Kathryn:           Hi everyone. We are season six, episode two of the podcast, and I have Matt ran back with me for the first time this season. Hi Matt.

Matt:                Hi Kathryn. It’s lovely to be back. It has to be said. I’ve, I’ve, I’ve missed our, uh, our podcasts, uh, over the summer, so it’s, uh, it’s great to be back. How are you keeping?

Kathryn:           I’m very, very well thank you. And I have to say it’s, it’s been good to have our usual natter beforehand as well. We [00:00:30] always have a good na listeners just beforehand and then suddenly look at each other and go, Oh, we really should start recording the actual podcast now. Uh, however, have you been Matt?

Matt:                Yes, Yes. Very good. Thank you. Been been away, uh, a couple of times. Um, the last trip we had was down to Budapest. Nice. Um, which was lovely. Just a long weekend kind of city break, but that, that was lovely. And um, back in kind of raring to go in in September when things start to pick up for everybody.

Kathryn:           Fantastic. Sounds, sounds good. So today everybody, we [00:01:00] are gonna be talking about organ donation and what it can mean if you are looking for protection insurance. This is the Practical Protection Podcast.

Speaker 3:        So

Kathryn:           Back into the usual swing of things. I am going to give us a little bit of a background about organ donation and then Matt is obviously gonna give us the really intense side of things for an underwriter, help explain altars as to what we need to [00:01:30] know as advisors. And for anybody listening who has had an organ transplant or has been a donor giving you some ideas as to what you might see if you are going to be applying for some potentially some insurances. So an organ donation tends to happen, um, usually when an organ is not working to the best of its ability. We do tend to think of organ donations as quite significant organs, um, that happen after somebody has died. Um, especially in the uk. Everybody is signed up to be, um, on the, [00:02:00] uh, organ donor list and people can opt out of it.

Kathryn:           But we are now in the sense of is more of a you have to opt out rather than opt in. So we often, often think of people as to say who have passed away. Um, maybe something like, uh, the kidneys, the liver, lots of different things, the heart as well. Uh, but we also can have organs that are donated from people who are living such as kidneys. Um, you can, it’s an interesting thing as well if you think about donations or anything like that. Um, when you go for your, and I did this when [00:02:30] I went for my, um, oh, when I could donate blood, I’m not allowed to anymore unfortunately, but when I could donate blood, um, at the same time I registered to be a stem cell donor. And that’s just an extra little, um, I think vi of um, I think blood that they take when you are there and then they find out your stem cell matches and everything.

Kathryn:           And that can be incredibly beneficial to somebody that is living with cancer. And just to give an idea as well, there are currently about, uh, 6,600 people on a, a transplant waiting list [00:03:00] in the uk and aren’t, you know, massively up to date statistics on some of it, but one of the most recent ones I found was that in April of 2022, there was just over 1,550 transplants in that month in the uk. So Matt, as an underwriter, somebody’s coming to you and an advisors coming to you and they are saying that somebody has had an organ donation and what are kind of the first things that are popping to mind?

Matt:                Okay. I think, um, maybe [00:03:30] if I could, Mike, can I take, I do sometimes I’m known to do this. Take a step back. Would that be alright? Always

Kathryn:           Happy for you to take step back, always

Matt:                Rather, excuse me. Um, rather than, uh, maybe answer your question directly. Um, one of the things that, um, we are, we are looking at here, um, and, and we’re providing the background to, um, o an organ donor stroke or organ recipient for that matter, um, is, it’s just picking up here. That’s really, [00:04:00] and it’s great that all the improvements in medicine and particularly around the immunosuppressants for um, uh, combating rejection over the last 20 years have actually made organ transplants the, uh, the treatment of choice. And I just wanted to pick up that specifically when somebody is being considered for organ transplant and if you sell critical illness, um, you’ll know that there is a ma major organ transplant [00:04:30] is actually specifically covered under that particular, under that particular plan protection plan. But people who really have untreatable, uh, people who considered for major organ transplant or organ transplants, I should say, people who are, who are un have untreatable endstage disease.

Matt:                Um, so that, that is pretty severe. So, uh, using um, uh, the example of the most common, uh, [00:05:00] donor dony, uh, organ situation in the UK and in the USA for that matter, which is kidneys, um, you’ll find quite often that people are um, are end stage kidney failure or to use a little bit more of a technical term end stage renal failure. Um, they’re often receiving dialysis. So you are in a, uh, the organ that they’re looking to transplant, generally you have to be in a pretty bad way in order to, um, [00:05:30] to, to get on and to use the CI definition as I understand it anyway. You do have to be on your official, uh, waiting list, UK waiting list. Kathryn, is that, is that, is that part of the definition still, um, in the marketplace?

