Life Insurance for Living Kidney Donors: A Canadian Undercover Investigation

Abstract

Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied.

Long-term medical risks to the living kidney donor

“…Outcomes for living kidney donors, such as perioperative complications, [12][13][14] psychosocial health, [15][16][17] and economic and insurability consequences, [18][19][20][21] are described elsewhere, as are outcomes for kidney recipients in relation to donor characteristics. 22,23 In this Review, we summarize studies that examine long-term medical outcomes for living kidney donors within the decade after donation, focusing on outcomes that can plausibly be associ ated with a reduction in GFR.…”

Living-Donor Kidney Transplantation

“…Insurability problems after living kidney donation have also long been identified as a source of worry for donors, with the limited data showing that at least some donors have experienced negative consequences (Table 3) (27)(28)(29). As with other financial aspects, risk of insurability effect varies widely.…”

“…However, there will be groups of people for whom the Affordable Care Act is not expected to provide accessible insurance or adequate access to care after donation (i.e., those who cannot afford premiums, those who live in states that opted out of expanded Medicaid, undocumented immigrants). Albeit limited, data do indicate that living kidney donation may affect life insurability (27)(28)(29)32). Boyarsky and colleagues' singlecenter survey showed that of the 186 donors changing or initiating a life insurance application after donation, 46 (25%) reported difficulty (29).…”

Experiences Obtaining Insurance After Live Kidney Donation

“…Insurance difficulties have also been reported in Germany (20, 21) and Norway (22). In a 2009 study, Yang and colleagues contacted Canadian life insurance companies directly, posing as insurance customers with or without a history of live kidney donation; "donors" spent more time on the phone than "nondonors", but there was no evidence of increased rates charged to "donors" on the initial call (36). In contrast with our study, a 1985 post-donation survey of 536 live donors in the United States found that racial minorities had greater difficulty obtaining insurance than other donors; also unlike our study, this study found no evidence of association between age or gender and difficulty obtaining insurance (23).…”