How Donating A Kidney Impacts Life Insurance Policies

Kidney donation can be a rewarding experience, with donors reporting higher quality of life scores and improved psychosocial health. However, it is important to consider the financial implications of kidney donation. While the direct medical costs of kidney donation are typically covered by Medicare or the recipient's private insurance, there are indirect costs that donors may have to bear, such as travel expenses and lost wages during recovery. In addition, kidney donation may impact a donor's ability to obtain life insurance, with some donors reporting difficulties in getting coverage or facing higher premiums. This is despite donors being healthier than the average person and undergoing rigorous health screening before donation. It is recommended that individuals considering donation obtain health and life insurance prior to donating and consult with a financial counselor to understand the potential costs.

Difficulty getting life insurance

Although kidney donors are some of the healthiest people in the nation, having passed a rigorous battery of tests, many report difficulty getting or changing life insurance policies after the surgery. This is because some life insurance companies discriminate against living donors who are trying to buy insurance. This is unfair, and in some states, illegal.

A study by Johns Hopkins University School of Medicine in Baltimore, Maryland, surveyed over 1,000 people who had donated a kidney at their hospital between 1970 and 2011. Almost 200 people had changed or initiated life insurance, and 25% reported similar trouble.

Kidney donors are healthier and less likely to have kidney problems than the general public, even with only one kidney. Kidney donors live as long if not longer than others. Data to support this has been published in Sweden, Japan, and the US.

Despite this, some insurance companies are still allowed to deny coverage for kidney donors, considering it a pre-existing condition. This is troubling, as donors have already undergone more health screening scrutiny than anyone else.

If you are a living donor and your organ donation has caused you to be discriminated against for life insurance, you can seek help from Donor Shield, which is the only comprehensive program in the United States protecting living kidney donors. Donor Shield is backed by the National Kidney Registry, which is the largest paired exchange program in the world.

Higher life insurance premiums

Life insurance premiums can increase for kidney donors, with some reporting higher costs or outright rejection when attempting to purchase life insurance. This is despite the fact that donors tend to be healthier than the average person and undergo rigorous health screening before the donation.

A study by Johns Hopkins University School of Medicine found that 25% of kidney donors who changed or initiated life insurance experienced difficulties, with some being denied coverage or informed that their donation was considered a pre-existing condition. This is in violation of the Affordable Care Act, which prohibits insurers from taking pre-existing conditions into account when determining coverage and pricing.

The impact on insurance costs can vary depending on the company, as some may be concerned about the potential risks associated with having only one kidney. Kidney donors are advised to shop around for life insurance to find the best rates.

It is recommended that individuals considering kidney donation obtain health and life insurance prior to the procedure, as it may become more difficult or expensive to obtain coverage afterwards. The National Kidney Registry's Donor Shield program offers legal support and access to reasonably priced insurance for living donors who face discrimination or inflated prices due to their donation status.

To summarise, while kidney donation can have a positive impact on the quality of life and psychosocial health of donors, it is important to consider the potential financial implications, including higher life insurance premiums.

Non-covered expenses

There are several expenses that donors need to consider that are generally not covered by insurance. These out-of-pocket costs include:

• Travel and hotel stay: Donors may need to travel to a transplant hospital away from home, incurring travel and lodging expenses during evaluation and recovery. Some transplant hospitals offer free or low-cost accommodation, but this is not always the case.
• Follow-up costs: While some follow-up/post-operative care is covered by the recipient's insurance, it is not always comprehensive. The extent of covered follow-up care can vary depending on the recipient's insurance plan.
• Lost wages: Time off work during the donor's recovery is typically not covered by Medicare or private insurance. However, donors may have other options, such as paid leave from their employer, sick leave, state disability, or the Family and Medical Leave Act (FMLA).
• Expenses for treatment of unrelated conditions: If any unrelated health conditions are discovered during the evaluation process, the treatment costs for those conditions are generally not covered.

It is important for potential donors to carefully consider these non-covered expenses and discuss them with the transplant center's financial counsellor and/or social worker to fully understand their financial responsibilities.

Medical risks

Donating a kidney is a major surgical procedure that carries certain medical risks, both immediate and long-term.

Immediate/Surgical Risks

• Infection (e.g., pneumonia or wound infection)
• Reaction to anesthesia
• Death (the worldwide mortality rate for living kidney donors is 0.03% to 0.06%)
• Conversion to open nephrectomy
• Need for re-operation (e.g., due to bleeding)
• Re-admission to the hospital
• Intestinal obstruction
• Testicular swelling and discomfort (in male donors)

Long-Term/Medical Risks

After donating a kidney, there is typically a 20% to 30% decrease in kidney function, as measured by the glomerular filtration rate. The remaining kidney compensates for the loss through a process called hyperfiltration. However, other long-term complications may include:

• Developing a disease that affects the function of the remaining kidney, such as natural kidney function decline as one ages, end-stage renal disease (ESRD), or an increase in protein spillage into the urine.
• A higher chance of high blood pressure, which may require medical treatment.

Psychosocial, Socioeconomic, and Emotional Risks

Living kidney donors may also experience psychosocial, socioeconomic, and emotional challenges. For example, they may feel disappointed if the donation does not improve their relationship with the recipient or experience depression, anxiety, or post-traumatic stress disorder. Additionally, their career choices may be impacted, especially in fields like the military, law enforcement, or firefighting. Donors should also refrain from participating in high-risk collision sports without adequate protective gear.

Psychosocial and socioeconomic risks

The decision to donate a kidney involves various psychosocial and socioeconomic factors that potential donors must carefully consider. While the surgery itself is a significant aspect, other risks and implications exist that can impact a donor's quality of life.

Psychosocial Risks

Psychosocial risks refer to the potential mental health and emotional consequences of donating a kidney. Some donors may experience feelings of worry, guilt, stress, and concern related to the surgery and the recipient's health. There is also a risk of disappointment if the donor expects their relationship with the recipient to improve because of the donation.

Additionally, donors may experience psychological conditions such as depression, anxiety, or post-traumatic stress disorder after donation. The intense screening process may also lead to the detection of medical issues that can impact a donor's psychological well-being.

Socioeconomic Risks

Socioeconomic risks are primarily related to the financial implications of donating a kidney. There are often indirect costs that are not covered by insurance, including travel expenses, hotel stays, lost wages during recovery, and childcare costs. These out-of-pocket expenses can pose a significant financial burden on donors, especially if they are unable to work during their recovery period.

Furthermore, donating a kidney may impact a donor's ability to obtain life insurance or result in higher premiums. Some insurance companies may consider kidney donation as a pre-existing condition and deny coverage or charge higher rates.

To mitigate these risks, donors should carefully evaluate their financial situation and insurance coverage before proceeding with donation. They should also seek support from transplant coordinators, social workers, and other resources to navigate these challenges.

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