Kathryn:           I’ll be honest and say that the top of my head, I am not completely sure.

Matt:                No, no, no. Sorry, I

Kathryn:           No, that’s fine. It’s, it’s good to show that, I dunno absolutely everything off the top of my head, head, but you knows

Matt:                Nor [00:06:00] definitions recommended by them there involved in so critical over the years talk that necessarily taking, taking it out, but broadening the uk li but I could, I could well be wrong. He,

Kathryn:           My, I could be wrong as well, but I, my instinct is that it does, that does need to be an official aspect to, to the need.

Matt:                No, no, I would agree. Has to be, I completely agree. Cause that’s [00:06:30] too much of a safeguard. If you took official whatever that’s supposed to mean of course out of it, I think that’s safeguard to be taken away and you get all types of, uh, uh, organ tracking going on, et cetera, et cetera. So, so as I was trying to, well as I was saying, what we have here is that people are put on, um, transplant lists who are uh, who are, can be very grave ill and of course, um, capital, I dunno if you have any statistics, but, um, there are a lot of people dying, uh, on waiting lists [00:07:00] in the UK because they can’t get a transplant. Um, I think, I’m trying to look in my notes here.

Kathryn:           I mean, I don’t have statistics, but I think probably giving some people some examples. So, you know, as an example, you know, very clearly, you know, um, people who need a heart transplants or potentially a lung transplant, I believe that there are certain conditions that would be cystic fibrosis where potentially people would be looking for lung transplants and absolutely we are talking, and again, with the heart transplants, when something’s happening with the hearts, that there’s [00:07:30] so many interventions that can be done with the heart in terms of medications, in terms of surgeries and things like that, that if we are at a point where there’s a transplant, then it does mean that, Cause it’s not a small undertaking having an organ transplants, it’s, it’s absolutely exhaust. It’s a pretty hef thing on the body and it is really a last resort type thing. I think a lot of information that we generally tend to hear about is things like kidney transplants and we would usually see that people would be more end stage kidney failure. I believe they were gonna be getting something back. [00:08:00] So then there’s, there’s quite a few stages of the kidney not being well before we would get to that point.

Matt:                Absolutely, Yeah. Yeah, I could, I’ve just, um, seen one note now. It’s, um, I think you’ve already mentioned that, uh, the waiting lists in the uk did you, you mentioned a number I believe Yes. Um, certainly kidney is the highest secondary to, uh, sorry, uh, head of liver and waiting list by age is, is is pretty much dominated by the 50 to 65 [00:08:30] year old category age. Yeah. And it’s flanked by the kind of the, the, the 10 year periods. So 40, 35 to 50 and 65 and above transplants in the younger age is particularly very young, is quite rare in terms of being put on a waiting list of course is what I’m saying here. Um, but the, um, am I going on too much Kathryn or you?

Kathryn:           No, no,

Matt:                You, um, is continue.

Kathryn:           [00:09:00] Yeah, no, I think it’s really interesting to say, you know, when I originally looked, and I think it’s interesting to say that the way that we can look at statistics, can you never really know exactly what you’re looking at. Say I went on to sort of some really official sites and there was so many numbers flying about everywhere and it was very confusing. And then some of them are saying, well, this is just for this month or this is for this year. And there was things, you know, moving around and, and obviously as well we have all the knock on effective, um, delays due to covid. Absolutely. So I think that would’ve affected things quite a bit because unfortunately quite a lot of people will have passed [00:09:30] while they were needing it. And then a lot of people are now, the weightiness is probably building up even more because we don’t have the, the well there are these, all these backlogs, but say that there’s over a hundred thousand people waiting that’s really hits home that there’s a lot of people who need this and if there’s a hundred thousand wait, there’s obviously been quite a few that all have probably had this as well.

Kathryn:           Um, and it’s important to be aware of it.

Matt:                Yeah, I mean 40,000 transplants performing in 2021. Yeah, that’s a, that’s [00:10:00] is it A lot of people obviously not as many as we would want, let me put it that way. But it’s, it’s a, it’s a lot of people and therefore it’s, and because of the advances in medicine, which again is something that is absolutely fantastic. Um, fantastic advance then more, we are going to see more and more people who’ve had transplants and who play definition require life cover. Yeah. Sorry, let me say protection cover, not just life cover, protection cover. Yes. Um, [00:10:30] in terms of, uh, just kind of carrying on if I may. Yeah, the, um, sadly the, the, the least productive is not the right word. The the, but um, liver transplants, um, are still really in their infancy in terms of, uh, absolute success or a liver transplant would generally, and please take statistically in general and average and exact, we have to be very careful with these words, but it only adds, [00:11:00] I say only it’s probably very, very important to people, but it adds 1.5 years on average to the donor, Sorry, the don sorry person receiving the liver transplant, which

Kathryn:           A lot doesn’t it for if from an advice point of view, somebody’s coming to us and wanting support and wanting to get cover and they’ve had a liver transplant because someone who is needing that we know straight away would need to go down incredibly specialist route. Yes. Someone who’s had the donation, [00:11:30] um, and is recovering that really stands out that 1.5 years extra and as a statistical average as to why we might find insurers are quite cautious about offering the cover.

