(NB The following statement was published by the Department of Health on 8 August 2003)
The Department of Health with the help of the Inland Revenue has prepared the following explanation of the proper reimbursement of a living organ donor’s expenses.
The Human Organ Transplants (HOT) Act, 1989 forbids the offer or payment of any inducement for the supply of a human organ. However, it does not prohibit the payment of reasonable expenses to a donor for travel and accommodation and any loss of earnings incurred if directly attributable to his/her donation of an organ.
NHS trusts and PCTs are permitted to make such payments and should do so if the live transplant is permitted under the HOT Act. The NHS is not legally obliged to make such payments. However, as a renal transplant is the most cost-effective treatment for end stage renal failure, and a live donor transplant may be the only option for a patient in liver failure, payment of the cost of the donor operation, and any associated donor expenses, is justified.
Renal transplantation now comes under the specialised commissioning groups’ arrangements. Whether the NHS Trust or a PCT actually refunds the donor is a matter for those commissioning arrangements but should be agreed beforehand and the method of making a claim and receiving payment explained to all concerned. The service agreement should be explicit about how any such payments are to be made, whether by the Trust or by an application to a PCT.
The level of any reimbursement will depend on any other sources of reimbursement available to the donor. Absence from work could be 6-12 weeks and those in employment may not be entitled to be paid their full salary (or even a reduced/basic rate) for all periods of sickness absence. An employer may not be willing to pay anything for “voluntary sickness” (although many employers will wish to fully support such a generous act). Some may be able to claim statutory sick pay but will probably wish to contact their local social security office as well as discussing it with their employer. If the donor is a member of a union they may want to seek advice on their rights from their union.
It may be more difficult to calculate expenses and travel costs if the donor is coming from abroad. It is of particular importance that any such expenses are only reimbursed by a PCT or Trust and not by the family of the recipient. Any payment, even of reasonable expenses, by the family could be interpreted as an inducement to donate.
The final decision as to whether expenses will be paid rests with the service commissioners following consultation with the Trust.
Any payments to living donors should ensure that, within reason, the donor is no worse off as a result of the donation, but neither should they gain any financial advantage. Any payments in excess of the amount needed to reimburse losses would constitute a payment for the donation and breach the HOT Act, 1989.
Reimbursement of personal expenses such as transport costs should be repaid in full on provision of receipts or in the case of e.g. mileage at an agreed rate such as the standard NHS rate. Such payments are legal under the HOT Act and are not subject to any tax liability.
Payments for loss of earnings are legal under the HOT Act but the method of payment and position with respect to any tax liability depends on the employment status of the individual.
Exceptionally, if the person is on unpaid leave for several weeks, they may need to make voluntary payments to make up lost pension contributions to e.g. a stakeholder pension or Class 3 additional voluntary National Insurance contributions for a state pension. Such voluntary contributions can be reimbursed without any tax liability. In view of the short time they are away from work live donors should not need to make additional National Insurance contributions but if they are unsure they should contact their tax office.
In the case of very high earners, full reimbursement of lost earnings may not make the transplant cost-effective. Trusts may wish to offer reimbursement up to the average national wage. There is no bar to reimbursements in excess of the average in exceptional circumstances as long as it is in the best interests of the recipient.
A person’s entitlement to Child Tax Credit will not be affected by the fact that (s)he is a live donor. A short absence from work should not affect a donor’s entitlement to Working Tax Credit, including the child care element, because assuming the donor plans to return to work as soon as (s)he has recovered, the Revenue would not regard the absence as affecting the donor’s “usual working hours”.
When entitlement to either or both of the tax credits is assessed, only taxable income is taken into account. So if donors receive non-taxable income, they are not required to report it to the Inland Revenue. Donors who need further information should contact the Tax Credit Helpline on 0845 300 3900 for further advice.
Transplant Policy Team
Department of Health
August 2003
Enquiries: 020 7972 4921
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 16 September 2003
Last updated: 19 March 2008
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