Do you get paid to donate a kidney?

No. Selling organs is illegal under the National Organ Transplant Act (NOTA) — you cannot be compensated for the organ itself. However, you can and should be reimbursed for the costs of donating: travel, lodging, meals, lost wages, and dependent care. That is different from being "paid." The National Living Donor Assistance Center (NLDAC) exists precisely to cover those reimbursable expenses for qualifying donors, so that financial hardship is not a barrier to giving the gift of life.

How much does it cost to donate a kidney?

The donation surgery itself is paid for by the recipient's insurance — you should not receive a bill for the surgical procedure, anesthesia, or hospital stay related to donation. What donors commonly pay out of pocket are: travel to the transplant center, lodging during evaluation and surgery, meals away from home, childcare, and — most significantly — lost wages during recovery, which can run four to eight weeks. The total varies widely but often falls between $3,000 and $10,000. Many of these costs are reimbursable through NLDAC or other programs.

Does donating a kidney cost the donor money?

It can — but it should not have to. Organ donation surgery costs are borne by the recipient's insurer. Non-medical costs (travel, lodging, lost wages) are the gap. NLDAC was created by federal legislation to close that gap, and it covers qualifying donors generously. If you did incur out-of-pocket costs, check whether you applied for NLDAC before donation — and if you did not, contact them post-donation to see whether retroactive reimbursement applies.

Will I lose wages while recovering from kidney donation?

Almost certainly yes, for at least some period. Most donors need four to six weeks off for a laparoscopic nephrectomy, sometimes longer for open surgery or complications. If you work a physically demanding job, your surgeon may extend that. The key question is whether your employer offers paid leave, whether you live in a state with living-donor leave protections, and whether you can access NLDAC's lost-wage reimbursement. Check all three before your surgery date.

Can I get reimbursed for lost wages after donating a kidney?

Yes, in many cases. NLDAC reimburses lost wages for qualifying donors, up to program limits (currently up to $20,000 lifetime per donor). You must meet income eligibility criteria and generally apply before or shortly after donation. The American Living Organ Donor Fund (ALODF) and the American Transplant Foundation also offer financial assistance that can supplement NLDAC reimbursements. Contact your transplant center's donor financial coordinator — they can help you apply.

What is the National Living Donor Assistance Center (NLDAC)?

NLDAC is a federally funded program administered by the Health Resources and Services Administration (HRSA) that reimburses living organ donors for travel, lodging, meals, lost wages, and dependent care costs associated with donation. It is not limited to kidney donors — liver, lung, and other living donors can qualify. Eligibility is income-based, and the transplant center must be partnered with NLDAC. Apply at livingdonorassistance.org or ask your transplant center's living-donor coordinator to initiate the referral.

Does NLDAC cover lost wages?

Yes. Lost wages are one of the primary reimbursable expenses under NLDAC, along with travel, lodging, meals, and dependent care. Reimbursement is based on your documented income and the duration of medically required recovery time. The program has a lifetime cap per donor and income eligibility requirements — contact NLDAC or your transplant center for current limits and your specific eligibility.

What are the NLDAC eligibility requirements?

NLDAC is income-based. To qualify, your household income must be at or below a certain threshold relative to the federal poverty level. You must be donating an organ to a transplant center that has a current NLDAC partnership, and you must apply before or around the time of surgery (retroactive applications may be accepted in some cases but are not guaranteed). The transplant center's living-donor coordinator handles the referral in most cases. Check livingdonorassistance.org for current income limits.

How do I apply for NLDAC?

The best approach is to ask your transplant center's living-donor financial coordinator or social worker to initiate the NLDAC referral on your behalf — they have done this before and can move quickly. You can also apply directly at livingdonorassistance.org. Apply as early as possible, ideally before or immediately after your surgery date, and gather documentation of your income (recent pay stubs or tax returns) and your travel and lodging expenses.