Matt:                No, absolutely, absolutely. And of course we’re about people who had, um, received, uh, um, a lobe of liver. So it is often the way rather than a whole liver, um, people [00:12:00] who are actually, the one thing I didn’t look at was actually people, whether this is always a cadaver, I can only assume, but certainly a cadaver or a or somebody who’s I’m afraid sadly died Yes. This transplant would actually happen. I can only assume that, um, although of course people can have sections of liver removed and live quite happily.

Kathryn:           Yes.

Matt:                So, um, you know, you’ll, you’ll see that with, with the more fortunate cancer patients, [00:12:30] for instance, who have had spread into the liver, that that part of the liver is cut out and, and they still live a very good wholesome life. Liver is a f absolutely fantastic organ without any shadow, a doubt. Um, the most difficult procedures, um, are the lungs.

Kathryn:           Okay. We’re

Matt:                Looking at statistics and really, and really there that’s, that’s because, um, again, it’s no surprise that the, the uh, individual who is being [00:13:00] operated on to give up their lungs, uh, would’ve passed away. And, um, they tend to be elderly. They tend to be, again, this dreaded average figure, um, tend to be elderly. And one of the key reasons because, uh, to make this thing most difficult is that a lot of the elderly, older older rather than elderly people have had lung infections themselves.

Kathryn:           Yes.

Matt:                So you have to be careful there. Um, [00:13:30] also, um, I think they’re pretty dumb difficult to remove from the body. So actually dam damage during the process of removal

Kathryn:           Yeah.

Matt:                Um, is now, I I turn this in aed way more difficult than the others. For instance,

Kathryn:           I would say I kind of feel like the lungs would be, have a lot more things kind of subtly attached to it, whereas you’re the ones I kind feel are just kind of floating and doing the thing.

Matt:                Yeah, no, I, [00:14:00] I completely agree. I could, I could not that I particularly want to see lungs being removed on the television, but um, I can absolutely pick,

Kathryn:           There’ll be somewhere, Matt, there’ll be a, somewhere that there’ll be, there’s,

Matt:                Oh,

Kathryn:           Excuse

Matt:                Me,

Kathryn:           Sorry. I was just thinking if we can maybe, sorry if we focus on the, maybe like the kidney side of things, if that’s all right. Yes. I think a lot of those, as advisor I know from my experience as an advisor, generally it tends to be more the kidney side that we hear about and people [00:14:30] coming

Matt:                Cause it’s the most common.

Kathryn:           Yeah. And I was just wondering if you could sort of explain what would be going on. So what would we be needing to know to be able to get a good indication from you as to what um, terms might be available?

Matt:                Okay. I mean the broad categories that, um, underwriters look at, first of all, all at at high level and then kind of they delve into the detail if you want, is, um, whether the, [00:15:00] um, was alive.

Kathryn:           Yeah.

Matt:                Whether, um, the was a close relative. Um, interestingly when I was about a young man, which was a long time ago, um, there was a a quite a, um, a focus on, uh, identical twin transplants.

Kathryn:           Okay.

Matt:                Um, because the, the rejection side is much less with identical twins cause of the genetic makeup

Kathryn:           [00:15:30] Okay.

Matt:                Of them. And, um, with, with rejection, what effectively happens is that the, the, the body of the person receiving the transplant, um, the, the antigens, uh, within the body, um, if, if a new transplant or new organ is actually put into the body, then sometimes, um, it’ll try and attack it cause they think it’s, um, um, alien if you want. So the closer the genetic [00:16:00] match between the individuals, um, the, the less chance of that happening.

Kathryn:           Okay. And

Matt:                That’s kind of a very high level what happens with, with, um, what can happen with rejection. Yeah. So the closer the genetic match, the, the better outcome is, is shown, hence why that’s important to an underwriter. Yeah. In that in background terms.

