The End Kidney Deaths Act introduces a ten-year pilot program offering non-directed kidney donors a refundable tax credit of $10,000 per year for five years—a total of $50,000.

This incentive is for Americans who choose to donate a kidney to a stranger on the national waitlist. By encouraging more living donations—the gold standard for treating kidney failure—the Act will dramatically increase the number of life-saving transplants.

According to the USRDS and data from the Centers for Medicare & Medicaid Services (CMS):

• Annual cost of dialysis per patient: ~$90,000 (Medicare pays about 80%).

• Median time on dialysis for those awaiting transplant: 3–5 years.

• Annual cost after a kidney transplant: ~$35,000 in the first year (due to surgery and immunosuppressive drugs), then ~$10,000–$15,000/year thereafter.

Over time, this cost difference adds up dramatically. Over a 10-year period:

• Dialysis cost = ~$900,000

• Transplant + maintenance = ~$300,000–$400,000

• Estimated savings = $500,000–$600,000 per patient over 10 years

2. Scholarly Estimates

A 2014 analysis in the American Journal of Transplantation found that Medicare saves approximately $146,000 in the first five years post-transplant per patient, compared to dialysis. Over a lifetime, with longer survival and reduced maintenance costs, the savings approach or exceed $1 million—especially for younger patients or those transplanted earlier in their disease.

Citation: Axelrod DA et al. "The economic implications of donor follow-up and living kidney donation: a cost-benefit analysis." Am J Transplant. 2014.

3. Congressional Budget Office & GAO Reports

Reports from the Congressional Budget Office (CBO) and Government Accountability Office (GAO) have cited similar projections when evaluating the costs and savings of transplant-related legislation, often supporting the idea that a successful transplant is significantly cheaper than years of dialysis, even with coverage of lifelong immunosuppression.

The refundable tax credit will significantly boost the number of living kidney donors who donate to strangers. By year ten, we estimate that taxpayers will have saved up to $37 billion.

• Please see Question 3 here for the charts.

• We estimate that by Year Ten, taxpayers will save between $10 billion and $37 billion. Ike Brannon, Senior Fellow at the CATO Institute and former Chief Economist to Senator John McCain, calculated that each kidney transplant saves taxpayers $517,000.

  SOURCE: CATO INSTITUTE, “SAVING LIVES WHILE SAVING MONEY” BY IKE BRANNON

  Brannon notes that the dialysis cost used in his 2023 calculation (shown in the table in Question 2) has likely increased significantly. While the exact increase is unclear, a 2024 study published in the American Journal of Transplantation (AJT) estimated taxpayer savings of $174,000 per transplant, in current dollars.

  We estimate that an average of 10,000 Americans will donate kidneys to strangers annually over the next ten years. Since roughly 80% of dialysis patients are covered by Medicare, taxpayers would save money on approximately 8,000 of those 10,000 transplants each year.

  The left table (Dr. Axelrod, AJT study) estimates $174,000 saved per recipient; the right table (Ike Brannon) shows $517,000 in savings per recipient.

  SAVINGS PER RECIPIENT ($517K) – TAX CREDIT INCENTIVE ($50K) MULTIPLIED BY NUMBER OF DONORS = BUDGET WINDOW SAVINGS

  CALCULATION:
  SAVINGS PER RECIPIENT OVER 10 YEARS
  MINUS TAX CREDIT INCENTIVE
  TIMES ADDITIONAL LIVE TRANSPLANT RECIPIENTS
  = BUDGET WINDOW SAVINGS

Over the past decade, 100,000 Americans have died while waiting for a kidney transplant. Each year, only 6,000 living kidney transplants are performed, leaving 90,000 patients on the waitlist—half of whom will die without intervention.

The End Kidney Deaths Act seeks to address this crisis by offering non-directed kidney donors—a $10,000 refundable tax credit annually for five years, totaling $50,000. This incentive aims to increase life-saving kidney donations.

Each month, about 1,000 Americans on the transplant list either die or become too sick for a transplant.

This statistic doesn’t account for the many kidney failure patients who never even make it onto the list—but could have benefited from a transplant if there were no shortage.

Today, more than 550,000 Americans are on dialysis. 800,000 Americans live with kidney failure— a number expected to surpass one million by 2030.

