Organ Transplantation - Improving Life and Reducing Risk
For some people, an organ transplant is a last hope. Their lives can be saved when doctors replace their damaged organs and tissues with healthy ones from living or deceased donors. Millions of people's sight has been restored with corneal transplants. Donated heart valves, skin, bone, veins and cartiledge help mend damage from burns and general wear and tear. Today the list of body parts that can be replaced includes hands and faces.
The positive health impact means many more individuals with this complex medical history are considering life insurance. We mostly associate organ grafting with kidney, heart, lung, pancreas, liver or severe blood disease and it’s these procedures that most commonly require underwriting assessment.
The main factors for success are finding a matching donor and controlling post operative organ rejection. Unfortunately, rates of infection, graft failure and death are significantly higher in the first few years, and predicting long-term outcomes is no easy task. Improved surgical techniques and better immunosuppressive drugs have helped but some procedures, lung and heart-lung transplants, for example, continue to have poor outcomes.
Caution is required at the underwriting stage and, not unreasonably, assessments of early applications will be postponed until a more reliable prognosis can be made. The effects of lifelong immunosuppression therapy cannot be overlooked nor can the threat of re-transplantation. Despite the risks, many transplant patients enjoy a healthier quality of life. For example, people who receive a kidney transplant do better than those who remain on dialysis, which carries potential for cardiovascular disease, hypertension and diabetes mellitus.
Many factors are associated with survival, including patient age and the original cause of an organ failure. For instance, socioeconomic factors can have an impact. The donor plays a role, too; patients survive longer with a kidney from a living donor. People with leukaemia, anaplastic anaemia and thalassaemia do best when the donor is their identical twin. When the pancreas and kidney are simultaneously transplanted in patients with type 1 diabetes and end stage renal failure, the outcome is better and has and lower risk for diabetic retinopathy, kidney, or heart disease.
Underwriters also see applications for cover from living kidney donors. For them the risk of early (within 90 days) postsurgical death is high, but thereafter, their survival rate and risk for end-stage disease is similar to non-donors. A long-term study by Serev et al. (2010) shows no negative impact on quality of life or mortality rate, and this allows underwriters to offer selected individuals life, critical illness and income protection insurance at standard terms.1
Transplantation is an important option for people for whom a new life can begin after successful surgery, albeit with some significant risks. The chance of rejection and side effects from therapy mean it’s not an easy decision. Despite the risks, it offers a chance for desperately ill people to live and is an act of humanity by healthy individuals. For underwriters, risk assessment remains complex but new evidence and better outcomes mean improved ratings are possible in many cases - both for patients and living donors.
For further reading on this topic, please also refer to my article “Organ Transplantation - Improving Life and Reducing Risk”.
- Segev et. al. (2010). Perioperative mortality and long-term survival following live kidney donation. JAMA, March 10, 2010–Vol 303, No. 10