Can I use debt settlement to pay off the credit card debt I put donation costs on?

If you have unsecured credit card or personal loan balances from donation-related costs and you genuinely cannot repay them, settlement may be an option as a last resort — but first exhaust NLDAC, state tax credits, and nonprofit credit counseling. Debt settlement involves stopping payments to creditors while a fund accumulates, which will likely lower your credit score. Any forgiven amount over $600 may be reported as taxable income on IRS Form 1099-C. Results are not guaranteed, and creditors are under no obligation to settle. Start with a nonprofit counselor through NFCC (nfcc.org) before considering settlement.

Financial help for living organ donors: lost wages, travel costs, and the debt left behind

You gave an organ to save someone's life. The surgery was paid for by the recipient's insurance — but the weeks of lost wages, the flights, the hotel nights, and the dependent care may have landed on your credit card. This guide puts every reimbursement and assistance program first, because much of this cost was always meant to be covered.

What a living donor actually owes — and what is covered

One of the most common misconceptions among living donors is that they will owe money for the surgery. They should not. Under standard insurance rules and federal transplant program requirements, the recipient's health insurance pays for all medical costs associated with the donor's evaluation, surgery, and immediate post-operative care. This includes the donor nephrectomy (for kidney donors), anesthesia, hospital stay, surgical complications, and follow-up medical visits related to the donation.

If you received a bill for any of those items, it is likely a billing or insurance routing error — see the section below on billing errors to audit and dispute.

What living donors are not automatically reimbursed for, and what creates genuine financial hardship, are the non-medical costs of donating:

Travel to the transplant center (which may be hundreds of miles away) for evaluation appointments, surgery, and follow-up
Lodging before and after surgery
Meals away from home
Dependent care (childcare, eldercare) during the hospitalization and recovery
Lost wages during recovery — which can range from two weeks to eight weeks or more, depending on the type of donation and the physical demands of your job
Long-distance phone and coordination costs

These costs are reimbursable through programs that many donors never learn about. The transplant center's living-donor team is required to discuss financial protections with you — but in practice, patients report that this information is not always presented clearly or early enough to prevent out-of-pocket spending. This guide fills that gap.

National Living Donor Assistance Center (NLDAC) — start here

The National Living Donor Assistance Center is a federally funded program administered through the Health Resources and Services Administration (HRSA) and operated by a consortium of transplant organizations. It was created specifically to remove financial barriers to living organ donation, and it covers the categories of non-medical costs listed above.

What NLDAC reimburses

Travel — mileage, airfare, or other transportation to and from the transplant center for evaluation visits, surgery, and medically required follow-up
Lodging — hotel or other accommodation costs during the pre-surgery stay and immediate post-surgical recovery near the transplant center
Meals — per diem meal allowances during travel
Lost wages — documented lost income during the medically required recovery period, up to program limits (currently up to $20,000 per donor lifetime)
Dependent care — childcare or eldercare costs incurred because the donor had to travel for donation

Who qualifies

NLDAC is income-based. Your household income must fall at or below a specified threshold relative to the federal poverty level. You do not need to be uninsured — the program is designed to cover costs that no insurance reimburses, regardless of your health coverage. The transplant center must have a current NLDAC partnership (most major centers do).

How to apply

The fastest path is to ask your transplant center's living-donor financial coordinator or social worker to submit a referral. They have done this before and know the documentation required. You can also initiate an application directly at livingdonorassistance.org. Apply as early as possible — ideally before surgery — and keep receipts for all travel, lodging, and dependent care. Lost wages require documentation of your pre-donation income (pay stubs or a prior-year tax return) and your employer's confirmation of days missed.

If you donated without applying for NLDAC, contact the program to ask about retroactive reimbursement. Eligibility for retroactive applications may be limited, but it is worth asking — especially if you incurred significant lost wages.

