Living kidney donors have no federal job protection and can lose insurance

A healthy person who donates a kidney to save someone's life has no federal protection against being fired for taking time off for the surgery and recovery. There is no federal law prohibiting insurance companies from treating living donation as a pre-existing condition, meaning donors can face higher premiums or denial of life, disability, or health insurance coverage after donating. The Living Donor Protection Act, which would prohibit insurers from discriminating against living donors and classify donation leave under FMLA, has been introduced in Congress repeatedly but has never been signed into law. The average living donor incurs $1,200+ in direct costs (travel, lodging) plus weeks of lost wages, and HRSA's reimbursement program caps at $6,000—often insufficient for donors in hourly-wage jobs who lose 4-6 weeks of income. The result is that living donation in the US skews heavily toward donors who are wealthier, white, and have employer-provided leave policies. This matters enormously because living donor kidneys have significantly better outcomes than deceased donor kidneys and the waitlist for deceased donor kidneys is 3-5 years. The structural reason this persists is that living donors are a constituency with no political lobby—they are by definition healthy people who gain nothing personally from donation, so there is no organized interest group fighting for their protections.