Travel Rights for People on Home Dialysis

Adapted from the LifeLines at Home article, “Leaving on a Jet Plane”

The Air Carrier Access Act (ACAA) of 1990 says airlines can’t discriminate against people with disabilities, and that includes people who are on peritoneal dialysis (PD) or home hemodialysis (HHD). The law applies to U.S. and foreign flights. The U.S. Dept. of Transportation (DOT) oversees air travel and has rules under the ACAA to help people with disabilities travel by air. These rules, called 14 CFR Part 382,i, cover your rights when you need an “Assistive Device”ii— like a portable dialysis machine.

Your rights include:

Not counting your dialysis machine as a carry-on item if it fits in the overhead bin or under the seat in front of you on the plane (Section 382.41(d))
Help with stowing and retrieving your machine as a carry-on item (382.39(b)(5))
Stowing your machine so it is one of the first things off the plane at the end of the flight, if you checked it as luggage (382.41(f)(2))
Giving your machine priority over other bags if space is limited (382.41(f)(3))
Baggage liability limits don’t apply if the airline loses or harms your machine—they must pay for your machine based on the purchase price (382.43(b))
Not being asked to sign a waiver of liability for loss or damage (382.43(c))

Your rights, when you check a dialysis machine as luggage, are often not well known by agents. Some may try to charge a fee if you have suitcases plus a machine. (NOTE: With high fuel prices, most airlines now charge a fee for checked bags.) Some will charge you if your machine weighs more than 50 lbs. DOT spokesman Bill Mosley says, “We’ve told carriers that they shouldn’t charge for dialysis machines, which are assistive devices.” Under the ACAA(Section 382.57), the airlines are not allowed to charge you for your dialysis machine.ⁱⁱⁱ

Here is the section of the manual that tells the airlines that they can’t charge you:^iv

Question: Are airlines allowed to charge for providing services to passengers with disabilities?

Answer: Airlines are not allowed to charge passengers for providing services or accommodations required by Part 382, but may charge for optional services or accommodations. Examples of required services for which carriers may not charge are assistance with enplaning, deplaning, and making flight connections, and the carriage of assistive devices (including the provision of hazardous materials packaging for wheelchair batteries, when appropriate). Examples of optional services for which carriers may charge are the provision of in-flight medical oxygen and stretcher service. (Section 382.57)

Right to bring your dialysis machine on a plane

Before you purchase a ticket, go to the airline’s website to check the carry-on bag limitations. You can use that information to determine if your PD cycler—in its case—will fit on the plane or must go as checked luggage. TheNxStage^® System One used for HHD is too large to fit in any airplane cabin and can only go as checked luggage

Plan to arrive at the airport two hours early; it takes time to talk to airline agents who don’t know about travel with a dialysis machine.

Right to carry medications and syringes with you

Bags go astray. It doesn’t happen often, but it does happen. To be safe, always pack all medications in your carry-on—never in checked luggage. Airplanes don’t have refrigerators, so if you have a drug that must be kept cold, ask your pharmacist how to package it for travel.

If you bring syringes, you must also bring along the drug you inject, such as insulin or EPO. And that drug must have a professionally printed label that says what it is. There is no limit to how many empty syringes you can bring, as long as you also have the drug with you.

Get help at the security line

If it has been a while since you last flew, you will find that some things have changed, including what you’re allowed to bring on a flight.

Liquids in carry-on bags must be 3 ounces or less in a bottle no bigger than 3.4 ounces. All of these liquids must be carried in a clear, 1-quart zip lock bag. Security will throw out anything larger. There is no limit on the amount of liquids you can pack in your checked luggage. The 3.4-ounce limit does not apply to medications, baby formula or contact lens fluid. For a full list of what is prohibited in carry-on and checked bags, visit the Transportation Security Administration (TSA) website.

At the security line, you’ll put your carry-on bags onto a belt to go through an X-ray machine. Ask for help, if you need it, to lift your cycler onto the belt. Because most airport security guards have never seen a PD cycler, you may have an easier time if you bring the manual for your machine and/or a letter from your doctor to explain what it is.

If your PD catheter has the titanium adapter, or if you have an insulin pump, pacemaker, a steel plate in your body, a prosthetic limb or other hidden medical device, tell the security guard before you go through the metal detector. Most airports will ask you to remove your shoes before going through the metal detector, so wear shoes that are easy to take off. If you set off the metal detector, the security guard will ask you to step aside for a more careful search.

Right to pre-board your PD cycler

As an assistive device, a PD cycler has priority for stowage. Be sure to measure it first so you know it will fit in an overhead bin. If you plan to bring your cycler onto the plane, tell the gate agent and ask for help to get your cycler on board and stowed if you need it. When boarding starts, the agent will ask for passengers who need assistance or extra time getting down the jet way to board.

Traveling with dialysate

If you do PD or use a NxStage machine for HHD, you’ll need to bring dialysate on your trip, too. Plan ahead so your supply company can ship most of the boxes to where you’re staying. Get more detail about planning ahead from the DaVita.com article, Traveling for Home Dialysis Patients. The airlines should also allow you to take a day or two of dialysate without a fee for extra or overweight luggage, but there will be a charge for more than that. All supplies must be in their original boxes, with the contents clearly labeled.

Better travel when you know your rights

Now that you know your rights as a home dialysis patient, travel may be a smoother experience. If you do encounter any problems, you can report it to the DOT Disability Hotline at 1-800-778-4838 (voice) or 1-800-455-9880 (TTY). You can also call DaVita Guest Services for many of your travels needs at 1-800-244-0680.