Donor Shield and NLDAC: Who Offers the Most Support and Protections for Kidney Donors?

Becoming a living kidney donor is a wonderful, generous act that can change the life of the donor and the recipient alike. Technically, there is no money involved in living kidney donation: kidney donors do not receive financial compensation for donating a kidney, and there should be no costs associated with donating a kidney.

However, while the kidney donor’s medical costs are typically fully covered by insurance, some donors will have out-of-pocket expenses that are not covered, such as travel expenses (plane tickets, car rentals and hotel accommodations if they are required to travel to a distant transplant center), childcare expenses (care for children during testing, surgery and the recovery period), and care for dependent adults (such as parents or adult children of the donor who cannot be on their own).

Fortunately, several financial assistance programs are available to cover costs associated with living organ donation. The two main programs are the National Living Donor Assistance Center (NLDAC) and the National Kidney Registry’s Donor Shield program. Here’s what type and amount of financial assistance each provides for living donors.

Lost Wage Reimbursement

Both NLDAC and Donor Shield offer reimbursement for lost wages due to kidney donation. There are slight differences in how the two programs calculate lost wages and quite a large difference in the amount offered.

Donors covered by Donor Shield are eligible for reimbursement of lost wages, up to a maximum of $2,000 per week for up to 12 weeks ($24,000 total). Lost wage reimbursement beyond two weeks requires additional clearance from the transplant center.

NLDAC offers lost wages for up to three days for evaluations and six weeks for surgery, recovery, and follow-up trips. NLDAC does not give a maximum amount for lost wages alone, but instead has a maximum of $6,000 for lost wages, travel expenses, and dependent care costs combined (see the Maximum Reimbursement section below for details).

In addition, eligibility for lost wage reimbursement through NLDAC is based on the recipient’s yearly household income (see the Eligibility section below for details).

Travel & Lodging Expenses

Both NLDAC and Donor Shield offer reimbursement for travel and lodging expenses, but the reimbursement method is different, as are the maximum amounts offered. Both programs allow donors to receive reimbursement for a travel companion as well.

With Donor Shield, covered donors pay for travel expenses out of pocket, then submit receipts and are reimbursed by direct bank transfer, which usually takes about 10 days after receipts are submitted. Covered expenses include airfare, lodging, meals, taxis or ride shares, car rentals, parking and mileage.

With NLDAC, donors are given a “controlled value card,” which is like a credit card with restrictions, to pay for their transportation expenses, including airfare, lodging, taxis, car rentals and meals.

Maximum Reimbursement

The reimbursement maximum is a major difference between the two programs. Both include other reimbursement types in the maximum reimbursement amount for travel: Donor Shield’s maximums are $24,000 for lost wages and $6,000 for travel and dependent care, while NLDAC’s maximum ($6,000) includes all reimbursement:  lost wages, travel and dependent care.

This means that a donor who receives $6,000 in lost wage reimbursement through NLDAC has reached the maximum, and would not be eligible for any reimbursement for travel or dependent care. A donor who receives $6,000 in lost wage reimbursement through Donor Shield would still be eligible for the full $6,000 in reimbursement for travel, lodging, and meals, assuming they received no reimbursement for dependent care.

In the same vein, a donor who is reimbursed for $6,000 in travel and dependent care costs through NLDAC would not be eligible for any reimbursement of lost wages, as the maximum would have been reached. With Donor Shield, a donor could receive reimbursement for $6,000 in travel and dependent care costs and also qualify for up to $24,000 in lost wage reimbursement.

Eligibility

Both NLDAC and Donor Shield have eligibility requirements for living kidney donors who want to receive financial assistance, but they are quite different. NLDAC considers the household income of both the donor and the recipient to determine eligibility, while Donor Shield does not.

Donor Shield coverage is available to all living kidney donors who donate through the National Kidney Registry at either an NKR Member Center or through a Donor Shield Direct transplant center. There are more than 100 NKR Member Centers and more than 25 Donor Shield Direct centers all across the United States, so there are plenty of options. Kidney donors who donate through one of these centers are automatically covered by Donor Shield—they do not have to apply or submit financial information, nor do their intended recipients. Find a Donor Shield center.

For NLDAC, eligibility is determined based on the transplant recipient’s yearly household income, which must be less than 350% of the current HHS Poverty Guidelines for the donor to be eligible for assistance. For example, a household of four people living in the contiguous United States must have an annual household income of $105,000 or less. See the full HHS Poverty Guidelines here.

If the recipient’s household income is higher, but they would have trouble paying for their donor’s expenses, they must complete and submit a financial hardship waiver worksheet with their application. While NLDAC does ask donors to submit information on their household income, the availability of financial assistance is not tied to donor income. However, NLDAC is funded by a federal grant, and if there is not enough funding to approve all eligible applications, NLDAC gives priority to donors with a lower household income. Donor Shield is backed by the National Kidney Registry and does not use government funding, so there is no concern that the program will not have enough funding to assist all eligible donors.

Primary vs Secondary Coverage

Another important distinction between NLDAC and Donor Shield is in how they treat other types of coverage available to the donor. Basically, Donor Shield steps up first, providing the full range of financial assistance without regard for any other assistance the donor might be entitled to. NLDAC, on the other hand, waits to see how much assistance the donor can receive from other sources before extending financial assistance.

Donor Shield coverage is considered primary when other assistance is available to the donor. That means donors who are covered by Donor Shield can use the financial assistance available through Donor Shield without having to apply for or consider any other types of benefits. Donor Shield coverage is not affected if the donor qualifies for short-term disability, for instance, or if the recipient is able to reimburse the donor for expenses. The NKR encourages donors to preserve their supplemental benefit plans, such as short-term disability, so that they do not exhaust these benefits in case they are needed in the future for other reasons.

Unlike with Donor Shield, NLDAC assistance is secondary, which means it is only available to donors who are not covered by other types of assistance, such as state programs, health insurance, or the recipient. The National Organ Transplant Act allows recipients to pay for the lost wages and travel and lodging expenses of their living donors, so if you apply for financial assistance through NLDAC, it will first assess your recipient’s ability to pay your expenses before approving your application. NLDAC also requires applicants to check if their health insurance offers a travel benefit for living donors before applying for help from NLDAC. In addition, NLDAC assistance is not available for donors or recipients who live in Iowa, because that state has an alternative reimbursement plan called the Anatomical Gift Public Awareness and Transplantation Fund.

Both NLDAC and Donor Shield offer financial assistance for living kidney donors, but there are significant differences in how donors qualify, how the reimbursement is handled, and the maximum amount available. See below for an overview of the assistance both programs provide.