Live Kidney Donation and Life Insurance

In June 2015, my Home and Auto insurance provider, AMICA of Rhode Island, sent me a letter offering Life Insurance under very favorable conditions. I expressed my interest and was told that the premiums required for the insurance would be based on the results of a medical examination.

The results of this examination were quite normal except for some renal parameters that had changed irreversibly after my kidney donation in March 2009.

According to the medical experts of Columbia Presbyterian Hospital in New York, kidney donors have increased Creatinine levels and reduced glomerular filtration rates (GFR) compared to their pre-operative baselines. However, unlike other patients with reduced GFR, kidney donors are not at higher risk of end stage renal disease (ESRD) or cardiovascular complications.

The leading medical research centers and organ transplant centers of the US, including Mayo Clinic, Columbia Presbyterian, University of Minnesota, University of Alabama, UCLA, etc.[1], all inform prospective live kidney donors that both their quality of life and life expectancy will stay about the same after the kidney donation.

As with all surgical procedures, there is a risk involved in extracting a kidney, but outcomes are generally positive and life expectancy, as studied by Ibrahim et al in a paper published in the New England Journal of Medicine (NEJM 2009, Vol. 360, pp 459-469), is similar to that of persons who have not donated a kidney. Those findings were also confirmed in a study  by S.J. Taler et al, published 2013 in the American Journal of Transplantation (Feb 2013, Vol. 13(2), pp 390-398).

These results are hardly surprising: Kidney donors are screened for underlying kidney disease and therefore represent a sub-segment of patients high above average in physical fitness and healthy habits. It would be an expensive waste of medical resources to transplant the kidney of an unhealthy donor, and it would put both the donor and the organ recipient at high risk.

In view of all the above, I was surprised to learn that AMICA determined that an adequate risk premium for my “poor renal health” would be $30,000 over 10 years. I was informed by the AMICA Life Insurance underwriting department that insuring people like me at normal premium levels would bankrupt the company. When I explained the reason for my “abnormal” renal parameters and provided a letter by Columbia Presbyterian, I was informed that they their procedures could not take into account events such as a kidney donation.

My next step was to write a letter to AMICA’s CEO, Mr. Robert A. DiMuccio, to give him an opportunity to correct the mistake made by his underwriting department. I attached the letter from Columbia Presbyterian and provided statistical details regarding the life expectancy of kidney donors.

Five weeks later I received the final verdict: There was no way AMICA would reverse the $30k kidney donor penalty, because my poor renal health was putting me into a high risk category.

This final decision was not surprising, given the fact that AMICA’s CEO conveniently referred my case back to his underwriting department: The same “medical experts” who were previously unwilling to evaluate my renal parameters in the context of my kidney donation, were asked a second time to review my case.

What this AMICA experience has done to me is to further strengthen my resolve to exercise 45-60 minutes daily, and to stick to healthy food only. I cannot control my risk to suffer from an accident, but I can optimize my lifestyle to ensure renal health and hopefully extend my life expectancy.

The AMICA experience is also making me think about ways to help increase the number of live kidney donors, currently at the 6,000 level in the US.

The mission of the American Transplant Foundation[2] is to save lives by reducing the growing list of women, men, and children who are waiting for a transplant. ATF does this by maximizing living organ donation, which is the most effective way to fulfill its mission.

On average, 21 people die every day from the lack of available organs for transplant. Seven percent of people on the waiting list—more than 6,500 each year—die before they are able to receive a transplant.

For ethical reasons, it is not allowed to buy or sell human organs in the US. So how could more prospective live donors be incented to help patients in need?

Certainly not by learning how AMICA is handling the underwriting of kidney donor life insurance!

But how about the following: Could prospective donors be encouraged by their families to make a life saving sacrifice if they would be offered a FREE life insurance until, say, age 75 or 80?

Which Life Insurance company would be willing to take this step that could potentially eliminate the donor bottleneck? And which charitable foundation would underwrite the expense for such an initiative, and perhaps even sponsor more research and follow-up?