Press release

American Kidney Fund Releases 2023 Living Donor Protection Report Card, Highlighting Progress Toward Better Laws to Support Living Organ Donation

Third annual Report Card maps movement among some states, while others fail to protect those giving the gift of life

ROCKVILLE, Md. (Feb. 23, 2023) — The American Kidney Fund (AKF) today released its third annual State of the States: Living Donor Protection Report Card. The 2023 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, nine states passed living donor protection laws: Delaware, Florida, Georgia, Louisiana, Minnesota, Nebraska, New York, Ohio and Virginia.

Since releasing the first annual Report Card in February 2021, AKF has worked closely with state legislators and AKF's Advocacy Network of 20,000+ Ambassadors to protect living organ donors and remove barriers to donation. This effort has contributed to legislation passing in 28 states, moving the national grade average from a D to a C. One of the most significant advancements in 2022 was the passage of a groundbreaking law in New York that provides direct reimbursements of up to $10,000 to living organ donors for expenses associated with organ donation not covered by insurance.

Increasing the number of living organ donors would reduce the number of Americans on the transplant waiting list and save lives. About 104,000 people are on the national transplant waiting list, and 87% of them are waiting for a kidney. On average, 13 Americans die every day waiting for a kidney transplant.

"If someone in your family had kidney failure, you'd want them to get a second chance at a healthy life with the best possible treatment. Receiving a kidney from a living donor is the healthiest and safest option for the tens of thousands of people on the transplant waitlist. Unfortunately, barriers and hurdles often stand in the way of those who selflessly want to give the gift of life. It shouldn't and doesn't have to be this way," said LaVarne A. Burton, President and CEO of AKF.  "Our third annual Report Card highlights the states that are making it possible for more people to donate a kidney, and the states that have more work to do — ultimately showcasing the need for federal legislation to provide a baseline of uniform protections across the nation."

Additional highlights from the 2023 Report Card include:

  • Three states — Arkansas, Connecticut and Louisiana — received an A grade, while 31 states received a B or C grade. Seventeen states received a grade of a D or F.
  • Four states — Delaware, Georgia, Ohio and Virginia — improved their scores to a B grade, bringing the total number of B states to 17.
  • Two states — Florida and Nebraska moved up to a D grade, while six other states remained a D.
  • Nine states offer no protections at all for living organ donors and received an F grade — Alabama, Michigan, Montana, Nevada, New Hampshire, South Dakota, Tennessee, Vermont and Wyoming.

The Living Donor Protection Act was previously 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. The re-introduction and passage of such an act in the 118th Congress 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 include 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 FMLA laws; and extended FMLA leave of more than 60 days.

Most transplanted organs are from deceased donors, and the wait for an organ from a deceased donor can last years. Living donation offers an alternative for individuals on the transplant waiting list and increases the existing organ supply for everyone.

Anti-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.

"As the nation faces many challenges related to organ donations — from shortages to organ transit issues — protecting living organ donors and removing barriers to donation are very actionable steps we can take to improve the current system," Burton said. "This Report Card shows the real, tangible impact we are making toward our commitment to make living organ donation more accessible to more people, and we will continue to push forward until everyone has the same opportunity."

In addition to advocating for policy changes, AKF is helping to make transplants possible for those who could not otherwise qualify financially. AKF's flagship financial assistance program, the Health Insurance Premium Program (HIPP), makes possible an average of 147 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 2022, HIPP not only helped more than 62,000 low-income kidney patients stay insured, but it also made kidney transplants possible for 1,767 dialysis patients — about 7% of all kidney transplants performed in the United States last year.

To explore the Report Card's state grades and its methodology, visit

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. 

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