What NLDAC does not cover

NLDAC does not reimburse the surgical or hospital costs of donation (those should already be paid by the recipient's insurance), and it does not cover ongoing medical costs unrelated to the immediate donation. It also does not cover the recipient's costs — if you are reading this as a transplant recipient looking for help with anti-rejection medications, see our separate guide: anti-rejection drug costs and assistance for transplant recipients.

Other donor assistance programs

NLDAC is the primary federal program, but several nonprofits offer supplemental assistance for donors who do not fully qualify for NLDAC or who need additional support beyond NLDAC limits.

American Living Organ Donor Fund (ALODF)

The American Living Organ Donor Fund provides financial assistance to living donors who face hardship as a result of donation, including lost wages, travel, and other non-medical expenses. ALODF is particularly helpful for donors who fall just outside NLDAC income limits or whose costs exceed NLDAC reimbursements. Contact ALODF directly through their website to inquire about current eligibility and application requirements.

American Transplant Foundation

The American Transplant Foundation offers financial assistance grants to both donors and recipients facing transplant-related financial hardship. Donors who have incurred out-of-pocket costs and do not have full NLDAC coverage should contact the Foundation to discuss their situation. The Foundation also provides education and advocacy resources for living donors navigating financial challenges post-donation.

DonorShield

DonorShield is an initiative that some transplant centers have adopted to provide additional financial protections and resources to living donors beyond what NLDAC covers. If your transplant center participates, ask your coordinator whether DonorShield assistance is available to you.

National Kidney Foundation

The National Kidney Foundation does not provide direct financial grants to donors in the same way NLDAC does, but it offers resources, advocacy, and referrals to assistance programs. If you are having difficulty navigating the assistance landscape, their helpline (1-855-NKF-CARES) can point you toward relevant programs.

Every UNOS-designated transplant center is required to have a living-donor advocate or living-donor advocate team — a separate advocate from the recipient's team, whose job is to protect the donor's interests. This team typically includes a social worker and, at larger centers, a dedicated financial coordinator.

This is an underused resource. These professionals know:

Whether your center has a current NLDAC partnership and how to submit referrals quickly
Which local or regional foundations have open assistance funds
Whether your employer has living-donor leave policies even if they are not widely advertised
How to dispute donor billing errors with the recipient's insurer
State-specific tax credits and leave protections that apply to your situation

If you donated without speaking to a financial coordinator, or if the conversation felt rushed or incomplete, you can still reach out post-donation. Ask the transplant center's main line for the living-donor social worker or the patient financial services department. You do not need to resolve this alone.

Job and leave protections — federal and state

Losing wages during recovery is the largest financial risk most donors face. Understanding your leave protections before surgery can prevent that loss from becoming credit-card debt.

Federal employees — paid organ donor leave

Federal civilian employees are entitled to up to 30 paid work days (42 calendar days for bone marrow donation) to serve as a living organ or bone marrow donor, under the Federal Employee Paid Leave Act provisions and OPM guidance. This leave is in addition to accrued sick or annual leave and does not require the employee to draw down their existing leave balance. If you are a federal employee, confirm this benefit with your HR office before surgery.

FMLA — job protection without wage replacement

The Family and Medical Leave Act (FMLA) provides up to 12 weeks of unpaid, job-protected leave for a serious health condition, which includes organ donation surgery and recovery. FMLA does not pay your wages, but it protects your job and requires your employer to maintain your health insurance coverage during leave. You must have worked for a covered employer for at least 12 months and 1,250 hours. Notify your employer of your intention to take FMLA leave before your surgery date.

State living-donor leave laws

Many states have enacted laws that go beyond FMLA, providing either paid leave or mandated unpaid leave specifically for living organ donors. As of 2025, more than half of U.S. states have some form of living-donor leave law. Examples include California (which provides paid family leave that can cover some recovery time), Illinois (which gives state employees paid donor leave), and several others with dedicated donor leave statutes. Check with your state labor department or a transplant advocacy organization for the rules that apply in your state.

