Press release

American Kidney Fund Releases 2022 Living Donor Protection Report Card, Highlighting Need for Federal Protections for All U.S. Donors

Second annual Report Card highlights progress among states, but more needs to be done to protect those giving the gift of life

ROCKVILLE, Md. (March 23, 2022) — The American Kidney Fund (AKF) today released its second annual State of the States: Living Donor Protection Report Card. The 2022 Report Card highlights progress among states in achieving protections for living organ donors, while pointing to the continued need for baseline federal legislation that would protect donors regardless of where they live. In the past year, seven states passed living donor protection laws: Connecticut, Kentucky, Maryland, New Jersey, Pennsylvania, Texas and Washington.

AKF works closely with state legislators, as well as AKF's Advocacy Network of more than 17,000 AKF Ambassadors, to introduce and advance legislation that protects living organ donors and removes barriers to donation. Boosting the number of living organ donors would reduce the number of Americans on the transplant waiting list and save lives. More than 106,000 people are on the national transplant waiting list, and nearly 92,000 of them, or 87%, are waiting for a kidney. On average, 13 Americans die every day waiting for a kidney transplant.

Highlights from the 2022 Report Card included the following:

  • Two states — Arkansas and Connecticut — continue to receive an A grade, while 31 states received a B or C grade. Eighteen states received a grade of a D or F.
  • Four states — Kentucky, Pennsylvania, Texas and Washington — improved their scores to a C grade, bringing the total number of C states to 17.
  • New Jersey moved up to a D grade, while six other states remained a D.
  • Eleven states offer no protections at all for living organ donors and received an F grade — Alabama, Florida, Michigan, Montana, Nebraska, Nevada, New Hampshire, South Dakota, Tennessee, Vermont and Wyoming.
  • The average grade for the United States remains a D.

"AKF applauds states that have chosen to stand up for the remarkable Americans who make a lifesaving organ donation. We urge all states to continue to pass these important laws," said LaVarne A. Burton, President and CEO of AKF. "A person's ZIP code should not dictate whether they can be a living organ donor. The Report Card makes abundantly clear that there is a need for federal legislation that will provide nationwide, uniform protections for living organ donors, so that more people can consider giving the gift of life."

The Living Donor Protection Act of 2021 was introduced in both the U.S. House of Representatives and Senate to provide baseline protections nationwide, ensuring that living organ donors have Family and Medical Leave Act (FMLA) and anti-discrimination protections. AKF continues to support the Living Donor Protection Act, mobilizing AKF Ambassadors to lobby their representatives in Congress to support this important legislation. In 2021, the bill gained 32 cosponsors in the Senate and 102 cosponsors in the House. The passage of such an act would mean that the lowest Report Card grade any state could receive would be a C.

The AKF Living Donor Protection Report Card measures seven different categories of publicly reported legislation in each U.S. state and the District of Columbia. These categories include anti-insurance discrimination 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 FMLA laws; and extended FMLA leave of more than 60 days.

Anti-insurance discrimination legislation prohibits life, disability and long-term care insurers from discriminating against living organ donors by charging them higher premiums or denying them coverage. Studies have shown and AKF Ambassadors have reported that living donors have had trouble changing or initiating a new insurance plan based on their status as an organ donor, but there is no difference in long-term risk of death for kidney donors when compared to a similar group of healthy people with both kidneys.

Living organ donors also require two to 12 weeks of recovery following surgery before returning to work, so job protection for living organ donors during recovery time is essential. Additionally, direct reimbursements, tax credits and tax deductions can offset all or part of the financial losses for donors that are associated with travel and lodging for testing and the surgery, medications that may be required after surgery, and other incidental costs not covered by insurance.

"Donating an organ to save someone's life is an act of profound generosity," Burton said. "At minimum, living organ donors should be protected from job loss, higher insurance costs or any other type of potential economic harm that will cause them undue hardship or discrimination."

AKF's flagship financial assistance program makes possible an average of 157 kidney transplants each month for low-income dialysis patients and continues to help them post-transplant for their full insurance plan year, ensuring continuity of care. In 2021, amid the pandemic, this program not only helped nearly 71,000 low-income kidney patients stay insured, but it also made kidney transplants possible for 1,889 dialysis patients — about 7% of all kidney transplants performed in the United States last year.

Details on the grades for each state can be found at

About the American Kidney Fund

The American Kidney Fund (AKF) fights kidney disease on all fronts as the nonprofit with the greatest direct impact on people with kidney disease. AKF works on behalf of 1 in 7 Americans living with kidney disease, and the millions more at risk, with an unmatched scope of programs that support people wherever they are in their fight against kidney disease—from prevention through transplant. AKF fights for kidney health for all through programs that address early detection, disease management, financial assistance, clinical research, innovation and advocacy. AKF is one of the nation’s top-rated nonprofits, investing 97 cents of every donated dollar in programs, and holds the highest 4-Star rating from Charity Navigator for 21 consecutive years and the Platinum Seal of Transparency from Candid, formerly known as GuideStar. 

For more information, please visit, or connect with us on Facebook, Twitter, Instagram and LinkedIn.