My daughter was born with renal failure and has been on dialysis since she was a week old. She is well covered by Medicare and Medicaid. I have private insurance. Soon I am going to be tested to see if I can donate a kidney to her. I have been told Medicare will cover the transplant surgery, but no one can tell me who will cover the testing. Do you have any idea?

E.H.

I'm considering donating a kidney to my brother. I do not have health insurance at this time. If I get insurance later, will it cost me more if I do this? I've heard that people who have donated are more likely to have high blood pressure?

D.T.

The continued success and long-term positive prognoses for organ transplants have resulted in an increase in insurance benefits for transplant services. Typical transplant coverage includes benefits for both the insured recipient and the donor, including the cost of all surgery, hospitalization and follow-up care. It appears that Medicare coverage follows this practice.
Before a transplant, potential donors must be screened in order to determine whether the organ will be compatible with the recipient. Normally, even this pre-transplant testing is covered by the insurance of the recipient. In the case of Medicare, a qualified Medicare counselor should be able to say whether Medicare will pay for the donor's testing. It seems likely that Medicare would cover the cost of testing if the program also pays for donor surgical and hospitalization costs.

If Medicare does not pay for pre-transplant testing, your own insurance, if it includes transplant benefits, will probably pay for the tests within normal coverage limits. Depending on the type of insurance you have, testing should be covered the way other medical services would be. To determine how Medicare treats donor costs, call 1-800-Medicare. You may also call the Medicaid office in your county or state to see how this program treats the cost of testing a potential donor. Finally, call your own insurance company and ask if there are any special rules governing this situation.

If none of these sources will cover the testing costs, which is unlikely, you may have to pay these costs yourself. Considering the importance of this process and the benefit to your daughter, this might be a small price to pay.

The second question, regarding future insurability of a donor, is an important one. Donating a kidney may have an effect on your ability to qualify for insurance or the price of coverage. You put your finger on just one of the concerns about a kidney donor -- that is, high blood pressure. There are other medical concerns, one being that after donating, you have only one kidney and more at risk for medical consequences if you develop problems in that kidney.

Generally, an uninsured donor who applies for insurance would be declined during the first year or two following the donation. This is a sort of wait-and-see period to determine how the remaining kidney is functioning. It is during the first two years that the person is most at risk. During this period, a person would spend more time with a doctor monitoring kidney function and overall health.

During the second or third year following the donation, the person is getting past the danger period and would probably qualify for insurance, though at a higher-than-normal rate. Such people might have to pay 75-100 percent more than a healthy nondonor. After another year or two, a person might have to pay 25 percent more or the same as a healthy nondonor. The timing may differ from insurer to insurer, but this is typical rule-of-thumb information.

The best advice I can give, however, is to get insurance before undergoing surgery for the removal of your kidney. It will certainly be more difficult to get insurance after you donate, and you are at a higher risk of medical problems. So it is in your best interest to get insurance now.

I am sure that others join me in my admiration for both of you in what you are about to do for loved ones.