Kathryn:           I was gonna say everything, just to to quickly just go back so I can just explain a term that advisors might hear as well from an underwriter, um, [00:16:30] is if it’s somebody that you said if, if the donor had been alive or not. So you, you often get asked was it a living donor or a cadaver? Yeah. Um, I always think cadaver sounds quite

Matt:                Yeah.

Kathryn:           Impersonal in a sense. Um, but I I think that’s, it’s just a, a term that is generally used. Um,

Matt:                It’s a medical term really. It is, yeah. It’s very widely used in medicine. Yeah.

Kathryn:           Yeah, absolutely. So, and, and yes, the underwriters will need to know that it’s one of the key things that for myself I will be asking somebody is, is whether or not that had been the [00:17:00] case. Cuz you said this’s a genetic match, um, and it’s probably more likely to be a genetic match is gonna, it’s obviously going to hopefully be accepted better by the body and most more likely if it has been, um, a living donor. Cause the, the chances of somebody passing at the same time who’s a family relative who’s a genetic match for somebody who just saw to be on the waiting list is probably quite, quite rare

Matt:                Indeed. Yeah. I mean, you know, as I say, you do see quite a few cases in the, in the news and in the media around, um, brothers and sisters and parents [00:17:30] donating kidneys, don’t you? Oh, absolutely. So, um, so

Kathryn:           Do you end up with three then, don’t you? I believe that don’t take one out, do they usually?

Matt:                Um, I think it rather depends, but yes, you can.

Kathryn:           Yeah.

Matt:                I don’t think it’s always, but yes, that certainly can.

Matt:                Um, I think, oh yeah, I could get all technical, but I won’t there <laugh>, excuse me, sorry. Full of cold. Um, keep on cough. I do apologize [00:18:00] to everybody. Um, okay. So as I say, very, very high level, um, you have got the, the living donor, um, whether it’s, uh, a member of Joe Public, if I can use that expression and uh, excuse me if I said what you by saying that, um, that’s the kind of category, a category or a category one, Category two would be a living close relative. Yeah. And then three then would be the dreaded [00:18:30] the, the, to use the horrible term cadaver, Yes. No law. Um, okay. Now in terms of success, I think we’ve probably saluted to their, in terms of, um, positive outcomes then Yeah. The, the, the close relative is best. Um, more often or not the, um, living re sorry, the living person donor, but not, not genetically matched in any way is second. And then, um, [00:19:00] the, the, the cadaver is generally third that said that the cadaver thing, so the cadaver event is, has been improving rapidly by medicine, being able to, um, keep the organ from that dead person transfused with blood and warm and functioning and not deteriorating in any way while it’s, uh, awaiting transplant. So again, that’s part of this overall positive message that, um, is going on in medicines [00:19:30] we regard all these access of organ transplants.

Speaker 4:        Yep.

Matt:                And can, can we just, um, I know I talk a lot Kathryn, and you know that as well as I do, but, um, I would just like to add here that we’ve focus, I think a lot on the person receiving an organ transplant. Just let everybody know, and I hope this, um, um, matches your experience in the marketplace. Yeah. But, uh, if somebody [00:20:00] has donated a kidney Yeah. And, um, has succeeded to have absolutely no problems for a period of time, which I believe is very short, um, as in months, um, for life insurance, they would be completely standard rates. Yes. That’s so I think yes, that’s, I think that’s quite important. Just to, just to note, so if you’ve given up a kidney, you’ve got over [00:20:30] the, the kind of the postoperative, uh, period, um, which happens with every surgery I might have, not just, um, then you’ll get standard rates. I think one of the, of the key issues there is that somebody actually is good health in the first place.

Kathryn:           So

Matt:                It has, but that kinda follows really

Kathryn:           Did you as well in terms of sort of the, the people who are, sorry, what you were saying about surgery then as well. I think that can [00:21:00] sometimes be quite a misconception for a lot of people. If you are, you know, if someone is due to have surgery, it’s very unlikely that an insurer is going to be offering cover until that surgery has happened and until, um, they are recovered from it. You know, it’s, it, it’s more sort of like on the side of assuming that obviously we always have to double check, always double check, you know, never assume, but probably in the back of your mind as an advisor think, right, the surgery coming, the likelihood of me getting this, the standard market [00:21:30] is probably not really going to happen. I still have to double check though and do everything right by the clients, but it might be that we needing to look at more specialist route.

Matt:                Yeah, it’s, it’s, it’s, it’s, it’s a really interesting, i I I would genuinely believe that, um, that is exactly what would happen if you went, if you were gonna have a donating a kidney in the next month or so, you would be postponed until a period, a short period after the operation. But I, I was looking at death rates as, [00:22:00] as I do as an underwriter, a lovely job. And, um, seeing the, the death rate for kidney donation is, is one in every 3000.

