Where You Live Impacts Your Ability to Save a Life Through Living Organ Donation, According to the 2024 American Kidney Fund Report Card

Assessment of all 50 states and District of Columbia finds mixed progress: Five states made living donation easier in 2023, while six states got F’s due to having zero policy incentives for living organ donation

ROCKVILLE, Md., Feb. 22, 2024 (GLOBE NEWSWIRE) -- The American Kidney Fund (AKF) today released its fourth annual  State of the States: Living Donor Protection Report Card with updates highlighting a drastic need for support of legislation focused on better support for living organ donors. Receiving a kidney from a living donor is the best option for someone in need of a new kidney. However, six states – Alabama, Montana, New Hampshire, Tennessee, South Dakota and Vermont – have zero policy protections (F grade) for living organ donors. Furthermore, the 15 states that have minimal (D grade) to zero protections (F grade) are home to nearly 1 in 4 of our country’s rural population – exacerbating rural communities’ already stark challenges in accessing health care.

The AKF Living Donor Protection Report Card measures states on seven different categories of publicly reported law 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 state family and medical leave laws; and extended family and medical leave of more than 60 days.

How All 50 States + DC Fared on the 2024 State of the States: American Kidney Fund Report Card

  • A (At least 5 out of 7 policy protections included)
    • Arkansas, Connecticut (6 protections) and Louisiana
  • B (At least 3 out of 7 policy protections included)
    • California, Colorado, Delaware, Georgia, Idaho, Illinois, Kansas, Maine, Maryland, Minnesota, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Utah, Virginia and Wisconsin
  • C (At least 2 out of 7 policy protections included)
    • Arizona, District of Columbia, Hawaii, Iowa, Kentucky, Massachusetts, Michigan, Mississippi, Missouri, New Mexico, North Dakota, Rhode Island, South Carolina, Texas and Washington
  • D (At least 1 of 7 policy protections included)
    • Alaska, Florida, Indiana, Nebraska, Nevada, New Jersey, North Carolina, West Virginia and Wyoming
  • F (Zero policy protections in place)
    • Alabama, Montana, New Hampshire, South Dakota, Tennessee and Vermont

Source: American Kidney Fund

Currently, chronic kidney disease (CKD) affects more than 1 in 7 adults in the U.S. However, the condition takes a disproportionate toll on people of color and those who live in rural communities, with a higher potential of poor outcomes. Black people in the U.S. are more than 4 times more likely than white people to develop kidney failure and Latinos and people of Hispanic ethnicity are twice as likely to develop kidney failure. Evidence also shows that rural Americans with kidney failure suffer worse mortality rates than their suburban and urban counterparts.[i]  Without dialysis or a kidney transplant, kidney failure people with kidney failure die.

“Where you live should not impact whether you are able to save a life through kidney donation, but our 2024 Report Card suggests that this may be the case. Compounding this challenge, we also know that kidney failure takes a disproportionate toll on people of color and rural communities: although Black and Latino Americans have more cases of kidney failure, they are less likely to get a kidney transplant or find a living kidney donor. Furthermore, research shows that there has been no improvement in racial disparities in living kidney donor transplants,” said LaVarne A. Burton, President and CEO of AKF. “Everyone deserves the best kidney care, no matter where we live or the color of our skin. As a nation, we must come together to prioritize solutions at the state level for living organ donors to ultimately help improve treatment of kidney disease for all.”

2024 Report Card Highlights

This year’s Report Card shows mixed progress across the country. In 2023, new laws that provide protection or financial support for living organ donors were passed in Michigan, Nevada, New York, Rhode Island and Wyoming. New York enacted a groundbreaking law that provides direct reimbursements of up to $10,000 to living organ donors for expenses not covered by insurance, while Michigan, Nevada, Rhode Island and Wyoming enacted anti-discrimination laws that prohibit life, disability and long-term care insurers from discriminating against living organ donors.

Only three states have earned an A on the Report Card, revealing that much more work needs to be done at the state legislative level. Out of three states in the country receiving A grades – Arkansas, Connecticut, and Louisiana – Connecticut scored the highest in the country. Additionally, out of seven possible types of living donor legislation, Connecticut currently has six laws in place, while Arkansas and Louisiana have five.

Federal & State Legislation Efforts

Since releasing the first annual Report Card in February 2021, AKF has worked closely with state legislators and AKF's Advocacy Network of more than 27,000 Ambassadors to protect living organ donors and remove barriers to donation. This effort has contributed to legislation passing in 32 states. Boosting the number of living organ donors would reduce the number of Americans on the transplant waiting list and save lives. More than 103,000 people are on the national transplant waiting list, and over 90,000 of them, or 88%, are waiting for a kidney.

“When I heard the news that my neighbor’s child needed a lifesaving kidney transplant, I knew that I needed to do everything that I could to donate my kidney to him,” said Beth Burbridge, a Louisville, Kentucky resident and AKF Ambassador. “Due to being denied paid time off work after donating my kidney, as recovery for kidney donation is typically 12 weeks, I returned to my job just six days after surgery. As an AKF Ambassador, I am passionate about advocating for policies to help ensure that lawmakers see the vital role legislation can play in protecting living donors like me from unnecessary hardships. It's time to advocate for laws that ensure the well-being of those who selflessly choose to give the gift of life.”

The bipartisan Living Donor Protection Act, introduced last April in both the U.S. House of Representatives and Senate (H.R. 2923 and S. 1384), would provide baseline protections nationwide, ensuring that living organ donors have FMLA and anti-discrimination protections. Passage of this legislation would mean that the lowest Report Card grade any state could receive would be a C.

In the absence of federal legislation to protect living organ donors, there is an uneven patchwork of protections that varies by state, and some states have no protections at all. More progress is desperately needed for every state to receive an A grade, providing equal access to kidney transplants for all. To help get there, AKF is focusing on states across the country with D and F grades.  AKF is working to pass living donor protections in these states and looking at paid and unpaid leave bills in states that have passed living donor protections. This effort includes states like Indiana and Mississippi, where work to improve the number of living organ donors focuses on more rural and medically underserved communities.

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 134 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 2023, HIPP not only helped nearly 60,000 low-income kidney patients stay insured, but it also made kidney transplants possible for 1,615 dialysis patients — about 6% of all kidney transplants performed in the United States last year. Additionally, AKF launched Kidney Health for All in 2023, a new website aimed at improving health equity in kidney disease, with a focus on reaching people from racial and ethnic minority groups who are most disproportionately affected by kidney failure.

To explore the Report Card's state grades and its methodology, visit KidneyFund.org/livingdonors.

Note: The 2024 Report Card includes updated grade colors, which include: A = dark blue, B = teal, C = light blue, D =lime green and F = grey.

About the American Kidney Fund

The American Kidney Fund (AKF) fights kidney disease on all fronts as the nation’s leading kidney nonprofit. AKF works on behalf of the 37 million 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. With programs that address early detection, disease management, financial assistance, clinical research, innovation and advocacy, no kidney organization impacts more lives than AKF. One of the nation’s top-rated nonprofits, AKF invests 97 cents of every donated dollar in programs, earning the highest 4-Star rating from Charity Navigator for 21 years in a row as well as the Platinum Seal of Transparency from Candid, formerly GuideStar.

For more information, please visit KidneyFund.org, or connect with us on FacebookTwitterInstagram and LinkedIn.

[i] https://www.kidneyfund.org/kidney-health-for-all/kidney-transplants


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