Employer living-donor leave policies

Some large employers — including several Fortune 500 companies and major health systems — offer voluntary paid living-donor leave policies as part of their benefits packages. These may not be prominently listed in standard benefits materials. Before surgery, ask HR explicitly whether your employer has a living organ donor leave policy, separate from standard sick or FMLA leave. The answer may surprise you.

Short-term disability insurance

If you have short-term disability (STD) insurance through your employer or purchased privately, organ donation surgery may qualify as a covered disability event. Review your policy's definition of "disability" and whether donor surgery is explicitly included or excluded. Coverage for voluntary surgery varies by policy — confirm with your insurer before surgery, not after.

State tax credits and deductions for living donors

Approximately 20 states have enacted income tax credits or deductions for living organ donors to offset the costs of donation. These vary significantly by state — some provide a credit for actual out-of-pocket costs, others offer a fixed credit amount, and some allow a deduction for lost wages. States with living donor tax provisions include (but are not limited to) Arkansas, Idaho, Minnesota, Missouri, New York, Ohio, South Carolina, and Utah.

To find out whether your state offers a donor tax benefit:

Search your state's revenue department website for "living donor tax credit" or "organ donor tax deduction"
Ask your transplant center's social worker — they often track this for their donor population
Consult a tax professional who is familiar with your state's rules; the credit can be meaningful, especially if you had significant lost wages

Federal income tax does not provide a specific organ donor deduction, but unreimbursed medical expenses above 7.5% of your adjusted gross income may be deductible if you itemize. Travel, lodging, and certain other donation-related costs may qualify as unreimbursed medical expenses to the extent they are not reimbursed by NLDAC or another program. Confirm with a tax professional.

The credit-card and personal-loan debt you already have

If you have already put donation-related costs on credit cards or taken a personal loan to cover lost wages and travel, and you have not yet fully recovered those costs through NLDAC or other programs, work through the following in order:

Step 1: Apply for NLDAC and other reimbursements first

Even post-donation, contact NLDAC to ask about retroactive reimbursement eligibility. If you are approved for even partial reimbursement, that directly reduces the balance you need to address through other means. The same applies to state tax credits — a credit received at tax time can pay down a credit card balance.

Step 2: Nonprofit credit counseling (NFCC)

If you have unsecured credit card or personal loan balances you are struggling to repay, contact a nonprofit credit counselor through the National Foundation for Credit Counseling (nfcc.org) before considering more drastic options. An NFCC member agency can enroll you in a debt management plan (DMP), which consolidates unsecured balances into a single monthly payment at a reduced interest rate — typically without the credit-score damage that settlement carries. Fee structures are regulated and modest.

Step 3: Triage the debt by type

Not all debt qualifies for the same options:

Credit cards charged for travel, lodging, or living expenses during recovery: unsecured. Eligible for a DMP or, in genuine hardship, settlement.
Personal loans taken to replace lost wages: unsecured. Same options apply.
Medical bills from the transplant center (which should have been billed to the recipient's insurer): dispute with the transplant center's billing department and the recipient's insurer first — this should not be your debt.
Any auto loan, home equity line, or mortgage payment you fell behind on during recovery: secured debt, handled differently — a HUD-approved housing counselor for mortgage issues; your lender's hardship team for auto. Debt settlement does not apply to secured debt.

Debt settlement as a last resort

For unsecured balances you genuinely cannot repay in full, debt settlement may provide relief — but it is a last resort after NLDAC reimbursement, state tax credits, and nonprofit counseling have been explored. A legitimate settlement program negotiates with creditors to accept less than the full balance owed, but only after a hardship fund has built up over months. This process has real costs and trade-offs (see the next section).

