*Purpose: The potential for out-of-pocket expenses incurred by living kidney donors has been identified as an important barrier to proceeding with live donation, with financial neutrality being an important goal of the transplant community. Since 2007, the government funded National Living Donor Assistance Center has reimbursed travel, meal and lodging expenses. However, to the best of our knowledge, wages lost as part of the donation process have not previously been reimbursed in the US.

*Methods: In 2018, the non-profit National Kidney Registry (NKR) piloted a program to reimburse lost wages, and in 2019, made this reimbursement available to donors participating in kidney paired donation or the NKR’s Donor Shield Program. A salary below $62,000 was required to apply. In addition, the NKR reimbursed travel and lodging (but not meal) expenses. Expenses were only reimbursed after the donor surgery was performed. The maximum allowable wage reimbursement was $6,000 and maximum travel reimbursement was $2,000, for a maximum total reimbursement of $8,000. We assessed how many donors used these financial benefits and how much they were reimbursed.

*Results: In 2019, 29 different programs facilitated reimbursements of donor costs (1-36 donors per center), for a total of 153 donors. Reimbursement was to 64 donors for wages only, 58 donors for travel/lodging only and 31 donors for wages as well as travel/lodging. Wages reimbursed ranged from $213.62 to $4,769.23 (median $1,955.59, mean $2,110.70). Estimated yearly salary of the 95 donors who received wage reimbursement ranged from $5,554.12 to $62,000 (median $40,248, mean $39,120.11). Travel/lodging reimbursed ranged from $44.00 to $2,000.00 (median $651.20, mean $816.12). Combined total reimbursement for wages and travel/lodging ranged from $44.00 to $5,769.23 (median $1,638.92, mean $1,785.30). Only one application for reimbursement was denied, for being over the salary threshold.

*Conclusions: Wages reimbursed by the NKR were substantially higher than travel costs, demonstrating the critical need for living donors to recover lost wages in moving toward the goal of financial neutrality. We believe this novel program of wage reimbursement has been successful and should be expanded more broadly to donors across the country. While we cannot prove that reimbursement of costs related to live donation permitted transplants that would not have otherwise occurred to proceed, we suspect that is the case. The NKR is currently collecting data about this question from donors receiving cost reimbursements.

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