The End Kidney Deaths Act Summary

The End Kidney Deaths Act (H.R. 2687/ EKDA) is a ten-year pilot program that provides a refundable federal tax credit of $10,000 per year for five years ($50,000 total) to individuals who donate a kidney to a stranger (non-directed donors). These kidneys would be allocated to patients who have waited the longest on the national transplant list. If enacted, the EKDA is projected to save up to 100,000 American lives over its first decade and reduce federal spending by $10–$37 billion.

The sponsor of the original National Organ Transplant Act stated in 1984 that if voluntary donation failed to meet the need, tax credits should be provided. That moment has arrived. The need for this legislation is urgent. Today, more than 90,000 Americans are waiting for a kidney, and 800,000 Americans are living with kidney failure, a number projected to exceed one million by 2030. For the past 15 years, roughly half of waitlisted patients have died before receiving a transplant. Meanwhile, living kidney donation has remained essentially flat for 25 years, despite decades of public education efforts.

Each year, only 400–500 Americans donate kidneys to strangers. These donors, known as non-directed donors, often initiate transplant chains that allow multiple incompatible donor-recipient pairs to receive lifesaving kidneys. The longest chain to date included 35 recipients. Non-directed donors are also sometimes the only possible match for highly sensitized patients. Yet despite their extraordinary impact, their numbers have not increased in over two decades.

Kidney transplantation is not only lifesaving. It is also dramatically more cost-effective than dialysis. The federal government currently spends approximately $50 billion per year (about 1 percent of the federal budget) on dialysis care for 550,000 Americans. Dialysis costs roughly $100,000 per patient per year. In contrast, each transplant saves taxpayers approximately $500,000 over time by eliminating years of dialysis costs while restoring patients to health and productivity.

Deceased donation alone cannot solve this problem. Three in one thousand deaths occur under circumstances that allow organs to be recovered. Although about 60 percent of Americans are registered as deceased donors, this yields only about 22,000 kidneys per year, far short of what is needed. Ending the kidney shortage requires scaling living donation, not managing scarcity.

Living kidney donation is already among the most tightly regulated procedures in medicine. Only about 2 percent of people who express interest are ultimately approved and complete the process. Donors must pass rigorous medical and psychosocial screening by licensed professionals, including evaluations of decision-making capacity, voluntariness, psychological stability, and adequate social support. Individuals with addiction risk, medical instability, or vulnerability are screened out. The End Kidney Deaths Act does not change any of these safety standards. It simply removes financial barriers for people who already qualify.

Over 50 organizations, along with transplant surgeons, economists, dialysis patients, recipients, and donors, support the End Kidney Deaths Act. Congress routinely uses the tax code to encourage socially beneficial behavior. Kidney donation is time-consuming, painful, and physically demanding. We compensate people for difficult public service in every other domain, including firefighters, police officers, and members of the military. Failing to recognize kidney donation as work is inconsistent with all other public policy and results in thousands of preventable deaths each year.

Surveys show that 95 percent of living donors would donate again, and the procedure is safer than childbirth or appendectomy. A majority of American voters support financial recognition for living donors. Every hour, another American dies waiting. The End Kidney Deaths Act offers Congress a rare opportunity to save lives, reduce spending, and finally end a deadly policy failure.