Centre for Health, Technologies and Social Practice

In Pursuit of Affordable Organ Transplants: Reflections from India

By Abin Thomas, PhD Candidate, King’s College London

 

Highlighting the issue of affordable health care in India, The Lancet ran a series of articles on this theme entitled “India: Towards Universal Health Coverage” in January 2011.[1] In this blogpost, I explore the existing ways of receiving affordable organ transplant in India, as the National Health Policy 2017 envisages spending 2.5 % of GDP in public health.[2]

The cost of transplant surgeries are not standardised across India. From newspaper reports one can see that a liver transplant surgery at private hospitals costs approximately 30 lakhs compared to the 10.5 lakhs in a government hospital.[3] A kidney transplant package in public hospital is close to 2.4 lakhs, whereas private hospitals charge 3- 14 lakhs.[4] Referring to the cost of transplant costs in Kerala, Dr. Jose Chacko Periyappuram who has performed the highest number of heart transplants in the state, observed in a newspaper article: “A heart transplant costs only Rs. 2 lakh in a government medical college… A heart transplant never costs more than Rs. 10 lakh. If the heart and lungs are transplanted together, it costs Rs. 14.39 lakh. The same surgery will cost Rs. 50 lakh outside Kerala.”[5]

In 2004, when cadaveric organ transfer was picking up in India, no insurance company provided financial support for organ transplant. The Times of India discussed the first heart transplant in Hyderabad with a headline “No insurance cover for organ transplant.”[6] The news report carried the core of the problem on why insurance companies were skeptical about insuring organ transplant procedure. The possibility of the patient getting even a partial insurance cover was dependent on whether he/she convinces the company regarding the absence of medical condition leading to the transplant surgery prior to his/her enrollment with the scheme. The lifelong medication of post-transplant life added further trouble to the insurance question in the country.

In the following years, major means of supporting expensive organ transplants came up in various states. In Tamil Nadu, Chief Minister’s Comprehensive Health Insurance Scheme (CHCHIS) supported costly medical procedures like liver transplantation, renal transplantation, and post-transplant medication.[7] Liver transplant package of Rs. 10.5 lakhs for Aarogyasri scheme beneficiaries was a significant step in the state of Telangana.[8] Maharashtra government included transplant operations of liver, bone marrow, and heart in the Chief Minister’s Relief Fund On 26 January 2016.[9] In Delhi, Aam Aadmi Swasthya Bima Yojna (AASBY) was proposed on January 6, 2016.[10]  Besides, the Prime Minister’s National Relief Fund (PMNRF) gives money to the kidney transplantations.[11] However, Central government’s insurance scheme Rashtriya Swasthya Bima Yojana (RSBY) still does not cover organ transplantation.[12] Dr. V. Jha, the Executive Director at The George Institute for Global Health, India, called for medical insurance cover for organ donors as part of Rashtriya Swasthya Bima Yojna.[13] Recently, the tender documents for the RSBY in Gujarat and Nagaland considered the question of organ transplantation.[14]

During my PhD fieldwork in Kerala, I came across a blog dedicated to the cause of kidney transplant called Kerala Kidney Site. A brief post in the blog summarised the issue of affordability in the context of kidney transplant: “Nowadays, kidney diseases increase in great number. Don’t we see the request for financial support to help with the transplant surgery in the newspaper every day?… Anyone can get this disease.”[15] One set of government steps like the Karunya Benevolent Fund,[16] the Chief Minister’s Fund, the local Member of Parliament’s Fund, and the local Member of Legislative Assembly’s Fund try to address the issue of affordability of transplant. Another set of significant initiatives such as the financial support from philanthropists, community based fundraising and anonymous crowdfunding initiatives are other attempts of dealing with the concern of affordability.

In 2014, Dr. Christopher Taylor Barry, a transplant surgeon and an organ donation activist, reflected on the nascent organ transfer program in the state. He referred to the evolving question of sustainable access to organ transfer in the state as a critical one. He argued that for a successful cadaveric organ transfer program, “the significant resources required can come from the Government, transplant patient self pay and insurance, corporate social responsibility (CSR) funds, and public- private partnerships with transplant NGOs.”[17] Dr. S. Vasudevan of the Government Medical College, Kottayam, repeated this argument in his paper.[18] Recently, Kerala finance minister, Dr. T. M. Thomas Issac, proposed to supply subsidised medicines for transplant recipients in his 2017 state budget speech.[19]

However, the access to organ transplant and sustainable medical care continue to be a challenge in Kerala as elsewhere. In my doctoral dissertation, I take up this question ethnographically and in greater detail.

 

References

[1] See for example, K Srinath Reddy et al.Towards achievement of universal health care in India
by 2020: a call to action,”
Lancet 377 (2011). This article laid out an ambitious timeline to achieve health care for all.

[2] “Health spending to be 2.5% of GDP,” The Hindu, March 17, 2017. http://www.thehindu.com/news/national/centre-cleared-the-long-awaited-national-health-policy-2017/article17487845.ece Accessed 15 May 2017.

[3] Rs. 1 lakh will be approximately 1200 GBP.

[4] M. Sai Gopal, “State hospitals to take up organ transplant surgeries,” The Hindu, August 4, 2015. http://www.thehindu.com/todays-paper/state-hospitals-to-take-up-organ-transplant-surgeries/article7497821.ece Accessed 17 June 2017. 

