Living kidney donors lose an average of $5,000-$20,000 in wages and expenses with no guaranteed reimbursement, so working-class people who want to donate simply can't afford to

Donating a kidney requires 1-4 days of hospitalization and 4-6 weeks of recovery before returning to work. The recipient's insurance covers the donor's surgical costs, but it does not cover lost wages, travel to the transplant center, lodging, childcare, or follow-up care costs. Research shows that 80% of living kidney donors experience financial loss, with lost income accounting for 23% to 84% of total costs. Average donor-borne costs range from $900 to $19,900 in the first postoperative year alone. So what? A 2021 survey found that 80% of donors who received financial assistance from the National Living Donor Assistance Center said they would not have been able to donate without it. This means the current system filters out the majority of potential donors who cannot afford to lose six weeks of income. Construction workers, hourly retail employees, gig workers, single parents — the people most likely to know someone who needs a kidney (because kidney disease disproportionately affects lower-income communities) are the least able to donate one. So what? The United States has roughly 90,000 people on the kidney transplant waitlist right now. Each kidney transplant saves Medicare approximately $250,000 over five years compared to keeping that patient on dialysis. Living donor kidneys last longer and work better than deceased donor kidneys. Every potential living donor who is priced out of donating means another patient stays on dialysis at enormous cost to the healthcare system and enormous suffering to the patient. The financial barrier to living donation is not just a personal problem — it is a systemic bottleneck that costs lives and money. This problem persists because U.S. law (the National Organ Transplant Act of 1984) prohibits 'valuable consideration' for organ donation, and lawmakers have been hesitant to create robust reimbursement programs for fear of crossing the line into organ markets. The Living Organ Donor Tax Credit Act, which would provide a $5,000 federal tax credit, has been introduced repeatedly but never passed. The result is a system that asks people to make an extraordinary sacrifice — giving away a body part — while imposing financial punishment for doing so.