The U.S. is the only industrialized country without a national paid leave policy. So now workers are giving up their own paid time off to help their colleagues.

Florida history teacher Robert Goodman went viral for begging his coworkers to donate their extra sick days so that he can finish chemotherapy. The 56-year-old colon cancer patient posted his plea to Facebook last month, and received 75 donated days from fellow Palm Beach Gardens school district employees in just four days. He told the BBC that he’s collected about 100 sick days in total; enough to take him through January 2019.

Urgent Help Now: Battling Cancer Chemo : I work at Pal Beach Gardens High School -I’m looking into catastrophic leave of…

Posted by Robert Goodman on Monday, July 23, 2018

“I wasn’t surprised that teachers were giving. Teachers are always giving all the time,” he told CNN. “When one of their own needs help they’ll always step up.”

The same holds true for nurses. When my mother, an emergency room veteran, was blindsided by late-stage lung cancer in fall 2014, she had almost enough accrued paid time off to get her through three cycles of chemo and 33 rounds of radiation therapy and recovery.

But when it became clear that the cancer had debilitated her so badly that she needed to retire, she was about a month short of the paid sick days needed to keep her insurance coverage — a must for the essential (and expensive) medications, tests and doctors’ visits — until she could go on her pension. I don’t know what we would have done if the Nassau University Medical Center on Long Island staff hadn’t donated their days — up to 10 apiece — for her to keep her benefits.

My mother passed away two years ago, but the treatment covered by her work insurance gave her several extra months and one last Thanksgiving and Christmas with us. And that’s thanks to her brothers and sisters in the ER who gave up their own time off with their families so that she could spend more time with hers, and who sacrificed their sick days when she was sickest.

My mom and her kickass coworkers from the hospital. They threw her a really sweet retirement lunch. Nurses are amazing. Xo

Posted by Nicole Lyn Pesce on Sunday, April 26, 2015

But as inspiring as this generosity is, my mom and Mr. Goodman’s stories aren’t heartwarming; they’re heartbreaking. Because the fact is, without their colleagues’ help, these two couldn’t continue the medical treatment necessary to save — or at least extend — their lives.

Once workers run out of paid time off — if they have it at all, as just 15% of private sector workers have paid leave — about 60% qualify for the Family & Medical Leave Act. This gives employees up to 12 weeks of unpaid, job-protected leave per year, and requires that their group health benefits be maintained during the leave.

But many people can’t afford to go three months without a paycheck; four in 10 U.S. adults don’t have enough money in their emergency fund to cover a $400 expense, let alone the months of work they can miss for a terminal illness like cancer, or a happier life event such as having a baby. (In fact, Good Morning America reported last month that Nebraska has launched a maternity leave donation program, where state employees can donate their vacation days to extend a coworker’s maternity leave.)

That’s why Jen, a Queens, N.Y. public school teacher who declined to give her last name, donated to a sick day pool for a colleague with breast cancer several years ago. And under her United Federation of Teachers labor union policy, she actually had to give up two of her 10 paid sick days in order for that teacher to get one; she was essentially penalized for her good deed. (The UFT told Moneyish that the city Department of Education set the two-for-one policy.)

“I didn’t know her personally, but you can’t leave someone with breast cancer without health coverage. So I was like, ‘Whatever you need,’” Jen, 38, told Moneyish. “The last thing someone with cancer or who’s terminally ill should be worrying about is, ‘How can I pay for this?’ It’s a shame.”

Sitting for my infusion of Oxaplatin. I’m adding it back into my treatment- it’s a hard drug to take. I had taken a…

Posted by Robert Goodman on Wednesday, August 8, 2018

But most workplaces don’t allow employees to donate their paid time off to coworkers. Neither the Bureau of Labor Statistics nor the Society for Human Resources Management even track data on donated paid time off; that’s how uncommon it is.

The International Foundation of Employee Benefit Plans did include a couple of questions about donated time off on its 2017 Paid Leave in the Workplace report, however, which surveyed about 500 member companies across a range industries about their benefits. It found that 28% of surveyed workers overall could donate unused paid time off to colleagues in need, with 30% able to donate paid vacation days, and 22% able to donate paid sick days. Public employees such as state, municipal and college/university workers were most likely to participate in this kind of donation program. Private sector employees working in healthcare and at nonprofits were also more likely to have this option.

But this is hardly a representative sample of the entire country, and donation policies are the exception to the rule, particularly in the private sector. Just 5.9% of private company employees in the report could donate their sick days, compared to 50.5% of public employees, like school teachers. “Public employers seem to offer the carryover of vacation and sick leave more often than do corporate types of employers,” Julie Stich, associate vice president of content at the International Foundation, told Moneyish, which means they have more available days to donate. Private companies are more likely to follow a “use it or lose it” paid time off policy where unused vacation or sick days are lost at the end of the year.

“It’s definitely a good benefit to offer, as it increases employee morale and goodwill. It creates employee loyalty to the company, and it’s great for employee retention,” she added. “But there are a lot of challenges for employers to offer this kind of benefit, which is probably a reason why it’s not as popular as one might think.”

Paid leave donation policies are a lot more complicated than they sound, agreed Phyllis Hartman, founder of the PGHR Consulting human resources company. For one thing, a company can’t legally disclose an employee’s medical condition without permission, so sharing a coworker’s situation gets complicated. There’s also very specific tax laws around donating paid time off; both the donor and recipient will be taxed for the days given, unless the employee in need falls under a specific medical emergency exception, or she’s the victim of a natural disaster (such as Hurricane Harvey last year) declared a “major disaster” by the U.S. president. Even then, the recipient will still be taxed; the donor will not.

“Companies have to balance what’s fair and what makes sense for the total organization, not just one person,” added Hartman. “So once you donate days for one person, now you have to do this for everyone else. And what happens if I gave up my paid sick time because my colleague needs it, but now I get sick, and I don’t have any leave left because I gave it up?” Or what if everyone donates to Mary’s cancer treatment, but not Sam’s?

So if you want to suggest bringing this option to your workplace, Hartman suggests doing your research on what is involved, and the places where this has been implemented in the past. The Society for Human Resources Management has posted guidelines online to creating a leave donation program, and sample policy statements. “When you go to your company, you can say, ‘I understand that this requires some steps, but I’d like to suggest we considering doing this, and I’ve done a little bit of research, and I have some ideas,” said Hartman.

Or take matters into your own hands, and help in other ways. “I’ve seen coworkers collecting money or collecting clothing on their own, without asking the company to do it,” said Hartman. “Maybe you can ask if anyone on your team wants to help you pitch in watching someone’s kid when she has to go to chemotherapy. Or you can research some local social service organizations or church groups nearby that might be able to assist with those things.”