Senate Appropriations Committee bill calls for reducing financial barriers to organ donation

By Alan D. Viard and Sally Satel

In a previous post, we commended the House of Representatives for passing a fiscal 2022 appropriations bill that called for easing financial barriers to organ donation. The committee report accompanying the bill recommended increased funding for a federal program financed by the Health Resources and Services Administration (HRSA) that reimburses some expenses incurred by living organ donors. The House committee report outlined an ambitious vision for the program, including extending the range of reimbursable expenses and significantly expanding income eligibility.

We remarked, “If the Senate follows the House’s lead, that vision can be fulfilled.” Last week, the Senate Appropriations Committee moved in that direction when it released a set of appropriations bills. The explanatory statement accompanying the relevant bill repeats nearly verbatim the language from the House committee report:

“The Committee supports the expansion of [the program] to reimburse a comprehensive range of living donor expenses for the greatest possible number of donors, including lost wages, childcare, eldercare, and similar expenses for donor caretakers, and removing other disincentives to donation. The Committee supports significant expansion of income eligibility for the program to allow as many donors as possible to qualify.”

HRSA adopted two modest expansions of the program last year. One revision allowed reimbursement for donors’ lost wages and child-care and elder-care costs, in addition to the travel, meal, lodging, and incidental costs that had previously been covered. The revision left in place a $6,000 cap on each donor’s reimbursement. The second revision made a donor eligible for reimbursement if the organ recipient’s income did not exceed 350 percent of the federal poverty level, up from 300 percent under the previous rules. (In 2021, 350 percent of the poverty level is generally $76,860 for a three-person household.) This revision also allowed reimbursement for donors making undirected donations to the next person on the waiting list, regardless of the recipient’s income.

The agency’s actions, however, fell short of the bolder expansions advocated in many of the public comments that it received, including our comment. Notably, we urged HRSA to set the ceiling at or above 500 percent of the poverty level. The Senate Appropriations Committee bill and the House bill now call for HRSA to move forward with the bolder expansions.

Each day, 13 Americans die while waiting for a kidney transplant. Financial barriers should not stand in the way of those who wish to donate. The Senate should join the House in expanding federal expense reimbursement for living organ donors.

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