Kidney transplantation not only saves lives; it also saves taxpayer money. The United States government spends nearly $50 billion dollars per year (1% of all $5 trillion collected in annual taxes) to pay for 550,000 Americans to have dialysis, a cost of approximately $100,000 per year per patient, a treatment that is far more expensive than transplantation over the life of a chronic kidney disease patient.

Only very healthy adults who pass a comprehensive physical and psychological evaluation, which takes an average of six months, are eligible to donate. Of 100 willing donors, only 2 actually proceed, as most are medically disqualified. Each transplant center has its own rigorous evaluation criteria. Interestingly, living kidney donors tend to live longer than the general population.

Taxpayers save $517,000 total every time someone on Medicare goes from dialysis to getting a kidney transplant. The value of a new kidney, in terms of quality of life and future earnings potential, is between$1.1 million and $1.5 million.

Kidney donors undergo multiple qualification physical and mental health testing that take up to six months to complete. Only those who are in top health are approved for kidney donation. Most applicants are disqualified. The transplant centers do such an excellent job at selecting healthy donors that living kidney donors live on average longer than the general population.

Please see Question 9 here for a chart that reviews the overall risk of kidney donation in comparison with other the annual professions:

Living donor kidneys last, on average, twice as long as those from deceased donors due to better health and a more precise match with the recipient. However, fewer than 1 in 100 Americans die in a way that allows their kidneys to be donated. Despite 60% of Americans being registered as organ donors, only 21,000 kidneys are transplanted each year from deceased donors.

Currently, 90,000 Americans are on the kidney transplant waiting list. Even with improvements to the deceased organ donation system, we could only add about 2,000 transplantable kidneys annually.

Each year, 27,000 kidney transplants are performed—two-thirds from deceased donors and one-third from living donors. Over the past 20 years, the waitlist has nearly doubled, while the number of living kidney donors has remained stagnant at around 6,000 annually for the past 25 years.

9,000 Americans are dying annually while waiting for a life-saving kidney transplant. Saving their lives with a kidney transplant from a compensated donor is the ethical choice rather than letting them die from preventable deaths.

Everyone in the entire donation process is paid except for the kidney donor and the recipient whose remaining years of life will be tripled once transplanted.

It's morally important to pay people for difficult work. Until now, we have not paid kidney donors for the time consuming, stressful and painful work of donation. In other situations, we pay people to do difficult work. Paid heroes like police officers and firefighters engage in difficult work that involves risks to save lives. The choice to not pay kidney donors for their generosity and heroism is arbitrary and resulting thousands of preventable deaths.

With the End Kidney Deaths Act, donors will finally be rewarded for their life-saving generosity. The kidney donors who founded the End Kidney Deaths Act campaign understand that donation is time consuming, stressful and painful work that is worthy of a tax credit. The tax credit system exists to encourage people to engage in prosocial behavior. What is more prosocial than having your body opened up and giving a healthy organ so a stranger can survive and thrive for decades? 

The 4 principles of ethics are beneficence (The duty to do good and help others achieve their best health.), nonmaleficence (“do no harm”), autonomy (The right of a patient to make their own decisions about their care), and justice (The duty to treat all people equally and fairly, without discrimination). The End Kidney Deaths Act upholds all four principles.

Nearly half of those 90,000 on the kidney waitlist will die waiting. From 2010-2021, 100,000 Americans, the number of people who fit in the largest football stadiums, were healthy enough to receive a kidney when they joined the waitlist, but instead suffered and died due to the long wait. Another 100,000 will certainly die in the next decade without the passage of the  End Kidney Deaths Act.

• EKDA will increase donations for low-income people: The abundance of transplantable kidneys after the passage of the End Kidney Deaths Act will disproportionately help low income people who are far more likely to die from the kidney shortage.

• Right now, low income people face financial barriers to donate: Most donors are high income due to the high personal costs of donation and their better health in comparison with low income people.

• It is morally important to compensate people for difficult work: It’s unjust that donors are unpaid for the stressful, time consuming, and physically uncomfortable experience of being a kidney donor. Because of the value they provide, we compensate people for difficult jobs and surrogacy that are far riskier than kidney donation.

Primarily middle and low-income kidney failure patients are dying due to the kidney shortage. The End Kidney Deaths Act will provide thousands more kidneys transplants for those waiting longest on the waitlist. This abundance of transplantable kidneys will disproportionately help the people who are far more likely to die from the kidney shortage. Low income people are in worse health than high income earners and are far less likely to qualify as kidney donors. Lower-income populations have lower rates of living kidney donation.

