I 

118TH CONGRESS 

2D SESSION H. R. 10282 

To amend the Public Health Service Act with respect to the Living Organ 

Donation Reimbursement Program. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 4, 2024 

Ms. DELBENE (for herself, Mr. BUCSHON, Ms. SCHRIER, Mrs. MILLER of 

West Virginia, Mr. NADLER, and Ms. KELLY of Illinois) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act with respect to 

the Living Organ Donation Reimbursement Program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Expanding Support 

5 for Living Donors Act of 2024’’. 


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1 SEC. 2. NO CONSIDERATION OF INCOME OF ORGAN RECIPI2 ENT. 

3 Section 377 of the Public Health Service Act (42 

4 U.S.C. 274f) is amended— 

5 (1) by redesignating subsections (c), (d), (e), 

6 and (f) as subsections (d), (e), (i), and (j), respec7 tively; 

8 (2) by inserting after subsection (b) the fol9 lowing: 

10 ‘‘(c) NO CONSIDERATION OF INCOME OF ORGAN RE11 CIPIENT.—The recipient of a grant under this section, in 

12 providing reimbursement to a donating individual through 

13 such grant, shall not give any consideration to the income 

14 of the organ recipient.’’; and 

15 (3) in subsection (i), as so redesignated— 

16 (A) in paragraph (1), by striking ‘‘sub17 section (c)(1)’’ and inserting ‘‘subsection 

18 (d)(1)’’; and 

19 (B) in paragraph (2), by striking ‘‘sub20 section (c)(2)’’ and inserting ‘‘subsection 

21 (d)(2)’’. 

22 SEC. 3. REMOVAL OF EXPECTATION OF PAYMENTS BY 

23 ORGAN RECIPIENTS. 

24 Section 377(e) of the Public Health Service Act (42 

25 U.S.C. 274f(e)), as redesignated by section 2, is amend26 ed— 


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1 (1) in paragraph (1), by adding ‘‘or’’ at the 

2 end; 

3 (2) in paragraph (2), by striking ‘‘; or’’ and in4 serting a period; and 

5 (3) by striking paragraph (3). 

6 SEC. 4. ENSURING ELIGIBILITY OF DONATING INDIVIDUALS 

7 WHOSE HOUSEHOLD INCOME IS AT OR 

8 BELOW 700 PERCENT OF THE POVERTY LINE. 

9 Section 377 of the Public Health Service Act (42 

10 U.S.C. 274f), as amended by section 2, is further amended 

11 by inserting after subsection (e) the following: 

12 ‘‘(f) ELIGIBILITY OF DONATING INDIVIDUALS BASED

13 ON HOUSEHOLD INCOME.— 

14 ‘‘(1) IN GENERAL.—In providing reimburse15 ment to donating individuals using funds from grant 

16 awards under this section, the recipient of the grant 

17 award shall not limit the eligibility of a donating in18 dividual for such reimbursement based on the indi19 vidual’s income if the individual’s household income 

20 is at or below 700 percent of the poverty line. 

21 ‘‘(2) DEFINITION.—In this section, the term 

22 ‘poverty line’ means the applicable poverty line as 

23 set forth in the most recent poverty guidelines of the 

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1 lished under the authority of section 673(2) of the 

2 Community Services Block Grant Act.’’. 

3 SEC. 5. MAXIMUM AMOUNT OF REIMBURSEMENT. 

4 Section 377 of the Public Health Service Act (42 

5 U.S.C. 274f), as amended by section 4, is further amended 

6 by inserting after subsection (f) the following: 

7 ‘‘(g) REIMBURSEMENT AMOUNT.— 

8 ‘‘(1) IN GENERAL.—The amount of reimburse9 ment of qualifying expenses provided by a recipient 

10 of a grant award under this section to each such do11 nating individual shall be the lesser of— 

12 ‘‘(A) the total amount of the donating indi13 vidual’s qualifying expenses; and 

14 ‘‘(B) the maximum permissible amount de15 scribed in paragraph (2). 

16 ‘‘(2) MAXIMUM PERMISSIBLE AMOUNT.— 

17 ‘‘(A) RULE.—Subject to subparagraph 

18 (B), the maximum permissible amount de19 scribed in this section is— 

20 ‘‘(i) for fiscal year 2026, $10,000; and 

21 ‘‘(ii) for subsequent fiscal years, the 

22 maximum permissible amount allowed 

23 under this subsection for the preceding fis24 cal year adjusted by the total percentage 

25 change (rounded to the nearest hundredth) 


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1 that occurred in the Consumer Price Index 

2 for all urban consumers (all items; United 

3 States city average) for the preceding fis4 cal year. 

5 ‘‘(B) EXCEPTION FOR RECIPIENTS BASED

6 ON INSUFFICIENT FUNDS.—The Secretary may, 

7 with respect to reimbursement provided by a re8 cipient of a grant award under this section to 

9 donating individuals, lower the maximum per10 missible amount under subparagraph (A) for a 

11 fiscal year if the Secretary— 

12 ‘‘(i) determines that such recipient 

13 has insufficient funds to provide the full 

14 amount that would otherwise apply under 

15 paragraph (1) to all donating individuals; 

16 and 

17 ‘‘(ii) at least 30 days before making 

18 such determination effective, provides to 

19 the Congress written notice of such deter20 mination, including a justification. 

