By Janet Coulter, MSN, MS, RN, CCM, FCM
On February 3, 2026, an important milestone in transplant advocacy became a reality. The Honor Our Living Donors (HOLD) Act was signed into law. This achievement was championed by the American Nephrology Nurses Association (ANNA) and other dedicated advocates who understand that living donors are heroes in every sense of the word.
For professional case managers, this is more than a legislative update. It is a practice-changing opportunity. Historically, financial assistance available to living organ donors included income-based eligibility restrictions tied to the transplant recipient’s income. That meant even when a donor faced real financial strain (lost wages, travel expenses, lodging, childcare) they might not qualify for support if the recipient’s income exceeded certain thresholds. The HOLD Act removes those income-based eligibility restrictions and bases reimbursement on the donor’s own financial circumstances. In simpler terms: support now follows the donor’s need not the recipient’s income. This shift aligns with what case managers have long known to be true. Financial barriers should never stand between a willing living donor and the life-saving gift they are prepared to give.
Financial strain has consistently been one of the most cited barriers preventing potential donors from moving forward. By addressing reimbursement eligibility inequities, the HOLD Act has the potential to remove a significant obstacle in the transplant process. It can expand access to living donations and, ultimately, saving more lives.
Living donor transplantation often results in:
- Shorter wait times
- Better graft survival
- Improved patient outcomes
- Reduced time on dialysis
As professional case managers, we are uniquely positioned to translate this legislation into tangible outcomes for our patients and donor families. We can help by:
1. Educating Early and Often
When discussing transplant pathways with patients and families, incorporate updated information about donor reimbursement eligibility. Many potential donors may have previously self-selected out due to perceived financial barriers.
2. Collaborating with Transplant Centers
Ensure transplant program partners are communicating updated eligibility criteria and helping donors navigate available support programs.
3. Advocating Proactively
Screen for financial concerns early in the transplant evaluation process. Normalize conversations about lost wages, travel costs, and household impact. Financial stress should be assessed as seriously as medical risk.
4. Promoting Health Equity
The HOLD Act represents progress toward reducing socioeconomic disparities in access to transplantation. Case managers can reinforce this progress by ensuring patients from vulnerable populations are informed and supported.
Living donors embody generosity at its highest level. They choose to undergo surgery, not for personal gain, but to extend someone else’s life, restore hope, and strengthen families. The HOLD Act recognizes that their sacrifice should not come with financial hardship. This legislation reflects what nursing and case management advocacy can accomplish. Organizations like ANNA continue to demonstrate that when clinicians speak with one voice, policy can evolve in ways that protect patients and those who care for them.
The HOLD Act is a reminder that advocacy works and that, as case managers, we are not only coordinators of care, but champions of access, equity, and possibility. Let’s honor our living donors by ensuring every eligible donor understands that financial barriers no longer have to stand in the way of giving the gift of life. Living donors embody courage, compassion, and selflessness. Our responsibility is to ensure that the systems surrounding them reflect those same values.
Share this news with colleagues and patient advisory groups. Let this milestone renew our commitment to advocacy, education, and collaboration. Together, we continue building a healthcare system where access is fair, support is equitable, and generosity is honored—not burdened.
NOTE: Chronic kidney disease (CKD) continues to affect millions of Americans. More than 800,000 individuals in the United States are living with kidney failure, and many rely on dialysis or transplantation as treatment options. For many, transplantation represents the best opportunity for extended survival, improved quality of life, freedom from lifelong dialysis, and reduced healthcare costs compared to dialysis. Living donor transplantation offers better outcomes and shorter wait times. Yet financial hardship has remained one of the most preventable obstacles in the donation process.
To learn more about this important advocacy milestone, visit ANNA’s Advocacy in Action update at annanurse.org.
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Bio: Janet Coulter, MSN, MS, RN, CCM, FCM is President of CMSA. She is a transplant case manager with a wide variety of experiences including educator, administrator, team leader, and Director of Case Management. Janet holds a Master of Science in Nursing from West Virginia University and a Master of Science in Adult Education from Marshall University. She has published many articles in CMSA Today and the Professional Case Management Journal and served as a reviewer for the Core Curriculum for Case Management Third Edition. She has served as President-Elect of CMSA, Chair of the CMSA Today Editorial Board, Chair of the Nominations Committee, and Vice-President of the CMSA Foundation board. Janet was the recipient of the CMSA National Award of Service Excellence and Southern Ohio Valley CMSA Case Management Leadership award and was recently inducted as a Case Management Fellow from CMSA.