*Purpose: This study examined the impact of financial obstacles (e.g., lost wages, travel, and dependent care expenses) on the decision to initiate an evaluation for living organ donation, and the extent to which lost wage reimbursement impacts the decision-making process. Financial obstacles disproportionately impact lower income populations and can contribute to inequities in access to transplantation.

*Methods: Using a grounded theory approach, we conducted and analyzed 22 semi-structured phone interviews (a sample size typical of grounded theory) with potential and past kidney and liver donors who had responded to a survey about the decision-making process for living organ donation and indicated that they have financial obstacles to donating.

*Results: We identified three key themes that influence the decision-making process: emotional attachment, temporal flexibility, and job security. These themes emerged when we divided our sample into three groups: “close relationship donors”; “broader network donors”; and non-directed donors (NDDs). Respectively, these are individuals interested in donating to a family member or friend; a specific person they do not know well or at all; or a non-specified individual. Most close relationship donors wanted to donate regardless of personal financial cost due to their strong emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but importantly, could reduce stress. Since NDDs were not donating to a specific individual, they had temporal flexibility and could wait until they felt financially stable enough to donate. While wage reimbursement might create this stability more immediately, they could also choose to wait until they can secure it in other ways. Lacking both emotional attachment and temporal flexibility, broader network donors were very active decision-makers. Wage reimbursement could be particularly influential in this group. Across all groups, donors with job security were more resolute about donating.

*Conclusions: Our findings underscore the importance of lost wage reimbursement to facilitate donation and/or reduce financial stress, and of policies to protect donor job security.

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