BMJ  2007;334:556 (17 March), doi:10.1136/bmj.39150.435058.DB

News

Organ transplant recipients may die when insurance for immunosuppressants runs out

Florida

Young transplant recipients who lose their insurance coverage are more likely to stop taking essential anti-rejection drugs, which can increase their risk of organ loss and death, a new study shows (Pediatric Transplantation 2007;11:127-31 doi: 10.1111/j.1399-3046.2006.00639.x).

"Kids with transplanted kidneys who lose their insurance have a nine times greater chance of dying than those who don't," said leading author Mark Schnitzler, associate professor in the departments of internal medicine and community health at St Louis University.

"Immunosuppressive drugs that prevent organ rejection are incredibly expensive; sometimes more than $13 000 (£6700; 9900) a year. Even for families with insurance, the co-payments can be a huge financial burden," he added.

In the United States, Medicare pays for most organ transplants. However, coverage of immunosuppressant drugs ends 36 to 44 months after surgery, or when the patient reaches adulthood. Only about 30% of young adults have health insurance. For people who have employer sponsored or private health insurance, coverage ends once a patient reaches a lifetime maximum amount stipulated by their policies.

As a result of these factors, many organ recipients stop taking immunosuppressant drugs; transplanted organs are rejected and patients' lives are shortened. Dr Schnitzler and his team studied the medical records of 1001 children who received a donor kidney between 1995 and 2001, half of whom lost their health insurance.

Dr Schnitzler said: "It is critical that we find a way to offer lifetime access to these children and their families so that our society does not continue to prematurely lose this promising pool of young adults."

"Pediatric transplant recipients have every desire to become independent and useful members of society. To achieve that goal, they need to keep their transplants healthy, and immunosuppressive drugs are essential to ensure that happens," Dr Schnitzler added.

He and his colleagues concluded that new public policies requiring lifetime healthcare coverage for organ transplant recipients would be cost effective, and would prolong patients' lives.

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