Medicare, which guarantees coverage for kidney transplants in the US, to announce that it will reimburse for lost wages, child care, transportation, and lodging as part of its payments to hospitals for performing transplants. That would free transplant centers from having to find the money themselves, and make this kind of reimbursement easy and automatic for all donors.

In the meantime, though, getting a virtuous competition going between transplant centers is the next best thing. Donors will naturally gravitate to centers that offer more protections, which makes NKR’s efforts to spread Donor Shield and encourage centers to offer it for all their donors, not just ones through NKR, a lever that could pressure other centers to get on board so they get more transplant business.

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