Living Organ Donation Reimbursement Program (LODRP) - Introduction: Living donor transplantation is the most effective and cost-efficient treatment for end-stage organ failure. Living organ donors incur substantial non-medical expenses in the evaluation, surgical, and recovery process, which are a disincentive to donation. These expenses can frequently exceed $6,000, which was more than 10% of annual income for 41.9% of US households in 2023. The prospect of losing wages, paying for travel costs to and from a transplant center, and funding dependent care is a barrier to healthy individuals who would otherwise be suitable voluntary organ donors. This barrier reduces access to transplantation and increases high-cost, high-mortality risk end-stage organ failure care. Since fiscal year 2007, the Health Resources and Services Administration (HRSA) Division of Transplantation (HRSA/DoT) has funded the Living Organ Donor Reimbursement Program (LODRP). In this grant application, we respond to the Funding Opportunity Number: HRSA-25-082 to continue the LODRP by extending and improving the National Living Donor Assistance Center (NLDAC). Approach: The NLDAC consortium of five institutions (Mayo Clinic, Phoenix, AZ; American Society of Transplant Surgeons, Arlington, VA; Arbor Research Collaborative for Health, Ann Arbor, MI; Northwestern University, Chicago, IL; and University of Kansas, Kansas City, KS) has collaborated extensively in transplant clinical practice, innovation, health services research, and administration. We propose to maintain and continuously improve the LODRP, the only national program for living organ donor reimbursement of travel, lost wage, and dependent care expenses available at all US transplant centers. Our primary goal is to provide smooth donor-centered service delivery to individuals who wish to donate an organ but are constrained by anticipated non-medical expenses. We will leverage the operational excellence of an experienced staff; secure, comprehensive, and state-of-the-art information technology systems; and skilled program evaluation team to ensure timely and efficient expense reimbursement for eligible program applicants. Working with our partners, we will continue to ensure financial disbursements are made to donors in a safe, timely, and efficient manner while maintaining strict compliance with federal regulations on data security, financial integrity, confidentiality, and program monitoring. We are committed to seamless collaboration with the Public Education for the LODRP (PE-LODRP) grantee to ensure the program reaches all eligible individuals, including material development, distribution strategy, and messaging to stakeholders. NLDAC will ensure that all aspects of the LODRP will be continuously evaluated with oversight by and in cooperation with HRSA/DoT, to ensure appropriate execution, program improvement, and to build long-term sustainability. Results: Financial barriers to live organ donation will be reduced for more than 2,000 approved donor applicants annually who yield more than 20% of annual live organ donors in the US. Over a 5-year time horizon, facilitation of living organ donation through the program has generated more than $250 million in federal savings in dialysis care costs. Impact: This program will reduce financial disincentives to living donation and therefore improve access to transplantation for those dying from end-stage organ failure.
