Cover all kidney transplant costs, patients recommend

Kidney patients and survivors have asked that the new health insurance fund should cover the full costs associated with organ transplants.

The moribund National Health Insurance Fund pays Sh500,000 for transplants but does not pay pre-evaluation and post-evaluation costs or for the drugs that survivors must take after the transplant.

Head of the Renal Patients Society John Gikonyo said these costs have always locked out thousands of eligible Kenyans from kidney transplants.

For instance, in 2021, only 160 kidney transplants were done in Kenya, yet 5,700 eligible patients were on dialysis.

“We have already made proposals to the Ministry of Health and they have technically accepted. The benefits package will include all these three levels. We don’t know the amount yet but we are glad that’s going to happen,” Gikonyo told the Star.

Dialysis–the process of removing waste and excess water from the blood-and kidney transplantation are the two treatment options for people with kidney failure.

But transplantation is preferred because it considerably improves the quality of life and lifespan of survivors.

Gikonyo said the Ministry of Health has technically agreed that the new Social Health Insurance Fund will fully cover kidney transplants under its chronic diseases package.

Before the transplant, patients must have a medical evaluation to decide if they are ready and eligible.

After the procedure, they also undergo a post-transplant evaluation and must take immunosuppressant drugs for life. All these costs are currently not covered by NHIF.

“Today pre-evaluation can cost more than Sh200,000. This means those who don’t have this money can’t access the Sh500,000 that NHIF pays for transplant," Gikonyo said.

"After transplant you need a minimum four post-transplant clinics and that is when everything is okay. At KNH, the total cost for one clinic is about Sh7,200.” 

“The immunosuppressant drugs will cost Sh60,000 a month for the first year. After that it is about Sh30,000-Sh40,000 a month depending on the type of drugs,” he added.

According to the Ministry of Health, Kenya has about five million people with chronic kidney disease.

The Kenya Renal Association–the professional body for kidney doctors and renal scientists–said transplantation in Kenya is performed at seven centres. Four are in Nairobi and three in Eldoret.

The country has 41 adult nephrologists, five paediatric nephrologists, and 260 renal nurses, most not trained in transplantation, the association said.

In a paper published by the Transplantation journal this week, four members of the renal association said Kenya is currently unable to provide adequate renal care for patients having end-stage renal disease.

“In Kenya, transplantation provides a significant cost saving from the third year onward. Currently, dialysis is supported by the government, but the total costs of transplantation are not covered despite its proven medical and economic advantages,” they said.

Their paper is titled, “Kenyan Policy on Organ Donation, Transfusion, and Transplantation: Implications for Africa and the Greater Transplant Community”.

They said Kenya is in a unique position to develop effective, successful, and potentially high-volume renal transplantation centres.

“The development of successful high-volume transplant centres in Kenya could lead to interregional training and result in potential multinational transplant collaborations in East Africa,” they said.

Speaking during World Transplant Day in June last year, Kenyatta National Hospital head of renal unit John Ngigi said many people suffering from kidney disease prefer going through dialysis rather than undergoing a transplant.

"The number of kidney transplants in the country is still low because a majority of patients opt for dialysis treatment," Ngigi said.

 That is because they cannot afford the costs associated with transplant and the immunosuppressant drugs.

Ngigi said kidney transplants are always recommended for patients who are eligible for the procedure as it improves the patient's quality of life.

"Kidney transplant is a better solution than dialysis as the ailing kidney is replaced by a healthy one. A patient who undergoes a kidney transplant has the opportunity to lead a quality productive life. The procedure can increase a patient's life expectancy by up to 20 years," Ngigi said.