Barriers to the use of a federal travel grant by living kidney donors

Living organ donation involves significant out-of-pocket costs, which burden donor candidates and may be an obstacle to donation. There is a single US grant (the National Living Donor Assistance CenterNLDAC) to cover live donor travel costs. Although there may be center-specific variability in grant utilization, prospective donorsand their intended recipientsmust also meet eligibility criteria. In fact, the NLDAC grant is used by <10% of US live donors annually. We studied 154 consecutive kidney donor clinic evaluations (November 1, 2014-August 30, 2015) to determine eligibility and usage patterns during the evaluation process. Of these, 63 (41%) were local, had travel benefits, or declined. Of the remaining 91 prospective donors who might have benefited from grant support, only 29 (32%) obtained the grant. The other 62 (68%) did not meet eligibility screening. The major reason prospective donors were ineligible was that the recipient's household income was outside the required means test (ie, >300% of the federal poverty level) (n=51; 82%). The remaining exclusions (n=11; 18%) included being a nondirected donor, not meeting residency requirements, and other. Expanding NLDAC eligibility criteriaby broadening the recipient means test or by taking steps to eliminate it from the NLDAC charterwould reduce financial burdens associated with live donation.