Organ Transplant Coverage Under Health Insurance

What is Organ Transplant Surgery?

Organ transplant surgery is a medical procedure where a damaged or failing organ in a person's body is replaced with a healthy organ from a donor. This procedure is performed to restore normal function, improve health, and enhance the overall quality of life for the recipient.

Some of the most commonly transplanted organs include the kidney, liver, heart, lungs, and pancreas. Before the transplant, doctors carefully match the donor organ with the recipient to minimise the risk of rejection and ensure a higher success rate.

Moreover, organ transplantation is a highly complex procedure that requires advanced medical expertise and significant financial resources. For example, the average cost of a heart transplant surgery in India is ₹10 lakh. Given such high expenses, most patients would need a considerable amount of savings to pay for the surgery, necessitating the need for health insurance.

Types of Organ Transplants in India

Listed below are the main types of organ transplantation performed in India:

1. Heart Transplant

   Heart transplant surgery is recommended for patients with end-stage heart failure or severe heart disease. It is done to replace a patient's damaged or diseased heart from a donor who has suffered brain death.

2. Lung Transplant

   Also known as pulmonary transplantation, lung transplant involves replacing the patient's lungs with a donor's lungs surgically. The lungs can be retrieved from a living donor's lungs or a deceased donor's lungs. However, only lung lobes are taken from a living donor.

3. Liver Transplant

   It is also called hepatic transplantation, in which the infected liver is replaced with the donor's healthy liver. Patients with end-stage liver disease and liver failure may require liver transplantation.

4. Cornea Treatment

   This is a laser treatment that restores vision in patients with corneal damage. The doctors use the procedure to reshape the cornea, and the procedure is called a phototherapeutic keratectomy. It is used to remove scar tissue and make the vision clear.

5. Kidney Transplant

   Commonly known as renal transplantation, kidney transplant is used for patients with end-stage kidney disease. It is generally classified as living-donor or deceased-donor transplantation, depending on the organ source.

Expenses Involved in Organ Transplant Surgery

The expenses involved in an organ transplant surgery are as follows:

• Organ Screening- Before an organ transplant, the donor must undergo various medical tests to check their overall health and ensure compatibility with the recipient. 
• Pre-hospitalisation Costs- Once the donor is finalised, both the donor and the recipient need to go through certain treatment and medication before the surgery begins. It may include vaccinations, dietary supplements, medications to prepare the body for surgery, and additional medical tests if required.
• Hospitalisation Costs- This involves the cost of nursing care, consultation fees, and room rent for the donor.
• Organ Transplantation Surgery- It covers the actual transplantation cost, organ harvesting cost, and the surgeon's fees. 
• Post-hospitalisation Costs for the Donor- After surgery, follow-up care is required to ensure a smooth recovery, which may involve expenses such as doctor consultations, medications, etc.
• Post-surgery Complications & Recovery- Any post-surgical complications, like functioning with one kidney, are common in organ transplantation patients. This can increase the cost of overall treatment, hospitalisation cost, and increased cost of recovery.

Does Health Insurance Cover Organ Transplant Surgery Cost?

Yes.

Most health insurance companies in India cover the cost of organ transplant surgery under a critical illness insurance policy. This policy provides a lump sum pay-out if the policyholder is diagnosed with a condition requiring an organ transplant. The pay-out can be used to cover various expenses, including hospital bills, medications, post-surgery care, and even non-medical costs, such as household expenses if the policyholder is unable to go to work due to physical limitations.

Generally, critical illness plans cover organ transplant surgery cost after a waiting period of up to 90 days and a survival period of up to 30 days. However, this might change depending on the insurer and the plan. Also, make sure you go through the policy document carefully to know the exact coverage and related conditions.

Conditions for Major Organ Transplant Coverage in Health Insurance

Certain conditions that one should keep in mind regarding organ transplant coverage in mediclaim insurance are given below:

• Critical illness insurance for organ transplant coverage can be purchased as a standalone policy or as an add-on to an existing health plan.
• Medical facilities follow strict guidelines related to organ transplantation. For this reason, the organ donor should be in compliance with the Transplantation of Human Organs Act 1994, provided the organ is being donated for personal use only.
• Most health insurance policies have a waiting period of up to 90 days before organ transplant coverage becomes available under a critical illness plan.
• Policyholders must survive for at least 30 days after being diagnosed with the need for an organ transplant to receive the lump sum coverage amount.

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