People generous enough to donate a kidney to a loved one or complete stranger could be penalised by health insurance companies which specify having just one kidney as a “pre-existing” condition which can constitute denial of cover. This is an additional insult to the injury that has been suffered by kidney donors for years – that of having to pay thousands for their own transplant-related medical care. Donna Luebke, a nurse practitioner in cardiology at MetroHealth Medical Center in Cleveland, told the American Statesman: "Right now it is the issue for living donors in this country," Luebke said. "I know of donors who have paid thousands of dollars out of pocket for complications." She thinks that as Congress debates reform of the health care system it should require that donors are covered.