American Kidney Fund's 5th Annual Living Donor Report Card Reveals Mixed Progress, Calls for Urgent Action to Support Living Donors

In report’s fifth year, 13 states continue to have zero or little policy incentives for living organ donation

/EIN News/ -- ROCKVILLE, Md., March 12, 2025 (GLOBE NEWSWIRE) -- Today, the American Kidney Fund (AKF) released its fifth annual State of the States: Living Donor Protection Report Card with updates revealing an urgent need for stronger living organ donor legal protections. Currently, there are more than 104,000 people on the national transplant waiting list, with a staggering 89% who need a kidney. Donating an organ is a selfless act, and becoming a living donor is easier with guaranteed paid work leave and protection from insurance discrimination. The report’s latest findings reveal that 13 states offer minimal to no policy protections for living organ donors, indicating a pressing need for legislative action to support individuals who make the life-saving decision to become living donors.

More than 815,000 Americans are living with kidney failure, and nearly 555,000 Americans are on dialysis. Between 2012 and 2022, the annual count of those on dialysis who received a kidney transplant increased by 52%; most of this increase was attributable to deceased donor transplants, according to the U.S. Renal Data System. Unfortunately, kidney failure takes a disproportionate toll on people of color and rural communities, with a higher potential of poor outcomes. In fact, compared to non-Hispanic White Americans, Black and Hispanic/Latino people are more than four times and more than two times respectively as likely to develop kidney failure.

“While a kidney transplant remains the best treatment for kidney failure, many will die before they get the chance to receive a transplant due to the shortage of donor organs,” said LaVarne A. Burton, President and CEO of AKF. “It’s been five years since we initially launched the Living Donor Protection Report Card and we are proud that since that time, 24 states have enacted vital legislation to support those who give thousands a second chance at life. However, there is still much work to be done to ensure that a person’s ability to donate a kidney isn’t determined by where they live. To help provide baseline protections nationwide, ensuring that living organ donors have FMLA and anti-discrimination protection, we are calling on Congress to reintroduce the Living Donor Protection Act.”

“Receiving a kidney from a living organ donor saved my life. In late 2022, I learned that kidney failure was inevitable. But, in January 2024, I got a message from a high school friend who I had not seen in 43 years saying that he had been tested, was a match for me and wanted to give me a kidney to save my life—In March 2024 he did just that,” said Danny Ernstes, a Fairland, Indiana resident. “As an AKF Ambassador, I am deeply committed to advocating for policies that protect living donors and ensuring that they do not face unnecessary hardships that could prevent them from donating. Legislation plays a crucial role in safeguarding the well-being of those who make the selfless decision to give the gift of life. It’s not just a second chance at life; it’s more time with the people you love.”

2025 Report Card Key Findings

The national average grade is a C, with 13 states receiving a D or F grade, highlighting the absence of critical laws nationwide to support people who want to donate a lifesaving organ. New Hampshire improved from an F to a D grade and Mississippi improved from a C to a B grade by passing legislation protecting living donors from discrimination by life, disability and long-term insurers. Michigan advanced to a B grade by introducing a one-time tax credit for nonmedical expenses related to transplant surgery.

Only six states have earned an A on the Report Card, meaning they have five or more protections in place: Arkansas, Connecticut, Illinois, Maine, New Jersey and Oregon.

Where All 50 States + DC Rank on the 2025 State of the States: American Kidney Fund Report Card

• A (At least 5 out of 7 policy protections included)
  • Arkansas, Connecticut (6 protections), Illinois, Maine, New Jersey and Oregon
     
• B (At least 3 out of 7 policy protections included)
  • California, Colorado, Delaware, Georgia, Idaho, Kansas, Maryland, Michigan, Minnesota, Mississippi, New York, Ohio, Oklahoma, Pennsylvania, Utah, Virginia and Wisconsin
     
• C (At least 2 out of 7 policy protections included)
  • Arizona, District of Columbia, Hawaii, Iowa, Kentucky, Louisiana, Massachusetts, Missouri, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, Texas and Washington
     
• D (At least 1 of 7 policy protections included)
  • Alabama, Alaska, Florida, Indiana, Nebraska, Nevada, New Hampshire, West Virginia and Wyoming
     
• F (Zero policy protections in place)
  • Montana, South Dakota, Tennessee and Vermont 

Source: American Kidney Fund

The AKF Living Donor Protection Report Card grades states on seven different categories of publicly reported legislation and regulations they have in place to protect living organ donors and encourage living organ donation in each U.S. state and the District of Columbia. These include protection from discrimination by life, disability and long-term insurers; job-protected leave from private employers; job-protected leave from public employers; tax credits for employers who provide paid leave; direct reimbursements, tax credits or tax deductions for donor expenses; paid leave via state family and medical leave laws; and extended family and medical leave of more than 60 days.

In the absence of federal legislation to protect living organ donors, there is an uneven patchwork of protections that varies by state, and some states have no protections at all. More progress is desperately needed for every state to receive an A grade, providing equal access to kidney transplants for all. To help get there, AKF is focusing on states across the country with D and F grades. AKF is working to pass living donor protections in these states and looking at paid and unpaid leave bills in states that have passed living donor protections. This effort includes states like Indiana and Tennessee, where work to improve the number of living organ donors focuses on more rural and medically underserved communities.

In addition to advocating for policy changes, AKF is helping to make transplants possible for those who could not otherwise qualify financially. AKF's flagship financial assistance program, the Health Insurance Premium Program (HIPP), makes possible more than 130 kidney transplants each month for low-income dialysis patients and continues to help them post-transplant for their full insurance plan year, ensuring continuity of care. In 2024, HIPP not only helped nearly 58,000 low-income kidney patients stay insured, but it also made kidney transplants possible for 1,601 dialysis patients — about 6% of all kidney transplants performed in the United States last year.

To explore the Report Card's state grades and its methodology, visit LivingDonor.KidneyFund.org.

NOTE: Some state grades may have changed from 2024 based on a recent review of existing legislation and regulations.

About the American Kidney Fund

The American Kidney Fund (AKF) fights kidney disease on all fronts as the nonprofit with the greatest direct impact on people with kidney disease. AKF works on behalf of 1 in 7 Americans living with kidney disease, and the millions more at risk, with an unmatched scope of programs that support people wherever they are in their fight against kidney disease—from prevention through transplant. AKF fights for kidney health for all through programs that address early detection, disease management, financial assistance, clinical research, innovation and advocacy. AKF is one of the nation’s top-rated nonprofits, investing 97 cents of every donated dollar in programs, and it has received 24 consecutive 4-Star ratings from Charity Navigator as well as the Platinum Seal of Transparency from Candid, formerly known as GuideStar.

For more information, please visit KidneyFund.org, or connect with us on Facebook, Twitter, Instagram and LinkedIn.

Nancy Gregory
                    American Kidney Fund
                    (240) 292-7077
                    ngregory@kidneyfund.org