Medicare benefits for foreign transplants

[Tío Riñon]

I was chatting with my clinic nurse the other day about a new dialysis patient's situation (I haven't met the person and she didn't share any personal information).  She indicated that this patient and his/her family have been struggling with the diagnosis and how to proceed with treatment.  One idea they have is traveling to Nairobi to obtain a kidney and then continuing on to India for the transplant procedure.

The nurse advised them to check with Medicare to see if the transplant drugs and follow-up treatment would be covered if the procedure was not certified here in the U.S.

Anyone know whether this is the case or not?  Has anyone had a foreign transplant?  If so, can you share your perspective on the process?

[iolaire]

I don't think it will be covered if its not performed at a US center (which is Medicare certified):
https://www.davita.com/treatment-options/paying-for-treatment/medicare-and-chronic-kidney-disease/t/5645
I want a kidney transplant – does Medicare cover this?
Yes, Medicare covers kidney transplants as long as the surgery is performed at a Medicare-approved hospital. When you have Part A insurance, it covers your hospital stay, full care of the living kidney donor, lab work and other hospital services. Part B covers doctors’ services for you and the living kidney donor, blood work and immunosuppressive drugs (medicine used to reduce risk of kidney rejection).

Also I would caution that Medicare's coverage only continues for 36 months after the transplant, so before someone rushes off to get a cut rate transplant they need to think seriously about how they will afford the post transplant drugs as Medicare's coverage ends.  If they were to have a transplant at a US center that center would provide support and resources to try to keep the kidney going for the rest of their life, i.e. knowledge and help applying for needs based programs, they will not get that from an Indian center.  I don't know what the global cost is for immunuospressents but I'd guess it would still be costly if you had to say fly to india once a year (or more) to buy meds.

Also don't forget the clinic visits after transplant, is the family ready to spend six months in India?  Who would provide followup transplant care as immunuospressents are tweaked?  Who will provide lab orders and know how to interpret all the results?

Here is the schedule of lab and clinic visits for post transplant care by The George Washington University Hospital for my transplant:

Time after surgery	Clinic frequency	Lab frequency
0-1 month	twice weekly	twice weekly
1-3 months	every 1-3 weeks	once or twice per week
3-12 months	every 3-6 months	once every other week
12+ months	6 months or yearly	monthly

Here is common milestones after hospital
once you are off pain medicine can drive
4-6 weeks stent removal
1-3 months go back to work
3 months lift more than 20 lbs
6 months can travel internationally and get deactivated vaccines
6 months can go to dentist with antibiotic

[smartcookie]

I would doubt very seriously that the medicines would be covered, just knowing Medicare.  They are sneaky like that!

[Simon Dog]

traveling to Nairobi to obtain a kidney and then continuing on to India for the transplant procedure

What would they do?  Take the kidney in a cooler?    How are they going to have the advance workup done so the Indian MDs can get right work before the kidney goes stale.

BEK transplant in Shanghai used to advertise on the web, but that was taken down due to political pressure.  The kidneys were VERY fresh from healthy donors.  I don't know if BEK is still in business.

[smartcookie]

I just got the image of a Shanghai doctor holding a sign outside a hospital saying "Fresh Kidneys!  Get 'em While They Last!"

[nursey66]

Medicare will only pay for the immunosuppressive drugs if they paid for the transplant. I know that for sure , my husband had his 1st transplant 15 years ago and was on his insurance through his job. When he was unable to return to his work ,EMT, he went on my work insurance and Medicare . They would not pay for drugs. When that kidney stopped working 11 years later, he did dialysis for 2 years and had another kidney transplant 2 years ago, Medicare now will pay for the drugs at 80% , his copay is only around $35 a month . I find this amazing, a lot less than before with the higher copays !!!

[Simon Dog]

I just got the image of a Shanghai doctor holding a sign outside a hospital saying "Fresh Kidneys!  Get 'em While They Last!"

Back when bek-transplant.com was active, the price was $70,000 for a kidney with a $5,000 surcharge for Type O (pos or neg).   Livers were somewhat more, and there was a package discount for both.  There are a few snippets of the site archived at wayback.com, but not much.   They were up front about the fact that organs came from executed prisoners.

[smartcookie]

That is crazy, Simon Dog!  I know patients who would definitely pay that to get off dialysis, though.