Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Maximizing IOTA Earnings Through Living Donor Eligibility Support
Daniela
Shuman
, BA Computer Science and Statistics, MS Computer Science
, Co-Director
, Project Donor
The Challenge
IOTA has made living donation a central performance and financial priority for transplant programs. While many donor candidates are motivated to donate, only 2% ultimately progress to donation. An estimated 20% are excluded due to reversible eligibility barriers such as elevated BMI or tobacco use. Most transplant centers lack the staffing and infrastructure to help these candidates overcome these barriers. As a result, a large pool of motivated donors remains untapped, constraining both living donor growth and IOTA earnings. This project explored whether structured eligibility support for initially ineligible yet motivated donors could increase successful progression to donation while generating measurable IOTA revenue.
The Approach
Motivated, yet ineligible living kidney and liver donor candidates were referred from 85 transplant centers, donor organizations, and social media. Ineligibility was defined by the respective transplant center’s eligibility criteria (e.g. BMI limit). Candidates were paired with a case manager who provided structured support and free, needs-based resources, including commercial weight-loss programs, nicotine-replacement therapy, and telehealth counseling. Support continued throughout the eligibility process and for one year post donation.
The Results
Over a 3 year study period (5/13/2022–11/18/2025), a total of 1,330 prospective donors enrolled in the program. Of those enrolled, 794 completed the program, while 536 remain active. Among those who completed the program, 173 (22%) achieved eligibility after a median time of 192 days. Weight-related support was the most common need (94.1%) followed by smoking cessation (9.4%). Weight-loss participants lost an average of 6.3kg to reach eligibility and required a mean of 6.5 months to donate. Of those who met their goals, 142 (82%) proceeded to kidney or liver donation by the end of the study period. Donors remained on the program for an average of 230 days post donation. Eligibility support increased annual living donations by an average of 6% across all centers who participated.
Based on the intervention’s 15% donation rate, eligibility support is projected to yield an 8.5% ± 4.9% increase in total transplants, or 38.4% increase in living transplants. Eligibility support resources cost an average of $496 per participant, or $76 per month. Total expected additional IOTA reimbursement attributable to successful conversions is estimated at $124,310 annually for current IOTA centers, $115,217 for all centers. This translates to an 11% median increase in funding from IOTA.
Insights & Lessons Learned
Targeted eligibility support for reversible barriers provides a practical, scalable, and cost-effective way to increase living donation. For transplant centers, this approach expands access to transplantation and also generates meaningful financial benefits through increased IOTA reimbursement. Integrating structured support into donor programs can substantially improve donor conversion rates and accelerate progress toward national living donor goals. These candidates represent a high-yield group for increasing living donation and should be prioritized in efforts to expand the donor pool.