While there are several potential barriers to convincing more people to become a living donor of an organ or stem cells, employers have an opportunity to reduce or remove one of them—money.
Tens of thousands of people with liver, kidney and other serious diseases are on waiting lists for organ transplants. "The wait times for organs can lead to a higher risk transplant surgery," said Joanna Balogh-Reynolds, director of clinical consulting at consultancy firm Segal in New York City. The challenge, then, is to increase the number of living organ donors, and this is where employers can make a difference.
By providing funds to cover travel and hotel costs to the designated medical facility and the donor's lost wages during recovery, employers not only can help improve the quality and length of someone's life, they can also potentially reduce their own health costs. "A patient on dialysis can incur health care costs of $200,000 per year," said Jon Friedman, chief medical officer of OptumHealth Medical Benefit Management, a division of United Health Group, in Manhattan Beach, Calif.
"The cost of a living donor transplant is less than $150,000, which represents a net reduction in medical costs," Friedman said. This does not include the improvements in the patient's quality of life, productivity, and long-term health and longevity. "A living donor graft lasts longer and brings a better outcome for the recipient," he added.
Supporting Living Donors
United Health Group had long provided financial support to help pay travel and lodging costs for the company's employees who volunteered to be living donors, with the company's short-term disability program available to help cover lost wages. In 2020, the company also extended this level of support to those willing to donate an organ or stem cells to a United Health Group employee or relative by adding reimbursement for lost wages to its existing reimbursement of travel and lodging costs, both of which are capped at $6,000.
Employers that want to implement a similar program will find the costs of doing so relatively consistent and, therefore, easier to predict and budget.
"An employer insuring 3,000 lives might see two to five transplants a year," said Balogh-Reynolds. "It is not a high-volume procedure." Even so, employers can manage these costs by setting parameters on what the program will cover and to what extent. In some cases, this could be a simple cap on reimbursed expenses or specific limits on mileage, or the number of nights of covered lodging, a per-diem allowance for meals, and so on.
United Health Group's living donor program is budgeted to support 10 to 12 living donations among its 325,000 employees. From June 1, 2020, to the end of January 2021, the company paid out benefits for four living donors. However, this may be an outlier year given the disruptions to the health care system during the COVID-19 pandemic. Even so, a smaller company offering similar benefits may only pay out once every few years, if that.
The cost of the testing and procedures involved in the transplant are generally covered by the recipient's health insurance plan for a specific period of time, such as for 60 days following the donor surgery. After that, the donor's own insurance coverage would take over.
State and Federal Legislation
Employers can review their responsibilities under relevant state and federal laws governing living organ donors. For instance, California law mandates that private employers with 15 or more employees provide employees 30 days of paid leave in a one-year period when an employee participates in an organ donation. Employers also are required to provide bone marrow donors with five days of paid leave. Employees must provide their employers with written verification that the procedure is medically necessary.
[SHRM members-only content: California Organ Donor Leave Policy]
Maryland is another state that requires most private employers to provide unpaid leave for employees serving as organ or bone marrow donors.
The federal Living Donor Protection Act, which has been introduced in both houses of Congress, would prohibit discrimination against living donors when it comes to life, disability and long-term care insurance. It would also allow living donors to use time off granted by the federal Family and Medical Leave Act to recover from donation procedures.
Employers may be eligible for tax credits for certain benefits, including paid leave, provided to living organ donors. The National Kidney Foundation maintains a summary of relevant laws and legislation.
Employers can support these living donor benefits by educating their employees about the benefits of living organ donation to those in need, as well as what is involved in being a donor, the recovery time and the general concerns a living donor candidate might have. The National Kidney Foundation also provides a list of resources, including other sources of financial support for living donors.
Providing living donor benefits, support and education can be a win-win for employer and employee, as "living donors can save someone's life while also saving costs," said Balogh-Reynolds.
Joanne Sammer is a New Jersey-based business and financial writer.