Getting evaluated and approved for kidney donation takes up to six months. The surgery and recovery can take six to eight weeks of time devoted to healing from the operation.

The result of not encouraging donors is nearly 1,000 people dying on the kidney waitlist every month. All of them were healthy enough to receive a kidney when they joined the waitlist. The waiting time killed them. Our current system results in so many heartbreaking preventable deaths. This is not ethical.

Once kidney donation is no longer unpaid work, people of all income levels will be able to donate. People with lower incomes tend to have social networks with fewer healthy people because health is related to income level. In addition, being placed on a waitlist or finding a willing donor often costs money. Kidney donation also costs money, an estimated 10% of annual income. The refundable tax credit will help low income donors and recipients the most by making donation affordable and increasing the number of kidneys for those waiting the longest on the waitlist, frequently middle and low income Americans. The tax credit will disproportionately help those most affected by the kidney shortage, those who so often bear the brunt of the kidney crisis’s consequences. The End Kidney Deaths Act will level the playing field, making it easier for those at all income levels to receive a life-saving kidney. 

Please see Question 12 here for a chart that reveals that less educated people are more likely to be on dialysis and less likely to be transplanted in comparison with more educated people. 

Financial compensation for donors can coexist with altruism. Donors can opt out of the funds from the tax credit or choose to donate those funds to charity. The majority of donors support financial compensation, and relying solely on altruism has led to preventable deaths.

Yes! Most Americans favor compensation for living kidney donors to increase donation rates.

Check out these four surveys:

• 2006 - American Journal of Transplantation: Public Attitudes Toward Incentives for Organ Donation: A National Study of Different Racial/Ethnic and Income Groups

• 2012 - Reuters Poll: Americans Show Support For Compensation Of Organ Donors

• 2016 - JAMA Surgery: Most US Voters Approve of Paying Kidney Donors, Survey Finds

• 2019  - Johns Hopkins Study Most Americans favor compensation for kidney donors if it leads to more saved lives

Survey Links:

1. Rodrigue JR, Crist K, Roberts JP, Freeman RB Jr, Merion RM, Reed AI. Stimulus for organ donation: a survey of the American Society ofTransplant Surgeons membership. Am J Transplant. 2009 Sep;9(9):2172-6.doi: 10.1111/j.1600-6143.2009.02741.x. Epub 2009 Jul 16. PMID: 19624568. 2014: Joint meeting of the ASTS and AST devoted to this topic,participants concluded “there is ‘no a priori reason not to work … toward a plan for pilot projects in offering incentives”. (Salomon D, et al,  AJT 2015) “We believe it important not to conflate the illegal market for organs, which we reject in the strongest possible terms, with the potential in the United States for concerted action to remove all remaining financial disincentives for donors and critically consider testing the impact and acceptability of incentives to increase organ availability in the United States.”

“Overall, there is strong support within the ASTS membership for changes to NOTA that would permit the implementation and careful evaluation of indirect, government-regulated strategies to increase organ donation.”

2. Salomon DR, Langnas AN, Reed AI, Bloom RD, Magee JC, Gaston RS; AST/ASTS Incentives Workshop Group (IWG). AST/ASTS workshop on increasingorgan donation in the United States: from removing disincentives to testing incentives. Am J Transplant. 2015 May;15(5):1173-9. Doi: 10.1111/ajt.13233. Epub 2015 Mar 31. PMID: 25833653.

3. A published study in American Journal of Kidney Diseases surveyed transplant physicians and surgeons globally. It found:

~60% supported incentives for living kidney donors

• A significant majority favored removal of disincentives (e.g., lost wages, travel) even if direct payments raised ethical concerns 

 4. UNOS/NKF surveys (~1990s–2000s)

The United Network for Organ Sharing and National Kidney Foundation jointly conducted national polls, finding:

• 48–52% of respondents, including medical professionals, supported “some form of compensation”

• Notably, younger physicians (<35) were more open (65–68%) to incentives than their older peers (31–35%).

Over 60% of living kidney donors are reimbursed for their costs and lost wages through programs like the federal Low-Income Donor Assistance Program (NLDAC) or Donor Shield, offered by the National Kidney Registry. Additionally, 22 states provide tax credits and deductions for donor expenses.

