April 26, 2018|
Life/Health Associate Underwriter, Cologne
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”.
Endnote
1. Segev et. al.
(2010). Perioperative mortality and long-term survival following live kidney
donation. JAMA, March 10, 2010–Vol 303, No. 10
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