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In India, organ transplant recipients are leading full, productive lives — working, raising families and contributing to society. Yet for most, the door to health insurance remains firmly closed
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Despite advances in medicine and decades of evidence that well-managed transplant patients can remain stable for years, insurers routinely reject applications from post-transplant recipients, citing ‘high risk’ without producing any actuarial data to prove it. The Insurance Regulatory and Development Authority of India (IRDAI),tasked with protecting policyholders, has neither mandated coverage nor ensured transparency in underwriting criteria.
This is not a theoretical grievance. In 2019, I became India’s first heart transplant recipient to secure a medical policy on a case-by-case basis. Yet in 2023, when I applied for a second policy with the same insurer, my application was outright rejected. The reason given: ‘She has been heart transplanted [sic], avoid.’ No individual health assessment, no scientific basis — just a blanket refusal.
Deafening silence
IRDAI has not banned insurers from covering post-transplant patients. It has also not issued any binding mandate requiring them to do so after assessing a person’s actual health status. In theory, coverage could depend on medical underwriting, health records, additional riders, and waiting periods. In practice, most insurers follow an unspoken rule: reject all post-transplant applications outright,apparently waiting for a mandate from the IRDAI, as policy agents say.
IRDAI’s 2019 standard exclusions do not list organ transplant surgery as a prohibited condition. Yet insurers, guided by in-house non-practicing doctors and actuaries, continue to deny coverage without individual risk evaluation. Between 2020 and 2024, nearly 25 heart transplant recipients lodged formal complaints with IRDAI; none received even an acknowledgement. The mother of a seven-year-old transplant recipient was also turned away.
When I filed an RTI seeking data on insured transplant recipients, I was told no such records exist. My first appeal yielded no response, forcing me to escalate the matter to the Insurance Ombudsman with proof of IRDAI’s inaction.
Courts and science
In May 2025, the Bombay High Court recognised the need for an organ transplant as protected under the constitutional right to life (Article 21), and implied that the right to life includes the right to obtain a health policy. Yet insurers have not changed practices. Anil Kumar, director general of health services, has called policy denial “unfair” and urged coverage for donors and recipients, but neither the Ministry of Health nor IRDAI has taken concrete action.
Sundar Sankaran, nephrologist, Aster Hospital, Bengaluru, and K.R. Balakrishnan, heart transplant surgeon confirm that transplant patients, when medically managed, can live long, healthy lives. Dr. Sundar warns that lack of coverage limits access to essential follow-up care, leading to missed appointments, delayed tests, and irregular immunosuppressant use, which heightens risks of complications and graft rejection.
A 2020 study by Dr. Balakrishnan found that heart transplant recipients in India survive an average of 10 years, with some reaching 15–20 years. Daily immunosuppressants, regular blood tests, and vigilant monitoring allow many patients to live nearly normal lives.
Need for reform
Denial of coverage imposes relentless financial strain. Purvi Shenoy, a schoolteacher and mother of a transplant recipient, spends about ₹25,000 per month on her son’s medications and diagnostic tests. Annual costs for most recipients range between ₹2–3 lakh, excluding biopsies. Insurance rarely covers outpatient medication or diagnostics unless hospitalised, forcing recipients to pay entirely out of their pocket. Ayushman Bharat offers no clarity on this either.
No public data shows that post-transplant patients cause insurers financial loss. Without evidence, the “high risk” label is merely an assumption. Meanwhile, recipients continue to study, work, run businesses, and pay taxes, shouldering 100% of lifelong medical costs – a clear violation of the constitutional right to life and health, condoned by regulatory inaction. India is the third-largest organ transplant nation, yet recipients remain unprotected. In June 2025, NOTTO proposed including heart and liver transplants, along with lifelong immunosuppressants, under Ayushman Bharat. Tamil Nadu covers diagnostic, transplantation surgeries and cost of immunosuppresants up to Rs. 22 lakh under its Chief Minister’s Comprehensive Health Insurance Scheme. It is important to document the uptake of this scheme.
Without systemic reform, the programme’s success remains incomplete and health inequities persist.
(Dr. Viney Kirpal is a former IIT- B professor and heart transplant recipient (2018). Her July 2025 book ‘New Life, New Beginnings: Compelling Stories by Organ Recipients, Donors, and Doctors’ , also discusses the thorny insurance question). vineykirpal@gmail.com )
Published – August 14, 2025 05:30 pm IST
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