American Kidney Fund's Sixth Annual Living Donor Protection Report Card Shows Progress Made, Highlights Need for More Laws and Regulations to Protect Living Donors

Eight states and the District of Columbia have an A grade, while 13 states have minimal or no protections in place

ROCKVILLE, Md., May 07, 2026 (GLOBE NEWSWIRE) -- Today, the American Kidney Fund (AKF) released its sixth annual State of the States: Living Donor Protection Report Card. While AKF has helped lead substantial gains for living organ donors in several states over the last year, there are many other states where little to no progress has been made. This lack of progress in many states continues to create barriers for would-be living kidney donors, preventing them from giving the gift of life to people in need of a kidney transplant. Receiving a kidney from a living donor is the best treatment option for someone with kidney failure, as they generally present fewer complications than deceased donor transplants and typically survive longer than deceased donor organs.

There are over 100,000 Americans on the organ transplant waitlist, and almost 90% of them are waiting for a kidney. About 28,000 Americans received a kidney transplant in 2025, with about 1 in 4 of those transplants coming from living donors. Increasing living donor protections has been an advocacy priority for AKF, which aims to help remove barriers living organ donors may face during the donation process, with the ultimate goal of increasing the number of living donors and saving lives. 

“Kidney transplants are the best treatment option and provide the greatest chance for people with kidney failure to live a healthy and normal life, but there are simply not enough deceased donor kidneys available for those in need,” said LaVarne A. Burton, AKF President and CEO. “Living donors are key to bridging this gap, but because there is no federal legislation in place to protect living donors, there is an uneven patchwork of protections that varies by state. This year’s report card shows that over a dozen states still have zero or minimal protections in place for living donors, meaning that where someone lives can impact their ability to donate. We can do better, and AKF will continue our efforts—including urging Congress to pass the Living Donor Protection Act—to help ensure all Americans have equal access to becoming a living donor and saving a life.”

“In 2020, I donated a kidney to my mother because I wanted her not just to live, but to continue living a full and vibrant life,” said Andrea Agee, an AKF Ambassador and living donor from Louisiana. “I was fortunate to have an employer that supported me through my recovery with generous leave policies. But as an employment rights attorney, I am aware that many workers are not afforded that same protection when they need time away from work for medical reasons—even for just a few days. Living donors can face lost wages, job insecurity, or even termination while recovering from surgery. Strong protections can remove these barriers and help encourage more people to consider living donation. No one should have to choose between saving a life and keeping their job.”

The AKF Living Donor Protection Report Card grades states on seven different categories of publicly reported legislation and regulations they have in place to protect living organ donors and encourage living organ donation in each U.S. state and the District of Columbia. These include protection from life, disability and long-term care insurance discrimination; job-protected leave from private employers; job-protected leave from public employers; tax credits for employers who provide paid leave; direct reimbursements, tax credits or tax deductions for donor expenses; paid leave via family and medical leave in state law or regulation; and more than 60 days of leave via family and medical leave in state law or regulation. Since the first Living Donor Protection Report Card was released in 2021, 28 states and the District of Columbia have enacted laws that support living donors.

Key Findings from the 2026 Report Card

While the number of states with an A grade in this year’s report card have increased from the number last year, there are still 13 states with a D or F grade, illustrating that the need remains for national legislation to support those who give the gift of life.

Here are the grade updates that occurred in this year’s report card:

• Maryland, Virginia and the District of Columbia improved from a B to an A grade after passing new laws that provide protections or financial support for living organ donors.
• Rhode Island went from a C to B grade by passing legislation that provides paid, job-protected leave for living organ donors.
• Alabama improved from a D to a B grade after enacting legislation that prohibits life, disability and long-term care insurers from discriminating against living organ donors and offers private employers a tax credit if they provide paid leave.
• Tennessee improved from an F to a C grade after enacting legislation that provides paid leave and insurance protections.
• South Dakota went from an F to a D state by passing legislation that prohibits insurance discrimination against living donors.

How all 50 states + DC are ranked on the 2026 State of the States: American Kidney Fund Report Card

• A (At least 5 out of 7 policy protections included)
  • Arkansas, Connecticut, Delaware, District of Columbia, Illinois, Maine, Maryland, New Jersey and Virginia
     
• B (At least 3 out of 7 policy protections included)
  • Alabama, California, Colorado, Georgia, Idaho, Kansas, Michigan, Minnesota, Mississippi, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Washington and Wisconsin.
     
• C (At least 2 out of 7 policy protections included)
  • Arizona, Hawaii, Iowa, Kentucky, Massachusetts, Missouri, New Mexico, North Dakota, Tennessee and Texas
     
• D (At least 1 of 7 policy protections included)
  • Alaska, Florida, Indiana, Louisiana, Nebraska, Nevada, New Hampshire, North Carolina, South Dakota, West Virginia and Wyoming
     
• F (Zero policy protections in place)
  • Montana and Vermont  

AKF is continuing its efforts alongside AKF Ambassadors across the country to urge states to pass more laws that will encourage and support people to become living donors. On the federal side, AKF is encouraged by the Senate Health, Education, Labor and Pensions Committee’s passage of the Living Donor Protection Act, and urges Congress to swiftly pass this legislation in both the Senate and House of Representatives. The Living Donor Protection Act would provide baseline protections nationwide, ensuring that living organ donors have Family and Medical Leave Act and anti-discrimination protections. Passage of this legislation would mean that the lowest Report Card grade any state could receive would be a C.

In addition to advocating for policy changes, AKF is helping to make transplants possible for those who could not otherwise qualify financially. AKF's flagship financial assistance program, the Health Insurance Premium Program (HIPP), makes about 140 kidney transplants possible each month for low-income dialysis patients and continues to help them post-transplant for their full insurance plan year, ensuring continuity of care. In 2025, HIPP helped over 58,000 people pay their health insurance premiums so they could access the health care they need to stay alive and made kidney transplants possible for 1,673 low-income dialysis patients—about 6% of all kidney transplants performed in the United States last year.

To explore the Report Card's state grades and its methodology, visit LivingDonor.KidneyFund.org.

NOTE: Some state grades may have changed from 2025 based on a recent review of existing legislation and regulations.

About the American Kidney Fund

The American Kidney Fund (AKF) fights kidney disease on all fronts as the nonprofit with the greatest direct impact on people with kidney disease. AKF works on behalf of the 1 in 7 American adults living with kidney disease, and the millions more at risk, with an unmatched scope of programs that support people wherever they are in their fight against kidney disease—from prevention through post-transplant living. AKF fights for kidney health for all through programs that address early detection, disease management, financial assistance, clinical research, innovation and advocacy. AKF is one of the nation’s top-rated nonprofits, investing 96 cents of every donated dollar in programs, and it has received 24 consecutive 4-star ratings from Charity Navigator as well as the Platinum Seal of Transparency from Candid, formerly known as GuideStar.

For more information, please visit KidneyFund.org, or connect with AKF on Facebook, Bluesky, X, Instagram and LinkedIn.

Nancy Gregory
American Kidney Fund
(240) 292-7077
ngregory@kidneyfund.org

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