21 ‘‘(C) SPECIAL RULES.—If the Secretary, 

22 with respect to reimbursement provided by a re23 cipient of a grant award under this section to 

24 donating individuals, makes a determination 

25 under subparagraph (B) to lower the maximum 


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1 permissible amount under subparagraph (A) for 

2 a fiscal year— 

3 ‘‘(i) such determination shall not af4 fect the amount of reimbursement for any 

5 approved donating individual prior to the 

6 effective date of such determination; and 

7 ‘‘(ii) the maximum permissible 

8 amount under subparagraph (A)(ii) for 

9 any subsequent year shall be calculated 

10 without regard to such lowered amount.’’. 

11 SEC. 6. ANNUAL REPORT. 

12 Section 377 of the Public Health Service Act (42 

13 U.S.C. 274f), as amended by section 5, is amended by in14 serting after subsection (g) the following: 

15 ‘‘(h) ANNUAL REPORT.—Not later than the end of 

16 fiscal year 2025 and annually thereafter, the Secretary— 

17 ‘‘(1) shall submit to the Congress, and make 

18 publicly available, a report on the impacts, ongoing 

19 activities, challenges, and future needs of the pro20 gram under this section; 

21 ‘‘(2) shall include in each such report, for the 

22 year covered by the report— 

23 ‘‘(A) an overview of the program under 

24 this section; 


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1 ‘‘(B) current and trended historical infor2 mation about the program under this section, 

3 including— 

4 ‘‘(i) the total number of donating indi5 viduals applying for reimbursement; 

6 ‘‘(ii) the average and median reim7 bursement amount provided to donating in8 dividuals; 

9 ‘‘(iii) demographic information regard10 ing— 

11 ‘‘(I) donating individuals apply12 ing for reimbursement; and 

13 ‘‘(II) donating individuals ap14 proved for reimbursement; 

15 ‘‘(iv) the types of expenses for which 

16 reimbursement was requested (including 

17 requests for reimbursement of non-quali18 fying expenses); 

19 ‘‘(v) the amount of funding provided 

20 to donating individuals with respect to 

21 each such type of expenses; 

22 ‘‘(vi) the amount of funding provided 

23 to donating individuals with respect to 

24 each organ category; 


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1 ‘‘(vii) the total amount expended to 

2 carry out this section, disaggregated by— 

3 ‘‘(I) the amount expended by the 

4 Secretary and the recipients of grants 

5 under this section on administrative 

6 expenses; and 

7 ‘‘(II) the amount provided to do8 nating individuals as reimbursement; 

9 ‘‘(C) the impacts of the program under 

10 this section, including— 

11 ‘‘(i) the number of completed dona12 tions for which reimbursement was pro13 vided; 

14 ‘‘(ii) the proportion of living donor 

15 transplants in the United States in which 

16 the donor received reimbursement through 

17 the program under this section; 

18 ‘‘(iii) an estimate of the savings to the 

19 Medicare program under title XVIII of the 

20 Social Security Act resulting from the pro21 gram under this section, both— 

22 ‘‘(I) for the year covered by the 

23 report; and 

24 ‘‘(II) cumulatively since the pro25 gram’s creation; 


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1 ‘‘(D) the types of donations made by do2 nating individuals receiving reimbursement, 

3 disaggregated according to— 

4 ‘‘(i) the type of organ donated; and 

5 ‘‘(ii) whether the donations were di6 rected, non-directed, or a paired exchange; 

7 ‘‘(E) a description of any efforts to expand 

8 or improve the program under this section; 

9 ‘‘(F) a description of the efforts of the 

10 Secretary and recipients of grants under this 

11 section to increase awareness of the program 

12 under this section; 

13 ‘‘(G) a description of challenges experi14 enced by the program under this section, in15 cluding— 

16 ‘‘(i) the number and percentage of do17 nating individuals applying for reimburse18 ment whose qualifying expenses ap19 proached or exceeded the maximum 

20 amount allowed under subsection (g); and 

21 ‘‘(ii) an estimate of the total funding 

22 needed to fully reimburse, without regard 

23 to the maximum amount allowed under 

24 subsection (g) or donor income eligibility 


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1 caps, all donating individuals in the United 

2 States for all qualifying expenses; and 

3 ‘‘(H) areas of concern regarding, and iden4 tified barriers to, the elimination of financial 

5 disincentives to living organ donation; and 

6 ‘‘(3) in addition to the matters listed in para7 graph (2), may include other such other matters as 

8 may be specified by the Secretary.’’. 

9 SEC. 7. AUTHORIZATION OF APPROPRIATIONS. 

10 Subsection (j) of section 377 of the Public Health 

11 Service Act (42 U.S.C. 274f), as redesignated by section 

12 2, is amended by striking ‘‘is authorized to be appro13 priated $5,000,000 for each of the fiscal years 2005 

14 through 2009’’ and inserting ‘‘are authorized to be appro15 priated such sums as may be necessary for fiscal years 

16 2026 through 2035’’. 

17 SEC. 8. GAO STUDY. 

18 Not later than 1 year after the date of enactment 

19 of this Act, the Comptroller General of the United States 

20 shall— 

21 (1) conduct a study on how the Medicare pro22 gram under title XVIII of the Social Security Act 

23 (42 U.S.C. 1395 et seq.) could, under existing statu24 tory authorities, pay costs that would otherwise be 

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1 ment Program under section 377 of the Public 

2 Health Service Act (42 U.S.C. 274f); and 

3 (2) submit to the Congress a report on the re4 sults of such study, including recommendations for 

5 any changes needed to achieve such purpose. 

Æ 


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