Why post-transplant recipients still can’t get health insurance in India

In India, organ transplant recipients are main full, productive lives — working, elevating households and contributing to society. But for many, the door to medical health insurance stays firmly closed

Regardless of advances in medication and many years of proof that well-managed transplant sufferers can stay secure for years, insurers routinely reject purposes from post-transplant recipients, citing ‘excessive threat’ with out producing any actuarial knowledge to show it. The Insurance coverage Regulatory and Improvement Authority of India (IRDAI),tasked with protecting policyholders, has neither mandated protection nor ensured transparency in underwriting standards.

This isn’t a theoretical grievance. In 2019, I turned India’s first coronary heart transplant recipient to safe a medical coverage on a case-by-case foundation. But in 2023, after I utilized for a second coverage with the identical insurer, my software was outright rejected. The rationale given: ‘She has been coronary heart transplanted [sic], keep away from.’ No particular person well being evaluation, no scientific foundation — only a blanket refusal.

Deafening silence

IRDAI has not banned insurers from overlaying post-transplant sufferers. It has additionally not issued any binding mandate requiring them to take action after assessing an individual’s precise well being standing. In principle, protection may depend upon medical underwriting, well being data, extra riders, and ready intervals. In apply, most insurers comply with an unstated rule: reject all post-transplant purposes outright,apparently ready for a mandate from the IRDAI, as coverage brokers say.

IRDAI’s 2019 normal exclusions don’t checklist organ transplant surgery as a prohibited situation. But insurers, guided by in-house non-practicing medical doctors and actuaries, proceed to disclaim protection with out particular person threat analysis. Between 2020 and 2024, almost 25 coronary heart transplant recipients lodged formal complaints with IRDAI; none acquired even an acknowledgement. The mom of a seven-year-old transplant recipient was additionally turned away.

Once I filed an RTI in search of knowledge on insured transplant recipients, I used to be advised no such data exist. My first enchantment yielded no response, forcing me to escalate the matter to the Insurance coverage Ombudsman with proof of IRDAI’s inaction.

Courts and science

In Could 2025, the Bombay Excessive Courtroom recognised the necessity for an organ transplant as protected beneath the constitutional proper to life (Article 21), and implied that the precise to life consists of the precise to acquire a well being coverage. But insurers haven’t modified practices. Anil Kumar, director common of well being providers, has known as coverage denial “unfair” and urged protection for donors and recipients, however neither the Ministry of Well being nor IRDAI has taken concrete motion.

Sundar Sankaran, nephrologist, Aster Hospital, Bengaluru, and Okay.R. Balakrishnan, coronary heart transplant surgeon verify that transplant sufferers, when medically managed, can stay lengthy, wholesome lives. Dr. Sundar warns that lack of protection limits entry to important follow-up care, resulting in missed appointments, delayed exams, and irregular immunosuppressant use, which heightens dangers of problems and graft rejection.

A 2020 examine by Dr. Balakrishnan discovered that coronary heart transplant recipients in India survive a mean of 10 years, with some reaching 15–20 years. Every day immunosuppressants, common blood exams, and vigilant monitoring permit many sufferers to stay almost regular lives.

Want for reform

Denial of protection imposes relentless monetary pressure. Purvi Shenoy, a schoolteacher and mom of a transplant recipient, spends about ₹25,000 per 30 days on her son’s drugs and diagnostic exams. Annual prices for many recipients vary between ₹2–3 lakh, excluding biopsies. Insurance coverage not often covers outpatient treatment or diagnostics until hospitalised, forcing recipients to pay solely out of their pocket. Ayushman Bharat provides no readability on this both.

No public knowledge reveals that post-transplant sufferers trigger insurers monetary loss. With out proof, the “excessive threat” label is merely an assumption. In the meantime, recipients proceed to review, work, run companies, and pay taxes, shouldering 100% of lifelong medical prices – a transparent violation of the constitutional proper to life and well being, condoned by regulatory inaction. India is the third-largest organ transplant nation, but recipients stay unprotected. In June 2025, NOTTO proposed including heart and liver transplants, together with lifelong immunosuppressants, beneath Ayushman Bharat. Tamil Nadu covers diagnostic, transplantation surgical procedures and value of immunosuppresants as much as Rs. 22 lakh beneath its Chief Minister’s Complete Well being Insurance coverage Scheme. You will need to doc the uptake of this scheme.

With out systemic reform, the programme’s success stays incomplete and well being inequities 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: Compelling Tales by Organ Recipients, Donors, and Medical doctors’ , additionally discusses the thorny insurance coverage query). vineykirpal@gmail.com )

Printed – August 14, 2025 05:30 pm IST