WASHINGTON (AP) - The US government proposed new rules on Tuesday (Dec 17) to increase organ transplants - steps to make it easier for the living to donate and to make sure that organs from the deceased don't go to waste.

The proposals come after President Donald Trump in July ordered a revamping of the nation's care for kidney disease that included spurring more transplants of kidneys and other organs.

Thousands die every year while waiting for a transplant. There are many reasons for the organ shortage.

An Associated Press analysis recently found some of the groups that collect organs at death secure donors at half the rate of others - leaving behind potentially usable organs.

And other studies suggest people hold off on volunteering to be a living donor because they can't afford the time off work.

Tuesday's proposals address those two challenges. If the rules become final, they would:

* Allow living donors to be reimbursed for lost wages and child care or elder care expenses incurred during their hospitalisation and recovery. Still to be determined is exactly who will qualify.

Currently, the transplant recipient's insurance pays the donor's medical bills, but donors are out of work for weeks recuperating and not all employers allow some form of paid time off.

* Hold the "organ procurement organisations" (OPOs) that collect deceased donations to stricter standards. Rather than self-reporting their success, each OPO's donation and transplantation rates would be calculated using federal death records that show the entire pool of potential donors each has to draw from.

For the first time, that change would allow the government to rank OPO performance. The proposal would require the government to do yearly evaluations and push low-performing OPOs to match those doing a better job.

The rules are open for public comment for 60 days before taking effect.

"Our broken system of procuring organs and supporting kidney donors' costs thousands of American lives each year," Health and Human Services Secretary Alex Azar said in a statement.

More than 113,000 people are on the US waiting list for a transplant.

It's not clear how big an impact the new rules would have, but a 2017 study led by University of Pennsylvania researchers calculated that a better-functioning system to secure deceased donors could produce up to 28,000 more organs a year.

And people lucky enough to receive a kidney or part of a liver from a living donor not only cut years off their transplant wait, but those organs tend to survive longer. Yet, fewer than 7,000 of the 36,529 transplants performed last year were from living donors.