Blog post

AKF Living Donor Protection Report Card: How well does your state protect living organ donors?

We released our first annual State of the States: Living Donor Protection Report Card yesterday! Learn more about the Report Card and how it will help inform our kidney disease advocacy work throughout 2021 on our blog.
AKF Living Donor Map with state ratings

Yesterday, the American Kidney Fund (AKF) released our 2021 State of the States: Living Donor Protection Report Card. The Report Card is our first annual assessment of how well laws in each state and the District of Columbia encourage living organ donation and reduce barriers for living organ donors. The Report Card is based on the laws on the books in the states in 2020 and will help inform our advocacy work throughout 2021.

The Report Card assigns an A, B, C, D or F grade to each state by measuring seven types of legislation:

  • 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 to living donors
  • Tax credits or tax deductions for donor expenses
  • Paid leave via Family and Medical Leave Act (FMLA) laws
  • Extended leave (more than 60 days) via FMLA laws

With a patchwork of laws in the states, protections for living organ donors are extremely inconsistent across the country. States that have very little to no protections for living donors — most of the states — make it harder for those on the transplant waiting list to access a kidney because of obstacles that may prevent living donors from choosing to give the gift of life. There are 108,000 Americans on the organ transplant waiting list and more than 93,000 of them — 86%–are waiting for a kidney. Seventeen people die each day waiting for an organ transplant, including 13 who die waiting for a kidney. Living donation offers an alternative for individuals awaiting transplantation from a deceased donor and increases the existing organ supply. Kidneys are by far the most common organ transplanted from living donors, followed by livers.

Over the last two years, AKF has worked to introduce living donor legislation in 33 states, and these laws were enacted in 12 of those states before being temporarily derailed in the other states by the COVID-19 pandemic. AKF will continue to introduce and pursue these pieces of legislation in 2021 and beyond. This is a top priority for AKF as we work to improve the lives of those living with kidney disease and make access to organ donation easier for those who need a kidney.

With the help of our network of 15,000 Ambassadors, AKF also actively supported the federal Living Donor Protection Act of 2019 in the 116th Congress, and we urge the new Congress to reintroduce the federal Living Donor Protection Act this year. A federal bill would provide a baseline of anti-discrimination by insurers, guarantee that living organ donors nationwide are covered by FMLA and direct the U.S. Department of Health and Human Services to update its materials on living organ donation to reflect these new protections and encourage more individuals to consider donating an organ.

While only two states have received an A grade in our first Report Card, this presents a huge opportunity for other states to strengthen their protections for living donors until there is an acceptable baseline level of protections established by federal legislation.

We encourage you to view our interactive Report Card webpage, where you can see all the state grades, compare your state to others, click on each state to see what living donor legislation they have enacted, learn more about how we came up with the grades and take our petition to show your support for federal living donor protection legislation. 

If you would like to learn how to get involved in your state to increase living donor protections and work on raising your state's grade, please contact me, Lindsay Gill, AKF's associate director of state policy & advocacy at


Lindsay Gill

Lindsay Gill is the associate director of state policy & advocacy at the American Kidney Fund.