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Insurance Article

Organ Donation: How Insurance Helps

October 22 2015

Breaking the cost barrier in organ donation

Organ donation is the transplant of a biological tissue or organ from one individual, called the donor, to another, the recipient, who is in need of a transplant. The common organs that can be donated include heart, kidneys, liver, intestine, lungs, pancreas, cornea, skin and bone marrow. Donated organs come from living or deceased donors.

In India, nearly 5,00,000 people die every year due to unavailability of donors. Thousands suffer from heart or liver diseases or await a kidney or cornea transplant. While the number of organ donations has increased significantly, there is still a considerable mile to cover to narrow the gap between donors and individuals in need.

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Challenges in organ donation

Some of the common challenges that need to be addressed to increase organ donation are:

1) Availability of matching donor

Compatibility between donor and recipient is an important aspect in organ donation. Matching blood and antigen type of donor and recipient is essential to prevent rejection by the recipient's body. Therefore, determining compatibility is the first step in the process of donation. Failure to get the right donor has resulted in delayed or no transplant in several cases.

2) Society's perception

The deep influence of religion and culture in all spheres of society create restrictions on organ donation. The concept of giving a part of one's body or that of a loved one is yet to gain wide acceptance.

3) Cost

Organ donations are highly expensive and can cost anywhere between 1 lakh and 20 lakh plus, based on the organ involved. This acts a barrier for individuals to opt for transplant.

How insurance helps

It is a little known fact that organ donation is covered under most health insurance covers, offering financial relief to those who have to undergo one. Most general insurance companies offering health insurance cover transplant surgeries under the regular policy. The medical expenses incurred by the donor are also reimbursed up to a certain amount.

What is covered

It is essential to understand the finer details of the scope of coverage to make the best use of your health insurance cover. Since organ donation involves two parties, the donor and the recipient, the financial aspect needs to be considered from the perspective of both parties.

An insured recipient gets cover for all the transplant-related expenses, from pre-hospitalization to post-surgery treatment and hospital visits. The treatment expenses are completely paid for, up to the sum insured. This is a boon, especially since treatment and medication might be required even after the surgery until the recipient's body has accepted the foreign part.

For an insured donor, expenses for storage of organ and surgery for removal of organ are covered under the health insurance policy. However, unlike an insured recipient, there are certain restrictions on the amount of cover for donors, and this differs based on the insurance provider.

Exclusions

The donor's health insurance policy does not cover the hospitalization expenses of the donor for the transplant. In addition, expenses for donor screening, post-surgical complications, medication or treatment post-surgery are excluded under the cover. In such cases, these expenses might have to be borne by the recipient.

It is important to know the sub-limits or admissible expenses covered for the insured recipient to be able to meet these additional costs. To ensure clarity in the finances, it is advisable to read your policy thoroughly and understand the terms and conditions. Obtaining a detailed cost break-up from the hospital or healthcare center beforehand will also help to identify the components that are included in the insurance policy.


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