Top officials in the UAE have announced plans to require medical insurance coverage for both organ donors and recipients in the country. A proposed law, set to amend existing regulations on organ donation and transplantation, calls for the incorporation of medical insurance provisions into the National Programme for Organ and Tissue Donation and Transplantation, known as "Hayat."

According to Dr. Ali Al Obaidi, chairman of the UAE National Transplant Committee, the previous law lacked clarity regarding the role of insurance in organ donation, but the new draft law makes it explicit. The proposed legislation mandates all insurance companies to support the Hayat program and encourages them to become strategic partners. Dr. Marwan Al Mulla, CEO of Health Regulation Sector at Dubai Health Authority (DHA), emphasized that transplantation and donation are patient rights and should be included in insurance coverage.

The DHA is collaborating with the national committee to enforce this mandate in Dubai. Last week, officials and representatives from various health authorities in the UAE met with insurance companies to discuss mechanisms ensuring accessibility and sustainability of the organ transplant program for everyone, regardless of nationality or gender.

The Present Scenario

Health insurance usually doesn't cover transplant surgeries, unless you have a premium health insurance plan or International Private Medical Insurance. The basic benefit plan by DHA doesn't include services and costs related to organ and tissue transplants, whether you're the donor or recipient. This exclusion also applies to follow-up treatments and complications unless they become emergencies when left untreated, according to the plan's benefits table.

The Proposed Road Ahead

Health insurance policies generally do not cover transplant surgeries, except for some high-end plans or International Private Medical Insurance options that may offer limited coverage for transplants.

The table of benefits in DHA's essential benefit plan currently does not include services and related costs for tissue and organ transplants, whether the insured is a donor or recipient. This exclusion also applies to follow-up treatments and complications unless they pose an untreated emergency.

When transplant procedures are covered, it's important to note that insurance usually addresses costs for the transplant and recipient only, excluding expenses for the donor. However, there are government programs and charitable organizations that offer support for transplant surgeries.

Why the Proposed Law is All the More Important!

The insurance companies typically avoid offering transplant coverage in their policies to keep health insurance premiums affordable. Transplant surgeries fall under the category of expert quaternary care, incurring significant costs. Finding a suitable donor is a challenging and demanding process in transplant procedures.

Additionally, the expert highlighted that post-transplant complications vary in severity, with some cases leading to loss of life. These complications can significantly impact a patient's lifestyle and well-being even after completing the transplant procedure. Consequently, while a health plan may cover the entire transplant procedure cost, it may not include the expenses for additional care required during the post-transplant period.

Reasons to Insure the Living Donor

According to the patient education document from Cleveland Clinic Abu Dhabi on living kidney donation, donors should be aware of costs not covered by their insurance.

The document also warns that after organ donation, health insurance may treat it as a pre-existing condition, leading to potential denial of payment for medical care. Post-surgery, insurance premiums may rise, and there's a risk of being refused future coverage.

The document outlines the financial risks for living donors, including non-reimbursement for travel, housing, child care, and lost wages related to live kidney donation. It also mentions the need for life-long follow-up at the donor's expense, potential loss of employment or income, and negative effects on future job opportunities.

Furthermore, it notes the negative impact on obtaining, maintaining, or affording health, disability, and life insurance. Future health issues for living donors may not be covered by the recipient's insurance.

New Year is All about Addressing the Health Insurance Gaps

Dr. Aliasger Bagasrawala, Director of Revenue Cycle at King’s College London in Dubai, anticipates that the upcoming law will address gaps in organ donation by covering both donors and recipients. The mandatory coverage is expected to alleviate financial challenges associated with organ retrieval, transportation, surgeries, and post-transplant care.

Once the new scheme is enforced, the transplant program will become sustainable and accessible, demonstrating the commitment of leadership and health authorities to ensure financial constraints do not impede residents' access to transplantation procedures. This reflects a reassuring national policy for UAE residents.

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By: Tanvi Pathak