HRSA living-donor reimbursement guidelines remove recipient-income eligibility test
Oct 11, 2026 edition · GC-2026-0166 · Published 2026-10-11 · Version 3 · Final
HRSA's final living-donor reimbursement guidelines remove recipient household income from eligibility and apply to applications reviewed from September 30. Donor-income priorities, documented hardship, available funding, other-payer restrictions, and qualifying-expense limits remain; the change does not create an unconditional payment entitlement.
What happened
HRSA's September 29 final guidelines implement the HOLD Act's prohibition on considering a transplant recipient's household income when determining a living donor's reimbursement eligibility. They apply to applications reviewed on or after September 30; earlier reviews follow the identified prior guidelines. The program reimburses qualifying nonmedical donation-related expenses, rather than purchasing organs or replacing every source of assistance. Reimbursement is unavailable where the specified state compensation, insurance, public health-benefit, or prepaid health-service sources can reasonably cover the expense.
The final framework gives highest priority to donors at or below 350 percent of the HHS poverty guidelines, with additional resource-dependent categories above 350 through 500 percent and hardship-waiver applicants above 500 through 750 percent. All three categories open at the start of a budget period, but lower-priority categories may close with notice if resources are insufficient. The final rules retain donor and transplant-center criteria, a recipient-related exemption for nondirected donors, documented hardship review, and a $6,000 total qualifying-expense cap. Removing the recipient-income test therefore leaves a donor-centered, funding-limited application and reimbursement process.
Scope and timing
- Authority status
- Final
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
Why it matters
Transplant financial counselors should avoid screening donors out using the superseded recipient-income test.
Recommended action
Review donor financial-counseling materials and the current application rules; preserve donor-income priorities, qualifying-expense and reimbursement limits.
Sources
- Modification of Living Organ Donation Reimbursement Program Eligibility Guidelines in Response To Honor Our Living Donors ActOfficial · Health and Human Services Department, Health Resources and Services Administration · 2026-09-29 · Source review 2026-10-11
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