In India, organ transplant recipients lead an entire and productive life that works, raises their households and contributes to society. Nonetheless, more often than not, the door to medical insurance stays firmly closed.
Regardless of medical advances and a long time of proof {that a} well-managed transplant affected person might stay steady for years, insurers routinely reject functions from post-transplant recipients, citing “excessive danger” with out producing actuarial information to show it. India’s Insurance coverage Regulation and Growth Authority (IRDAI), which is tasked with defending policyholders, doesn’t mandate protection or guarantee transparency in underwriting requirements.
This isn’t a theoretical dissatisfaction. In 2019, I turned India’s first coronary heart transplant recipient to safe healthcare coverage on a case-by-case foundation. Nonetheless, in 2023, once I utilized for a second coverage with the identical insurance coverage firm, my software was fully rejected. The explanation given: “She was coronary heart transplanted (sic), averted.” There isn’t a particular person well being evaluation or scientific foundation – merely an inclusive rejection.
Deafening silence
IRDAI doesn’t prohibit insurance coverage corporations from protecting post-transplant sufferers. In addition they don’t difficulty binding missions that require them to take action after assessing an individual’s precise well being. In concept, protection may rely upon medical underwriting, well being information, extra riders, and ready durations. In actuality, most insurers comply with implicit guidelines. Because the coverage agent says, it seems to be ready for a delegation from Ildai.
IRDAI’s 2019 normal exclusion doesn’t listing organ transplant surgical procedure as a banned situation. Nonetheless, insurers proceed to refuse protection with out particular person danger assessments, led by in-house non-practical physicians and actuaries. Between 2020 and 2024, almost 25 coronary heart transplant recipients filed formal complaints with Ildai. Nobody acquired approval. The mom of the 7-year-old transplant recipient was additionally turned away.
Once I submitted an RTI asking for information on the insured transplant recipient, I used to be informed that no such information existed. My first enchantment didn’t reply and compelled the Insurance coverage Ombudsman to escalate the problem with proof of Ildai’s inaction.
Courts and Science
In Might 2025, the Bombay Excessive Court docket acknowledged the necessity for organ transplants protected beneath the constitutional proper to livelihood (Article 21), implying that the appropriate to life contains the appropriate to acquire well being insurance policies. Nonetheless, insurance coverage corporations haven’t modified their practices. Well being Companies Director Anil Kumar referred to as the coverage denial “unfair” and urged compensation for donors and recipients, however neither the Ministry of Well being nor Ildai took any concrete motion.
Coronary heart transplant surgeons, Sundar Sankaran, transplant sufferers, from Astor Hospital, Astor Hospital, Bengaluru and KR Balakrishnan, have confirmed that they’ll dwell an extended, wholesome life when managed medically. Dr. Sundar warns that lack of protection will restrict entry to important follow-up care, result in missed appointments, delayed testing, irregular immunosuppressant use, and elevated danger of problems and graft rejection.
A 2020 research by Dr. Balakrishnan discovered that Indian coronary heart transplant recipients common 10 years, with some reaching 15-20 years. Every day immunosuppressants, common blood assessments, and vigilance monitoring permit many sufferers to dwell near-normal lives.
The necessity for reform
Refusal to cowl imposes a cruel monetary burden. Faculty instructor and mom of a transplant recipient, Purvi Shenoy spends round £25,000 a month on her son’s drugs and diagnostic assessments. The annual value for many recipients ranges from £2-3 larks excluding biopsies. Insurance coverage hardly ever covers outpatient drugs or diagnoses except hospitalized, and forces recipients to pay absolutely from their pocket. Ayushman Bharat hasn’t made this clear both.
There isn’t a public information exhibiting that post-transplant sufferers trigger monetary losses for the insurance coverage firm. With out proof, the “excessive danger” label is merely an assumption. In the meantime, recipients proceed to check, work, run their enterprise and pay taxes on 100% of their lifelong medical bills. It is a clear violation of the constitutional proper to life and well being that has been tolerated by regulatory inaction. India is the third largest organ transplant nation, however its recipients aren’t protected. In June 2025, beneath Ayushman Bharat, it was not proposed to incorporate coronary heart and liver transplants together with lifelong immunosuppressants. Tamil Nadu covers the prices of analysis, transplant surgical procedure and immunosuppression as much as Rs. Rs 220,000 beneath the Prime Minister’s complete medical insurance scheme. It is very important doc the incorporation of this scheme.
With out systematic reform, program success will stay incomplete and well being inequality will persist.
(Dr. Viney Kirpal is a former IIT-B professor and coronary heart transplant recipient (2018). Her July 2025 e-book, New Life, New Beginnings: A Convincing Tales of Organ Recipients, Donors and Docs, additionally discusses troubling insurance coverage questions). vineykirpal@gmail.com)
Printed – August 14th, 2025 05:30 PM IS
