*Purpose: To identify the severity of financial and employment challenges present for potential living kidney donors and the value of strategies to make kidney donation cost-neutral,

*Methods: we surveyed 588 potential donors undergoing evaluation at five transplant centers about the maximum amount of out-of-pocket costs and length of time off work they could take, and whether ten strategies would make it easier to donate.

*Results: Donors were 61% female, 56% White, 15% Black, 16% Hispanic, and 8% Asian. Nearly half (54%) had a college education. 46% had an income <$75,000, with 52% able to support themselves for < 6 months if income was lost. Most donors (78%) could take > 1 month off work without serious consequences, with 16% reporting <2 weeks. Though a majority (52%) were able to pay donation costs of >$1,000, 7% reported not being able to pay anything. Over 70% of donors reported that 9 of 10 strategies, like covering costs of meals, travel, lost wages, insurance protections, transplant priority for a relative, or a charitable donation would be moderately/extremely helpful, with non-Whites reporting that these strategies would be more helpful than Whites (Table). Only 42% reported that a cash gift would be moderately or extremely helpful, with non-Whites reporting greater helpfulness than Whites. When asked what amount of money would be fair, 60% reported that they would not want any money, while 10% reported amounts >$100,000 (Table).

*Conclusions: Increases in the number of potential living donors, particularly non-white donors, might be possible if greater financial and donor protections, including, potentially, cash gifts, were made available and advertised more broadly.

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