*Adjusted mean donation rates estimated using linear spine function assessing differences in rates of donation from before 1997, when federal legislation/initiatives commenced, from 1997 to 2002, and from 2002 to 2006. Dotted lines represent adjusted (for annual incidence and prevalence of end-stage renal disease in each state) mean donation rate among states with legislation. Solid lines represent adjusted (for annual incidence and prevalence of end-stage renal disease in each state) mean donation rate among states without legislation. (A) §Slopes of regression lines represent mean increase in overall living kidney donation rate per year before 1997 (a), from 1997 to 2002 (b), and after 2002 (c) for states with legislation; and mean increase in overall living kidney donation rate per year before 1997 (d), from 1997 to 2002 (e), and after 2002 (f) for states without legislation; presented as mean slope (95% CI). **CI = Confidence Interval. †Mean increase in rate per year after 2002 (c) statistically significantly less than mean increase in rate per year during 1997–2002 (b) for states with legislation (change (95% CI): −2.28 (−3.29 to −1.27), p < 0.01). ‡ Mean increase in rate per year from 1997–2002 (e) statistically significantly greater than mean increase in rate per year before 1997 (d) for states without legislation (change (95% CI): 1.18 (0.57 to 1.81), p < 0.01). §Mean decrease in rate per year after 2002 (f) statistically significantly less than mean increased in rate per year during 1997–2002 (e) for states without legislation (change (95% CI): −2.44 (−3.43 to −1.46), p < 0.01). (B) §Slopes of regression lines represent mean increase in living-related and living-unrelated donation rates (respectively) per year before 1997 (a and g), from 1997 to 2002 (b and h), and after 2002 (c and i) for states with legislation; and mean increase in living-related and unrelated donation rates (respectively) per year before 1997 (d and j), from 1997 to 2002 (e and k), and after 2002 (f and l) for states without legislation; presented as mean slope (95% confidence interval). †Mean increase in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change in mean increase (95% CI): −2.05 (−2.92 to −1.19), p < 0.01). ‡Mean decrease in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change from previous mean increase (95% CI): −1.71 (−2.61 to −0.82), p < 0.01). §Mean increase in rate per year from 1997 to 2002 statistically significantly greater than rate of increase before 1997 (change in mean increase (95% CI):0.75 (0.56 to 0.94), p < 0.01). ¶Mean increase in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change in mean increase (95% CI): −0.47 (−0.77 to −0.17), p < 0.01). ‡‡Mean increase in rate per year from 1997 to 2002 statistically significantly greater than rate of increase before 1997 (change in mean increase (95% CI):1.07 (0.86 to 1.28), p < 0.01). §§Mean increase in rate per year after 2002 statistically significantly less than rate of increase during 1997–2002 (change in mean increase (95% CI): −0.84 (−1.17 to −0.51), p < 0.01).