Credit and tax safeguards before settling any debt

If you are evaluating debt settlement for unsecured balances related to your donation costs, go in clear-eyed about what it involves:

Credit score impact: settlement programs typically require you to stop making minimum payments while a dedicated account builds up over months. Missed payments are reported to credit bureaus, and accounts resolved as "settled for less than the full balance" may lower your score significantly. The damage is typically not permanent, but it is real and can affect housing and employment for a period.
Taxable forgiven debt: the IRS treats canceled debt over $600 as ordinary income, and creditors typically issue a Form 1099-C for the forgiven amount. If your total liabilities exceeded your total assets at the time of forgiveness (insolvency), you may be able to exclude the forgiven amount from income under IRS rules — but this is fact-specific and requires confirmation from a tax professional, not an assumption.
Not guaranteed: creditors are under no legal obligation to settle. Legitimate settlement companies will tell you this directly and will not promise specific savings amounts or outcomes. Any firm that provides such assurances before a specific debt is actually settled is a warning sign.
Unsecured debt only: settlement is available only for unsecured balances — credit cards, personal loans, medical-credit accounts. It cannot be used for auto loans, mortgages, or any other secured obligation.
No upfront fees from legitimate providers: under the FTC's Telemarketing Sales Rule, a legitimate settlement company cannot charge a fee until a specific debt has been settled and you have made at least one payment toward that settlement. If a company asks for money before any resolution, walk away.

Billing errors donors should always audit

Billing errors in the transplant context are common, and some of the most frequent ones affect donors directly. Review every statement or Explanation of Benefits (EOB) you receive and dispute any of the following:

Surgical or hospital bills addressed to the donor rather than billed to the recipient's insurance: the donation surgery is covered by the recipient's insurer. Contact the transplant center's billing department immediately if you receive these bills with your name as the responsible party.
Duplicate billing: charges appearing on both the hospital's bill and a separate physician's bill for the same service.
Unbundling: services that should be billed together (and therefore at a lower rate) being billed as separate line items.
Charges for services not received: always compare itemized bills against your actual records of what occurred.
NLDAC reimbursements not applied: if NLDAC approved a reimbursement and you did not receive it, follow up directly with NLDAC and your transplant center coordinator.

If the recipient's insurer is refusing to cover the donor's surgical costs on the grounds that it is "voluntary" surgery, this is incorrect — the National Organ Transplant Act and standard transplant protocols require the recipient's insurer to cover donor medical costs. Escalate through the transplant center's financial team and, if needed, file a complaint with your state insurance commissioner.

Free resources — the complete list

NLDAC — National Living Donor Assistance Center — federally funded reimbursement for travel, lodging, meals, lost wages, and dependent care. Apply through your transplant center or directly online.
American Living Organ Donor Fund (ALODF) — supplemental financial assistance for donors facing hardship beyond NLDAC coverage.
American Transplant Foundation — financial assistance grants for donors and recipients; education and advocacy resources.
Your transplant center's living-donor social worker and financial coordinator — the fastest path to NLDAC referrals, billing dispute assistance, and state-specific resources. Call the transplant center's main line and ask for the living-donor advocate team.
National Kidney Foundation helpline — 1-855-NKF-CARES; referrals and navigation assistance for kidney donors and recipients.
Your state labor department — for state living-donor leave law details; search "[your state] living organ donor leave law" or call your state's department of labor.
OPM (for federal employees) — opm.gov for information on the 30-day paid organ donor leave benefit for federal civilian employees.
Your state revenue department — search for living donor tax credit or deduction; available in approximately 20 states.
NFCC — National Foundation for Credit Counseling — free or low-cost debt management plan counseling for unsecured credit card and personal loan balances; find a certified counselor at nfcc.org.
IRS Publication 502 — for guidance on which unreimbursed donation-related expenses may qualify as deductible medical expenses if you itemize.

This page covers the donor's financial hardship. If you are a transplant recipient looking for help with the ongoing cost of anti-rejection medications, see our separate guide: anti-rejection drug costs and immunosuppressant assistance for transplant recipients. The two pages address entirely different audiences and should not be confused.