Does Health Insurance Cover Kidney Transplants?

• Written by Yashita Sinha

  Reviewed by Akhil Pillai

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Medical science has transformed dramatically over generations, making life-saving procedures like kidney transplants a reality for patients with end-stage kidney failure.Organ transplants, once unimaginable, are now the last ray of hope for patients with vital organ dysfunction.

Among these, kidney transplants stand out as one of the most commonly performed and successful surgeries in India. In this blog, we’ll break down kidney transplants, including their requirements, cost, and life after transplant. Here’s everything you need to know.

What is a Kidney Transplant?

A kidney transplant is a surgical procedure where a dysfunctional or damaged kidney is replaced with a healthy kidney from a living or deceased donor. This is generally the treatment option for patients with end-stage kidney disease, increasing the quality and longevity of life more than long-term dialysis. This life-saving procedure has become increasingly common in India, despite its cost and complexity.

What are the Requirements of a Kidney Transplant?

Below are the requirements for both donors and recipients :

For Kidney Donors

• Minimum 18 years old
• Must be in good physical and mental condition
• Must not have any current alcohol or substance abuse issues
• Must not have any active infections

For Recipients

• End-stage renal failure and undergoing dialysis
• A thorough understanding of post-procedure care
• Must be in good physical and mental condition with strong social support
• Must be healthy enough to undergo surgery
• CKD with glomerular filtration rate (GFR) less than or equal to 20 ml/min
• Must be willing to post-transplant medications and follow the transplant team’s suggestions
• Must not have medical conditions that could interfere with the procedure

What is the Cost of a Kidney Transplant in India?

The cost of a kidney transplant in India typically ranges from Rs. 5 to 15 lakhs, and potentially higher in some cases. This amount covers the expenses related to hospital stays, surgery, immunosuppressants, doctor fees, anaesthesia, laboratory tests, medications, and follow-up visits.

The overall cost of kidney transplants is also influenced by certain factors, including

donor availability, severity of the patient’s condition, duration of the hospital stay, surgeon fees, diagnostic and other lab tests, location and clinical infrastructure of the hospital, choice of food, and accommodation.

Is There an Age Limit to Be Evaluated for a Kidney Transplant?

There isn't a specific age limit to be evaluated for a kidney transplant. While some transplant centres might have a specified upper limit, others have no such limit. Moreover, many programs accept patients in their 60s as they are more focused on the overall health of donors and whether their bodies are capable of safely undergoing the procedure.

Are Kidney Transplants Covered in Health Insurance in India?

Yes, kidney transplants are generally covered by most health insurance plans in India. This coverage includes pre- and post-hospitalisation expenses, surgery costs and organ donor expenses. Most critical insurance plans also cover treatment expenses if the surgery is required due to end-stage renal disease.

Also Read: Discover the Top Causes of Kidney Stones and How to Prevent Them

Importance of Kidney Transplant Coverage

Here’s why kidney transplant coverage matters:

Financial Safety

For patients with end-stage renal failure, it becomes challenging to bear the kidney transplant costs without a health insurance policy. Given the medical inflation in India, undergoing the treatment with no financial safety net can create an unnecessary financial burden. Thus, medical coverage significantly eases the financial burden on patients and their families.

Emotional Security

Kidney Transplant coverage not only ensures financial safety but provides emotional security as well. Under the medical policy, patients get access to the best hospitals with experienced transplant teams that ensure long-term success. This allows them to focus on their recovery rather than managing financial concerns.

Things to Remember While Buying Kidney Transplant Insurance

Here are the top things that people should keep in mind when purchasing kidney transplant insurance:

Check if Kidney Transplant is Explicitly Covered

Since not all health insurance plans provide coverage for organ donor expenses, ensure that your policy explicitly covers kidney transplants, including organ donor expenses.

Evaluate the Sum Insured

The average cost of a kidney transplant in India ranges from 5 to 20 lakhs, depending on numerous factors. Therefore, it is important to choose a plan with an adequate sum insured that covers both pre- and post-hospitalisation and surgery costs.

Understand Coverage for Donor Expenses

Although most health insurance companies cover the organ donor expenses, not all of them do. Therefore, look for a plan that fully or partially covers these costs.

Look at the Waiting Period

Some policies have a 2–4 year waiting period for organ transplants. Those who are at risk or have already been diagnosed with a chronic kidney condition should consider plans with waiting period modifications or shorter waiting periods.

Review the Claim Settlement Ratio of the Insurer

While choosing an insurer, remember to look at their claim settlement ratio. A high CSR ensures that insurers are trustworthy and have a track record of honouring claims.

What Happens After a Kidney Transplant?

Typically, after a kidney transplant, patients are asked to spend a few days in the hospital. This way, the hospital staff can monitor their recovery. After the transplant, there are two possibilities: the kidney either starts functioning immediately or takes several days to weeks, potentially requiring temporary dialysis. During this time, doctors perform regular blood tests to monitor the efficiency of the transplanted kidney. Immunosuppressants are given in cases where the patient’s immune system rejects the new kidney.

Note: It is common for patients to experience persistent anxiety and mood changes during the recovery period. Therefore, doctors recommend support groups and counseling. Patients are also advised to gradually resume physical exercises and maintain a kidney-friendly diet.

Plan for Protection That Goes Beyond Surgery

A kidney transplant can be a life-saving procedure. But, without the right medical and financial support, the cost of treatment expenses can easily become overwhelming. While a health insurance plan can help ease the burden of surgical and hospital expenses, it might not be enough in the long run.

That’s where critical illness insurance steps in. It covers the entire treatment expenses upon the diagnosis of serious illnesses like end-stage renal failure, ensuring you have the freedom to manage treatment needs without exhausting your savings.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.