[5] Jose Chacko Periyappuram, “Have a heart, don’t snuff out organ donation,” Onmanorama, April 21, 2017. http://english.manoramaonline.com/news/columns/straight-talk/2017/04/21/have-a-heart–don-t-snuff-out-organ-donation.html Accessed 19 May 2017.

[6] “No insurance cover for organ transplant,” Times of India, April 1, 2004. http:// timesofindia.indiatimes.com/city/hyderabad/No-insurance-cover-for-organ-transplant/articleshow/ 593908.cms Accessed 24 September 2016.

[7] “Press release: Chief Minister’s Comprehensive Health Insurance Scheme,” P.R. No. 031, Date: 13 January 2017. http://cms.tn.gov.in/sites/default/files/press_release/pr130117_e_031.pdf Accessed 18 January 2017.

[8] M.  Sai Gopal, “State hospitals to take up organ transplant surgeries,” The Hindu, August 4, 2015. http://www.thehindu.com/todays-paper/state-hospitals-to-take-up-organ-transplant-surgeries/article7497821.ece Accessed 17 June 2017.

[9] “Maharashtra government increases aid for medical treatment from CM’s Relief Fund,”http://www.dnaindia.com/money/report-maharashtra-government-increases-aid-for-medical-treatment-from-cm-s-relief-fund-2170691, dnaindia.com, 27 January 2016, accessed 18 June 2017. The Rajiv Gandhi Jeevandayee Arogya Yojana of the Maharashtra state government enabled many kidney transplants in Mumbai. See Sumitra Debroy, “Mumbai public hospitals set pace for affordable kidney transplants”, Times of India, 24 October 2016, http://timesofindia.indiatimes.com/city/mumbai/Mumbai-public-hospitals-set-pace-for-affordable-kidney-transplants/articleshow/55019873.cms, accessed 23 May 2017.

[10] Durgesh Nandan Jha,  Times of India, January 06, 2016. “Rs 500cr to keep city in pink of health?,” http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=Rs-500cr-to-keep-city-in-pink-of-06012016008027 Accessed 15 January 2017.

[11]Prime Minister’s National Relief Fund. http://www.mea.gov.in/prime-ministers-national-relief-fund.htm Accessed 18 June 2017.

[12] http://www.rsby.gov.in/faq_scheme.aspx#1 Accessed 18 June 2017.

[13] V Jha, “Towards achieving national self-sufficiency in organ donation in India – A call to action,” Indian Journal of Nephrology 24 (2014).

[14] See Department of Health & Family Welfare Gujarat, “TENDER DOCUMENT For Implementation of “Rashtriya Swasthya Bima Yojana” and Senior Citizens Health Insurance Scheme In the State of Gujarat,” Released on 29th May, 2017. http://rsbygujarat.org/pdf/RSBY%20Tender%20Document%202017-18%20(GUJARAT))%20.pdf Accessed 18 June 2017. Also see Department of Health & Family Welfare, “Selection of “Insurance Companies” for implementation of RSBY in 11 districts of Nagaland,” Released on 17th May 2016. http://nhmnagaland.in/Programmes_file_path/RSBY%20Tender%20Docment.pdf Accessed 18 June 2017. Another state insurance covers medical care for the workers and their immediate dependents called Employees’ State Insurance (ESI). This scheme runs into problem with respect to lack of clarity regarding the amount for the medical treatment cover. See “Employees State Insurance should foot scribe’s liver transplant bill,” Times of India, March 6, 2013. http://timesofindia.indiatimes.com/city/hyderabad/Employees-State-Insurance-should-foot-scribes-liver-transplant-bill/articleshow/18824461.cms Accessed 24 September 2016.

[15] “Kidney Asughangal,” Kerala Kidney Site, March 23, 2009. https://sree1010.wordpress.com/2009/03/23/കിഡ്നി-അസുഖങ്ങള്%E2%80%8D/ Accessed 25 April 2015.  My translation.

[16] The Kerala state government initiated Karunya Benevolent Fund, in October 2011, as a lottery system to provide financial assistance to poor persons suffering from cancer, hemophilia, kidney and heart diseases and for palliative care. In America, some studies have pointed at the possibility of lottery system in meeting the expense of organ transplantation. Ronald J. Ozminkowski et al. referred to this trend and suggested that “using random lotteries to allocate transplantable organs” is rooted in the principle of equity. For instance, Ronald J. Ozminkowski et al. “Access to Heart and Liver Transplantation in the Late 1980s,” Medical Care 31, no. 11 (1993), p. 1028.

[17] “Deceased Donor Transplantation in Kerala: An Interview with Dr. Barry,” livercancergenomics.com, December 9, 2014. http:// www.livercancergenomics.com/deceased-donor-transplantation-in-kerala-an-interview-with-dr-barry/ Accessed on 25 August 2016.

[18] S. Vasudevan, “Socio Economic Rehabilitation of Solid Organ Transplant Recipients,” Kerala Medical Journal, 8, no. 4 (2015).

[19] “Budget Speech 2017-18,” Dr. T. M. Thomas Issac, 3rd March 2017. https://kerala.gov.in/documents/10180/f04399a1-e891-4400-a05a-b68d64251d34 Accessed 29 April 2017.

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