According to a new study published in the American Journal of Transplantation, kidney donors may face insurance challenges, despite little evidence that they have increased health risks.

The authors of the new study cite recent high-profile news stories providing examples of donors being classified as “high-risk” by insurance companies due to only having one kidney, even though the donors have no evidence of kidney injury or disease.

Surveys of insurance companies show that only a small proportion of companies claim that they would charge higher insurance premiums to donors after donation. Despite this, in a survey of transplant centers in the US, 39% of centers reported that potential donors decline donation due to apprehension over future insurance problems.

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The Patient Protection and Affordable Care Act specifically states that insurance companies can no longer refuse kidney donors health insurance or charge them a higher rate.

However, the effect of donation on ability to later obtain health or life insurance has not been measured in a study since 1986.

To investigate, researchers from the Johns Hopkins University School of Public Health in Baltimore, MD, surveyed 1,046 people who donated a kidney at their center between 1970 and 2011. The donors were asked whether they changed or initiated health or life insurance after donation, and what difficulties they faced when doing so.

Among the 395 donors who changed or initiated health insurance after donation, 27 (7%) reported having some difficulty. In the group who reported difficulties, 15 were denied health insurance and 12 were charged a higher premium, while eight were told that – because they were kidney donors – they had a pre-existing condition.

Among the 186 donors in the study who changed or initiated life insurance after their donation, 46 (25%) had similar difficulties. Twenty-three of these people were denied life insurance altogether, 27 were charged a higher premium, and 17 were told their donor status meant they had a pre-existing condition.

In addition, the researchers found that men and donors above the age of 40 were more likely to report having difficulty changing or initiating life insurance.

Other insurance-related difficulties facing donors that were observed by the researchers included delays and added paperwork.

These results show, therefore, that a high proportion of kidney donors encounter problems with changing or initiating insurance – particularly if it is life insurance.

The authors note that, among industrialized nations, the US is the only country in which not all live kidney donors are covered by health insurance. They also observe that the Patient Protection and Affordable Care Act specifically states that insurance companies can no longer refuse kidney donors health insurance or charge them a higher rate.

Lead author Dr. Dorry Segev says:

Kidney donors are among the healthiest individuals in the population. It’s such a shame that some insurance companies are giving donors a hard time, often because of a misinterpretation that the normal biological changes that occur after donation are an indication of kidney disease.

This is a reminder that we need to remain strong advocates for our donors, and they need to remain strong advocates for themselves, educating insurance companies when these situations arise.”

However, in February, Medical News Today reported on other research from Johns Hopkins that found kidney donors have a small increased risk of developing kidney disease after donation, compared with healthy non-donors.

That study estimated that 90 per 10,000 kidney donors will develop end-stage renal disease before the age of 80, compared with 14 per 10,000 healthy non-donors.