Insurance issues in living kidney donation.

Abstract

INSURANCE ISSUES IN LIVING KIDNEY DONATION We have undertaken a study to ascertain the perspective of U.K. insurance companies to provision of insurance to living kidney donors. WHICH (consumer guide) and customer directories were used to identify the major life and health insurance providers in the United Kingdom, who were then invited to complete specific questionnaires. The results were as follows: 14 life insurance companies, insuring approximately 6.5 million customers (79% of U.K. life insurance market), replied. When questioned regarding their policy if an existing customer should die during kidney donation, 13 of 14 stated that they would pay the agreed life insurance sum. One company did not provide an answer, as they had no experience of the situation and are currently deciding their position for future reference. No companies required to be informed by a customer of their intention to donate. Furthermore, all would accept new customers after previous kidney donation and would not charge an increased premium but indicated that time considerations since donation were a factor in assessing such customers (Table 1). Table 1: Time since living kidney donation for new customers considered relevant by life and health insurers in the United KingdomRegarding health insurance provision, seven major health insurance companies replied; however, one did not complete the questionnaire because they do not market new business. Of the remaining six companies, half cover existing customers for kidney donation. Should an existing customer require a transplant, one company would pay recipient medical expenses and would also pay donor costs if the recipient and donor were both policy holders. All companies accept new customers after previous kidney donation, although two of six stipulate that they exclude any problems arising from donation. Two of six charge an increased rate and four of six do not. Time since donation is considered to be relevant for new customers, as shown in Table 1. Insurance companies providing life insurance to almost 80% of the life insurance policy holders in the United Kingdom would honor the terms of their agreement should a customer die as a consequence of live kidney donation. Premiums are not raised; therefore, kidney donation has no long-term financial implications regarding life insurance. When considering new customers applying for insurance, there were significant inconsistencies among both life and health insurers in the amount of time postdonation that respondents considered relevant. Deaths associated with live kidney donation are rare but occur predominantly in the perioperative period, as do the great majority of complications (1,2), and so these time considerations could be considered to be without scientific foundation. It has been postulated that the increased life expectancy in donor populations may be attributed to exclusion of concomitant illness by the rigorous assessment (3–5). Considering this, the reluctance of certain health insurers to provide medical expenses for donors or sickness benefit is disappointing. Equally, it could be argued that life insurance premiums should actually be reduced postdonation. Kidney donation may have financial implications for health insurance; however, the long-term effects of this are minimized because of the current structure of the National Health Service in the United Kingdom. The inconsistencies in many aspects of insurance provision to live kidney donors highlight the necessity to share information and strive for evidence-based practice from insurance providers. Sarah Clarke Jennifer A. Lumsdaine Stephen J. Wigmore Murat Akyol John L. R. Forsythe