To the Editor:
We are responding to the Melcher et al.  article, which recommends that the National Living Donor Assistance Center (NLDAC) pay for travel and lodging for nondirected donors (NDDs). We commend the work done by this group of stakeholders and believe the publishing of their findings is vital to improving the process of kidney paired donation. We do, however, need to clarify one point in their many important recommendations.
The article recommends “The National Living Donor Assistance Center should provide travel and lodging expenses to the NDD.” It is important to note that there are limits to the NLDAC program that were put in place by the U.S. Congress. NLDAC cannot pay for the travel and lodging expenses for all NDDs. The Organ Donation Recovery and Improvement Act (ODRIA)  established the legislative parameters for NLDAC. ODRIA states that individuals may not receive compensation from the grant if these expenses can reasonably be paid by a State or Federal program, an insurance company or the recipient of the organ. ODRIA requires means testing of the recipient's household income.
In practice, this means a recipient must be identified before an application can be filed with NLDAC. Because NDDs do not have a recipient identified before their evaluation trip to transplant center, NLDAC cannot reimburse those expenses. However, after a recipient is identified, a NLDAC application may then be filed. It should be noted that NLDAC received 42 applications between 2008 and 2012 for NDD, of which 32 were approved, providing NDDs with reimbursement of travel expenses through NLDAC.
If the recipient's household income is below the income threshold of 300% of the HHS Poverty Guidelines, NLDAC is allowed to reimburse those donor's expenses for the surgery and medical follow-up trips. If the recipient's income is above the income threshold, NLDAC may reimburse the donor's expenses if financial hardship is proven by the recipient. If the application is not approved, the National Organ Transplant Act (NOTA)  allows the recipient to reimburse the donor's expenses.
Lastly, we agree with the article's recommendation that payers should cover donor travel and lodging costs given that, by donating and traveling, the donor is enabling not only the recipient's transplant, but also those of other recipients.
This letter represents the views of the authors and does not necessarily represent the views of the grant funder.
A. O. Ojo1*, R. M. Merion2, D. H. Howard3 and P. H. Warren4
1Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
2Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, Michigan
3Department of Health Policy and Management, Emory University, Atlanta, Georgia
4National Living Donor Assistance Center, American Society of Transplant Surgeons, Arlington, Virginia
*Corresponding author: Akinlolu Ojo, email@example.com
The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.