The End Kidney Deaths Act Summary

The End Kidney Deaths Act (EKDA) is a ten year pilot program to provide a refundable tax credit of $10,000 each year for five years ($50,000 total) to living kidney donors who donate a kidney to a stranger, which will go to those who have been waiting longest on the kidney waitlist. By the 10th year after the passage of the EKDA, up to 100,000 Americans who had been dying on the waitlist will instead have healthy kidneys, and taxpayers will have saved $10-$37 billion. While initially qualified to be on the waitlist, 100,000 Americans died due to the long wait times between 2010-2021. In the decade after the passage of the EKDA, up to 100,000 waitlisted Americans will receive a life-saving living kidney transplant that will on average last twice as long as a deceased donor kidney.

The lead sponsor of the National Organ Transplant Act said 40 years ago in 1984 that if transplant centers conclude efforts to improve voluntary donation are unsuccessful, tax credits should be provided to donors. The EKDA tax credit will provide far more access to lifesaving transplants for the 90,000 Americans currently on the kidney waitlist. For the last 15 years, 50% of those on the waitlist died before receiving a kidney transplant. 800,000 Americans currently suffer from kidney failure; that will likely exceed one million by 2030. 

For the past two decades, 300-400 nondirected donors each year have donated kidneys to strangers. Frequently, kidneys from non-directed donors are used to initiate a chain of kidney transplants for incompatible donor/recipient pairs called kidney chains. This multiplies the positive impact of non-directed donation. The longest chain included 114 recipients. Nondirected donors can also be the “miracle matches” for those who are highly sensitized and unlikely to find a compatible kidney. Non-directed donors do not include people who are donating on behalf of a specific person in a chain or paired exchange.

Kidney transplantation not only saves lives; it also saves money for the U.S. taxpayer. The federal government spends around $50 billion dollars per year (1% of the $5 trillion collected in annual taxes) to pay for 550,000 Americans to have dialysis therapy. This is a cost of approximately $100,000 per year per patient, a treatment that is far more expensive than transplantation.

Regarding deceased donation, fewer than 1% of deaths occur in a manner (in a hospital on a ventilator) that enables the organs to be recovered. Currently, the 60% of Americans who are registered as deceased donors provide kidneys for about 20,000 Americans annually. If the deceased donation system were working at an optimal level, we could add around 2,000 new kidneys per year, not nearly enough to end the kidney shortage. The key to ending the kidney shortage is to dramatically increase the number of living kidney donors. 

Eminent organizations and leaders in the transplant community including kidney dialysis patients, recipients and donors support the EKDA. Congress uses the tax credit system to encourage prosocial behavior. Kidney donation is a generous and brave choice that is time consuming painful and stressful. It is morally important to pay people for 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 in thousands of preventable deaths. 

95% of living donors state in surveys that they would donate again because saving a life is emotionally rewarding. Kidney donation is safer than both childbirth and appendectomies. The majority of American voters believe living donors should be financially incentivized to increase donation rates. The End Kidney Deaths Act will bring us closer to finally ending the preventable deaths due to the tragic kidney shortage that impacts millions of Americans.