Reducing Financial Disincentives for Living Donors

1. Reducing Financial Disincentives for Living Donors

2. Authorization • Funded by Health Resources and Services Administration, Division of Transplantation • Competitive grant awarded in 2006 to the University of Michigan in partnership with the American Society of Transplant Surgeons • Up to $2 millions yearly • Reauthorized in 2010 until 2014

3. Mission • Mission is to reduce financial disincentives to living organ donation • To establish and operate a nationwide system to provide reimbursement of travel and subsistence expenses, and other non-medical expenses for individuals being evaluated for and/or undergoing living organ donation. • Priority will be given to those individuals who cannot otherwise afford the expenses.

4. Oversight & Work Groups Program Team Advisory Group Application Review Committee

5. Authorizing Legislation NOTA National Organ Transplant Act ODRIA Organ Donation Recovery and Improvement Act An award may be made under subsection (a) only if the applicant involved agrees that the award will not be expended to pay the qualifying expenses of a donating individual to the extent that payment has been made, or can reasonably be expected to be made, with respect to such expenses-- `(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; `(2) by an entity that provides health services on a prepaid basis; or `(3) by the recipient of the organ. • The term ‘valuable consideration’ does not include the reasonable payments associated with the removal, transportation, implantation, processing, preservation, quality control and storage of a human organ or the expenses of travel, housing, and lost wages incurred by the donor of a human organ in connection with the donation of the organ.”

6. Eligibility Guidelines • Recommendations by the Advisory Group • Developed and Finalized by HRSA • Recipient’s Ability to Pay Considered • NOTA Allows Recipient to Reimburse • Limited Funds Available • Preference for Greatest Need

7. Program Criteria • Donor is a person of good faith facing travel expenses toward the intended donation of an organ • Donor & Recipient are U.S. citizens or lawfully admitted residents and primary residence is in the U.S. or its territories • Travel originates from the donor’s primary residence • Donor and Recipient understand and are in compliance with Section 301 of NOTA. “..it shall be unlawfully to …knowing acquire, receive or transfer any human organ for valuable consideration”

8. Eligibility 300%Poverty Guidelines Source: HHS Federal Poverty Guidelines (FPG) 2012

9. Applications are evaluated and given a Preference Category based on recipient and donor household income Preference Categories Donor Recipient Donor Donor Recipient Recipient Recipient Donor Donor Recipient or

10. Why Applications Not Approved • Recipient income above the income threshold and financial hardship is not proven • Application is filed too late • 10 business days Preference 1-3 • 15 business days Preference 4

11. Eligible Travel Expenses No Mileage Requirement Transportation, Lodging, Meals and Incidentals for: • Trip 1: Evaluation • Trip 2: Hospitalization for Surgical Procedure • Trip 3: Follow up Visit • Additional trips may be added for donor complications or other health related issues • Can pay for travel up to two years after surgery Program includes: • 5 trips: 3 for Donor and 2 for Accompanying Person(s) • Up to a maximum of $6,000.00 per approved application • Federal per diem rate for Meals • Up to 150% of Federal rate for Hotel

12. Who Files Applications • NLDAC Experience • 60% Social Workers • 20% Registered Nurses • 10% Financial Coordinators • 10% Other Allied Professional NLDAC Database 2012

13. How to File Application • Donor & recipient complete application worksheets and gather income document to verify household incomes • Give worksheets and income documents to transplant professional (filer) • Transplant professional login to secure website and complete web-based application

14. After Application Approved • Applications reviewed each Monday and donors are notified on Thursday • NLDAC staff call all approved donors to verify contact information and give verbal instructions • Approval letter & budget sent to donor via email and application filer is cc’d on email. • AMEX card ordered & electronic account created

15. Controlled Value Cards Electronic Donor Accounts • Exclude Merchant Codes Not Related to Travel • Add or Remove Funds in Seconds

16. Program Statistics • Averaging 72 applications/month • 89% approved for funding • $2,500 average spent per donor • 95% Kidney donors • 5% Liver donors • 49% of Approved applicants have completed donor surgery NLDAC Database 2012

17. # of Applications by Fiscal Year FY=September 1 through August 31 NLDAC Database 2012

18. % Transplant Centers Who Have Filed NLDAC Applications (Living Donor Programs n=235) NLDAC Database 2012

19. NLDAC Donor Survey-Approved Applicants How did you hear about NLDAC? Transplant Center NLDAC Web Site Recipient Friends Relatives Living Donor Organizations. Other NLDAC Database 2012

20. % of Approved Applicants Who Would Recommend NLDAC to Other Living Donors NLDAC Database 2012

21. Donor Travel - Annual Expense Budgeted 9/1/12-8/31/13 FY=September 1 through August 31 NLDAC Database 2012

22. % NLDAC Applications by UNOS Region2008-2011 # NLDAC Applications Filed /# of Living Donor Transplants OPTN Database 9/6/12 NLDAC Database 2012

23. Call to Action – Include NLDAC in QAPI • Ensure all eligible patients have equal access to the program • Add NLDAC to your QAPI Report • # NLDAC Applications submitted • Monthly/Quarterly NLDAC Database 2012

24. Additional Resources • National Living Donor Assistance Center www.livingdonorassistance.org • Health Resources and Services Administration www.organdonor.gov • University of Michigan www.med.umich.edu/index.html • American Society of Transplant Surgeons www.asts.org For more information: Holly Warren holly.warren@asts.org 703-414-1606