Remember: Healthy kidneys do three things:

1. Remove wastes from the blood
2. Regulate levels of water and different minerals
3. Produce hormones that control body functions

When the kidneys no longer work well enough, dialysis treatment or a kidney transplant is required.

There are two sources for kidney transplants: a "living donor" transplant and a "cadaveric" transplant.

Living donor transplants are usually from a blood relative (i.e. immediate family members). The donor’s blood group and tissue type must "match" the person receiving the kidney.

Cadaveric donor transplants are from a person who has recently died. This issue of "compatibility" is still key to "matching" a kidney between the deceased and a potential recipient.

Following the kidney transplant, it is important to monitor both the function of the kidney and prevent "rejection" by the body. To do this requires blood tests and medications.

Blood tests that are used in the post-surgical period include:

• WBC (white blood cells)
  
• HCT (hematocrit or % of red blood cells in the blood)
  
• PLT (platelets)
  
• BUN (a waste product normally removed by the kidney)
  
• Creatinine (a waste product normally removed by the kidney)
  
• Electrolytes

Below is a typical list of medications that are used in the post-surgical period include:

A client with a history of a kidney transplant presents underwriting problems. Survival following a kidney transplant depends on five things:

• Age
  
• What caused the kidney failure
  
• Severity of associated disorders
  
• Closeness of match
  
• Type of donor (live or cadaver)

These are the primary factors that are assessed in determining insurability. The following questions will allow you to screen clients with a history of kidney transplant.

1) What was the cause of the kidney failure that led to transplantation?

Underwriting Comment: It is important to know what precipitated the kidney failure. Was it a disease of the kidney (i.e. glomerulonephritis), or was it secondary to another medical problem (i.e. diabetes)? The cause (also called etiology) will have a significant bearing on the both the success of the transplant and the assessment for life insurance.

2) How old was the client at the time of the kidney transplant?

Underwriting Comment: The ideal age for a kidney transplant is between 15 and 65. Clients under 15 or over 65 are considered for life insurance on an "individual consideration basis."

3) What was the source of the new kidney?

Underwriting Comment: The ideal source is a kidney from an identical twin. After that, a kidney from a live, related donor who has an identical "match" is the next best choice. This is usually from a sibling. The next best choice is from a live donor who had a good "match". Finally, there is a kidney from a cadaver.

REMEMBER: The time of postponement from the date of the kidney transplant until the client is insurable depends first and foremost on the source of the kidney (i.e. 3 months for an identical twin as opposed to 2 years with a cadaveric kidney). In addition, the cost of insurance for the client increases with a less than optimal "replacement" kidney.

4) What are the current medications that the client is taking?

Underwriting Comment: As noted above, transplantation requires the use of medications in the post-surgical period. It is important to document all the medications the client is taking for their kidney transplant and any other medical problems (i.e. hypertension or diabetes).

5) Does the client have other medical problems?

Underwriting Comment: Clients with additional significant medical problems in addition to their kidney transplant will generally not be insurable for individual coverage. It is important to "discover" the full extent of their medical history in the "screening" phase of the case.

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