Modification of Living Organ Donation Reimbursement Program Eligibility Guidelines in Response To Honor Our Living Donors Act

HRSA finalized modifications to the Living Organ Donation Reimbursement Program (LODRP) eligibility guidelines pursuant to the Honor Our Living Donors (HOLD) Act, enacted as part of the Consolidated Appropriations Act, 2026 (Public Law 119-75) in February 2026. The HOLD Act prohibits consideration of an organ recipient's household income in determining a living organ donor's eligibility for reimbursement. The final guidelines replace the prior recipient-income-based framework with a donor-centered household income (HHI) framework grounded in the donor's own financial circumstances. The finalized framework establishes three priority categories. Priority Category 1 covers donor applicants with HHIs at or below 350 percent of the HHS Poverty Guidelines. Priority Category 2 covers donors with HHIs above 350 percent and no more than 500 percent of the HHS Poverty Guidelines. Priority Category 3, newly created in response to public comment, is a separate financial hardship waiver category for donors with HHIs between 501 and 750 percent of the HHS Poverty Guidelines, requiring that documented donation-related and qualifying non-discretionary expenses reduce the donor's effective HHI below 500 percent. All three priority categories open simultaneously at the start of each project period, with lower categories subject to closure upon HRSA determination of insufficient funding, with advance notice to transplant centers and the public. Maximum reimbursement remains $6,000 per organ donated for qualifying non-medical expenses, including travel, meals, lost wages, and child and elder care, for expenses incurred through donor evaluation, donation surgery, and follow-up care within two years of the procedure or beyond in exceptional circumstances. The qualifying hardship waiver expense categories were expanded from the proposed version to include pet care, disabled adult care, out-of-pocket medical expenses for the entire household (not limited to donation-related costs), and legally mandated payments to support a family member outside the household such as child support. The final guidelines also expressly state that non-directed donors are exempt from recipient-related eligibility criteria and documentation requirements and may apply without an identified recipient. HRSA confirmed that existing program certifications require both donor and recipient to acknowledge compliance with Section 301 of the National Organ Transplant Act (42 U.S.C. 274e), which prohibits transfer of human organs for valuable consideration affecting interstate commerce. HRSA will submit a separate Paperwork Reduction Act package for OMB review covering data collection on donor, donor candidate, and recipient demographics. The program is currently operated by Mayo Clinic Arizona and the National Living Donor Assistance Center under a cooperative agreement authorized by 42 U.S.C. 274f.