The US, unlike other industrialized nations, has no national health care. Since post-WWII, health insurance has been provided and partially supplemented through one’s employer. However, not every employers offers health insurance to their employees, and not every employee can afford their portion of the health insurance premium even if it is offered. Then there are the self-employed or unemployed.
In short, far too many people in the US (40-50 million) have no health insurance. And there is no rule prohibiting transplant programs from accepting uninsured living donors*, even if it means they will be unable to obtain follow-up and maintain their health, long-term.
Of living kidney donors in the US between July 2004 and September 2006, 10,021 had known health insurance status at time of donation, and 4852 did not.
– 18% lacked health insurance at the time of donation.
– 21% of black LKDs had no health insurance as compared with 13% of whites.
– 35.6% of Hispanics had no health insurance.
– 26.2% of LKDs aged 18-34 at the time of donation had no health insurance, compared with 15.2% of 35-49 year olds, and 11.2% of 50-64 year olds.
More interestingly, the researchers looked at OPTN regions for differences in accepting uninsured kidney donors, and more so, the region’s general uninsured rate.
14.8% of Region 10 (Ohio, Michigan, Indiana) had no health insurance.
37% of Region 10’s LKDs had no health insurance.
The authors acknowledge the limitations of their study, most notably the almost 4900 LKDs with no health insurance status (Why this was missing is not addressed. The transplant center should report the LDs’ insurance status on the living donor registration form). However, the writers also suggest that this results in an underestimation of the true instance of uninsured living kidney donors, rather than over. Which is a pretty scary proposition.
*and even if a person has health insurance at the time of donation, they may lose their health insurance afterward, due to a layoff or otherwise. Until the Affordable Health Care Law was passed in mid-2010, for-profit health insurance companies could refuse coverage to a living donor for having a ‘pre-existing condition’. Now, they can’t outright deny coverage, but they can put the living donor into the ‘high-risk’ pool and make it not affordable.
Gibney EM, Doshi MD, Hartmann EL, Parikh CR, & Garg AX (2010). Health insurance status of US living kidney donors. Clinical journal of the American Society of Nephrology : CJASN, 5 (5), 912-6 PMID: 20413444