However, despite these reimbursement programs, the number of living kidney donors has remained stagnant at around 6,000 annually for the past 25 years.

Reimbursing donors for costs and lost wages does not increase the rate of living kidney donation.

The majority of donors are fully compensated for their costs and lost wages so that they are financially cost neutral. 22% receive the reimbursement from the federal program NLDAC. 40% are reimbursed through Donor Shield. 23 states offer tax credits and deductions for donors’ expenses. Reimbursing donors is the right thing to do, but has not resulted in an increase in the donation rate for 20 years. The living kidney donation rate hovers around 5,000 or 6,000 annually, never even reaching 7,000.

When countries fully reimburse all donors for costs and lost wages, the average subsequent increase in donations is around 16%. There has been no increase in the number of living kidney transplants in the past 25 years even though most USA donors’ costs are now being reimbursed.

There is considerable unused capacity at most U.S. transplant centers, and increasing the number of donors will lead to more surgeries. The goal is to perform more kidney transplants and reduce the waitlist, benefiting patients in need.

Liver donation is riskier and not as taxpayer cost-reducing as kidney donation. While the End Kidney Deaths Act currently focuses on kidney donors, it's possible that compensation for liver donors could be considered in the future.

A refundable tax credit can be accessed by both those who do and those who do not pay federal taxes. 

Implementation will be done through the IRS similar to tax credits for people who purchase electric vehicles. Transplant centers will certify that the donation was nondirected.

While the medical costs of kidney donation are covered by the recipient's insurance, donors are responsible for covering travel, out-of-pocket expenses, and lost wages. Programs like the federal National Living Donor Assistance Center (NLDAC) and the National Kidney Registry's (NKR) Donor Shield help offset these costs for over 60% of donors, making the donation process more affordable.

Donors should not be financially burdened by the act of donation.

The End Kidney Deaths Act team is in favor of providing a full reimbursement for all costs and lost wages for all living organ donors. In countries where such reimbursement is standard, the number of living organ donors increases by 16%. This could potentially add around 720 new living kidney donations annually, further addressing the kidney shortage.

The End Kidney Deaths Act could save up to 100,000 lives over the next decade.

Since 2000, the number of non-directed kidney donors has grown from just 18 to around 400 annually. With the Act’s passage, we estimate adding 10,000 non-directed donor kidneys each year, resulting in 100,000 more transplants by year ten.

In the past decade, 100,000 Americans on the kidney transplant waitlist have died. With this legislation, we have the opportunity to save the next 100,000 lives.

The End Kidney Deaths Act can help combat the underground market for kidneys and reduce human trafficking because we will have an increased number of transplantable kidneys. It can also motivate individuals to become healthier to pass donor screening, potentially further reducing overall healthcare costs.

The End Kidney Deaths Act will greatly help low income Americans who are only 12% of the population but 34% of new cases of ESRD. Low income Americans receive only 6% of transplants.

The Declaration of Istanbul was aimed at preventing transplant tourism. While the End Kidney Deaths Act deviates from one principle of the Declaration of Istanbul by offering compensation, it aligns with the other ten principles and is expected to standardize compensation and reduce worldwide organ trafficking. 

The End Kidney Deaths Act team firmly opposes organ markets. Under this legislation, kidneys donated to strangers will be allocated to individuals at the top of the waitlist—those most at risk of dying due to the kidney shortage. Private payment for kidneys will remain illegal, ensuring that the allocation process continues to prioritize those who have been waiting the longest for a matching kidney.

The American Medical Association (AMA) policy H-370.958 supports exploring pilot programs to compensate living organ donors. The End Kidney Deaths Act proposes a ten-year pilot program specifically designed to compensate kidney donors. Below is a page from the AMA’s policy repository for reference.

It is important to note that the AMA’s Opinions E-6.2.1 and E-6.2.3 express concerns about compensating organ donors.

Here is the page from the American Medical Associations’ policy page.

• Removing Disincentives to Kidney Donation: A Quantitative Analysis

• Most Americans favor compensation for kidney donors if it leads to more saved lives

• Views of US Voters on Compensating Living Kidney Donors

• The Organ Shortage Continues to be a Crisis for Patients with End-Stage Renal Disease

• A Regulated System of Incentives for Kidney Donation - It’s Time for a Trial!

• Lets Allow a Fair Trade in Kidneys | Frederike Ambagtsheer | TEDxAmsterdam