The Health Resources and Services Administration may no longer weigh an organ recipient’s household income when deciding whether a living donor qualifies for travel and expense reimbursement. The change took effect Sept. 30, 2026, and applies to applications reviewed on or after that date. It follows a federal law enacted in February that ordered the agency to drop the test.
The program still pays no more than $6,000, a ceiling that has not moved since 2007. That sum is a cap on documented, out-of-pocket costs, not a payment for donating an organ.
The recipient’s finances drop out of the decision
In a final notice published Sept. 29, 2026, HRSA said the Living Organ Donation Reimbursement Program’s guidelines now prohibit consideration of an organ recipient’s household income in determining a living donor’s eligibility. The donor’s own finances, not the person receiving the organ, are now the measure.
The notice was signed by Ann M. Sheehy, HRSA’s Principal Deputy Administrator. It is published at 91 Federal Register 61415.
A $6,000 ceiling set before 2008
The maximum reimbursement is $6,000, and the notice records that it has been in effect since 2007. The notice reports no change to it in the years since. A donor who spends more than that on flights, lodging, lost wages and dependent care absorbs the difference.
The figure is a reimbursement limit. A donor receives money back only for expenses actually incurred and documented, and only up to the cap. Nothing in the program pays a person for giving an organ, and federal law forbids selling one. Applicants and recipients must certify that they are complying with the National Organ Transplant Act’s ban on organ sales.
What Congress ordered in the Honor Our Living Donors Act
The Honor Our Living Donors (HOLD) Act was enacted in February 2026 as part of the Consolidated Appropriations Act, 2026, Public Law 119-75. The program rests on Section 301 of the National Organ Transplant Act, codified at 42 U.S.C. 274e. HRSA’s notice describes itself as the agency’s response, revising its eligibility guidelines to match the statute.
The law still tells the agency to give preference to people who are more likely to be otherwise unable to meet the expenses. That language explains why donor income still matters even though the recipient’s income no longer does.
Donor household income still sets the order of the line
HRSA ranks applicants by the donor’s own household income against the HHS Poverty Guidelines, in three tiers:
- Household income at or below 350 percent of the guidelines receives the highest priority.
- Income above 350 percent and up to 500 percent is next, if funding allows.
- Income above 500 percent and up to 750 percent can be considered through a financial hardship waiver, again if funding allows.
The waiver is not filed by the donor alone. The notice says a transplant social worker or other appropriate transplant center representative submits the written request on the donor’s behalf, along with documentation of hardship such as lost wages or dependent care costs. Because the upper tiers depend on available funds, a donor in them may be able to apply without being certain of payment.
Conditions the notice leaves in place
Several requirements are unchanged. The donor and recipient must both be U.S. citizens or lawfully present in the country, and both must have primary residences in the United States or its territories. Travel must begin at the donor’s primary residence. The notice describes eligible applicants as individuals who in good faith incur travel and other qualifying expenses toward an intended donation.
Non-directed donors, who give to no one in particular, are exempt from recipient-related criteria and documentation and may apply without an identified recipient. The expense categories and per-diem rules the program reimburses are laid out in the same notice.
Scale of the program and where to ask
HRSA reports that the program has received more than 21,000 applications since its inception and approved nearly 89 percent of them, supporting over 12,000 living donations. Applications run through the program’s cooperative agreement recipients, Mayo Clinic Arizona and the National Living Donor Assistance Center.
Questions about the revised guidelines go to Allison Hutchings of the Division of Transplantation in HRSA’s Health Systems Bureau, at 240-290-2179 or livingdonorsupport@hrsa.gov, according to the Federal Register notice. The notice carries the effective date, the $6,000 maximum and the three income tiers cited above.
Income-tested programs older Americans never applied for
Many older households qualify for income-tested help and never apply, often because each program has its own limits and its own office. The Benefits Checklist is written for retirees and family members who want one place to see which of those programs to look into.
The Benefits Checklist is a 69-page guide covering 11 benefit programs, with the 2026 income limits, a 50-state phone directory and a printable tracker that comes with the download.
Check a household’s income against the 2026 limits for 11 benefit programs →
This article was produced with AI assistance and checked against the primary sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
