Times of India
17 February 2011
By Bushra Baseerat
Hyderabad, India

An estimated one lakh new cases join the long list of patients needing kidney transplants each year in the country. And it was to address the growing number of renal failure cases in the state that kidney transplant procedures were included in Aarogyasri. But over three years later, not only are hospitals wary of taking up transplant cases, the scheme too seems to be falling short of providing a complete cure to patients.

Except a handful of private hospitals, most healthcare centres refuse to take up transplant cases citing the poor budget allocation under Arogyasri. Government hospitals are unable to take up such procedures owing to poor infrastructure. But those patients who manage to get a kidney transplant, are left short of a complete cure. Why? Well, the insurance scheme funds the surgery and a year of medication, following which the patients are left to fend for themselves. Doctors say that patients need immmuno–suppressive drugs for the rest of their lives following the transplant, which is not happening in the case of Aarogyasri patients who get free medication only for a year.

Aarogyasri scheme offers Rs 1.5 lakh for surgery to hospitals and another Rs one lakh to patients for drugs for a year. After one year, patients are not given funds for medicines. "If you are bailing them out, then why not bear the cost of drugs for life. Otherwise, the patient is prone to die after a couple of years (following the transplant). In this scenario (where surgeries are done but life–long medication is not funded), death is only being postponed by a year or so," says Dr Gopala Krishna, who performed the first kidney transplant in a government hospital (at Osmania General Hospital) in the country and former president of Indian Society of Organ Transplantation.

Experts cite the example of Tamil Nadu, where patients who undergo transplants get a passbook based on which they are given free drugs at government hospitals.

So far, 351 kidney transplants have been facilitated through the scheme since 2007 in Andhra Pradesh. Hospital administrators admit they do not take up complicated cases. "If we anticipate complications post surgery, we do not take such cases because the package offered under Arogyasri goes up by a few lakhs in such cases," says a transplant surgeon from a corporate hospital. He further says that usually, patients go back to their villages where they don’t even have access to these medicines.

"Hospitals are requesting government to give medicines to patients lifelong post transplant operation. Many of the Arogyasri beneficiaries cannot afford drugs. If the patients neglect or take drugs irregularly, the body rejects the organ," says Dr S Saharia, transplant surgeon at KIMS. Further, Vikram Upalla, MD, of a company which runs a chain of dialysis centres in the city, says, "Government should provide these drugs as after one year, the dosage gets reduced and the cost comes down. If patients do not take these drugs, they will run into complications leading to death as well."

According to Arogyasri Trust officials, the package of Rs 2.5 lakh for kidney transplant is the highest the scheme is offering for any of the 952 procedures it is funding.

"After a year of the procedure, the medicine cost drops to Rs 3,000 per month. By this time the patient would be in a position to work and can afford to buy drugs on his own," said Dr Ch Chandrasekhar, executive officer (technical), Arogyasri Healthcare Trust. He added that initially, the transplant package was of Rs two lakh and after representation from hospitals, it was increased to Rs 2.5 lakh. He added that the trust does not keep track of these patients once the drugs are given to them.