Kathryn:           Oh, right.

Matt:                So that’s fractional if you convert that back into, um, a loading, cash loading either per, uh, or or a percent mortality, which I know we’re talk about little bit later, um, it’s quite, so if mortality rates are seven, another statistic, seven die [00:22:30] for every 100,000 living donor surgeries.

Kathryn:           Right.

Matt:                It’s tiny. Yeah. And yet no doubt the insurers would still do exactly what you said. Um, I think they, they, well, I, I can kind of understand maybe, or have a degree of understanding of why they wouldn’t, but, uh, then again, that’s not for say necessarily, but the, the statistics of people dying who are giving up um, a kidney are tiny. Yes, absolutely tiny. [00:23:00] That’s the kind of thing I wanted to say. In fact, I think it was another brilliant statistic, um, from America, which kind of hits home here. You 80, it’s 80 times, 88 0 times more risky to be born in the, in the USA than to donate kidney.

Kathryn:           I mean, that is quite scary,

Matt:                Isn’t it? Isn’t that amazing statistic? It’s

Kathryn:           Amazing. Most

Matt:                Statistics,

Kathryn:           It’s amazing for us, it’s scary for people in America. I mean,

Matt:                Sorry, I shouldn’t laugh. Um,

Kathryn:           No, but I, [00:23:30] it is, it’s just how could that even, it’s just unfathomable that

Matt:                What do you mean in the context of, uh, mortal infant mortality rate? I presume you’re talking about that.

Kathryn:           Yeah, I just, yeah, I just, yeah,

Matt:                Yeah. Like it’s, it’s statistic I found and again, women statistics, statistics, statistics. But that one kind of made me think, right. I’m gonna have to mention that because, uh, the last thing we ever want to do with life insurance is stop somebody actually doing a kidney because they’re worried about, um, dying or, or any other issue that’s called kind of really [00:24:00] why, just wants to spend a couple of minutes on, on this, uh, on some of the statistics that come out to that particular area.

Kathryn:           Absolutely. So I think if we sort of got, cause we’ve been talking about the surgery and stuff like that. So just a quick one down from an advice point of view, for an advice point of view, if I was speaking to somebody that came to me and they tell me that they’ve had something like a kidney donation, then I would be saying to them quite a lot of the time, my, my usual thing is when and why, you know, we’re gonna need to know when that donation happened, but also the why, what was causing it. It’s very likely that there was [00:24:30] some, you know, end stage kidney failure. Um, but we need to know and establish that as as well. And an important thing sometimes to be aware of, and I have said this before, is that if somebody has had private medical insurance, they might get some things.

Kathryn:           I think, I think transplants are included in this. Madison has, tell me if I’m wrong. Um, but I think they sometimes can get treatment sooner than people on the nhs, which can mean that people who’ve had treatment through the NHS might have been a much worse health than somebody [00:25:00] who’s been treated privately. Um, we would be looking for whether or not the donation was from a living relative or a cadaver. You’d be looking for the signs of rejection. I know you mentioned that before Matt, any kind of ongoing medications and then also things that are known as the GFR reading, which is the, uh, is Gulf fox drop Rome you’re eating and the creatinine levels. So I dunno if you could just maybe have a quick chat about those GFR and creatinine levels. Forma please.

Matt:                Yeah, sure. Absolutely. Um, both of these, um, [00:25:30] related to the kidney, the function of the kidney, there no real, no real surprises there in terms of the gfr. So the fil rate and gra these tiny little, um, vessels, if I call that in the, uh, within the kidney that actually filter all the waste products, um, um, from the blood and then back into, uh, excuse me, urine in particular. Now [00:26:00] gfr, is it renal? In other words, kidney specialists certainly think that the, the GFR all grow filtration rate is the best indicator of kidney function. Now I’ve heard that disputed by eminent, um, nephrologist. Um, and, but however that, that is the standard, that’s what the textbook says is my understanding. Now, infiltration rate, as I say, it’s, it’s the rate at which the kidneys, [00:26:30] um, uh, pass, uh, toxins from the body. So you can well imagine that if the reading is low, then the, uh, kidneys, the doctors will look at the kidneys and think maybe we need to investigate this further.

Matt:                But it could well be a sign the kidneys are not functioning as they should. Yeah. Um, you would generally look at, uh, a reading of [00:27:00] below 60, which may mean kidney disease, but look, the may here please and below 15 may mean kidney failure. Very high level. I say very high, a high level, um, because the actual reading is dependent on age here. Um, and a number of other things in, in including the height weighting gender, ethnicity even, um, doesn’t, it’s generally okay, [00:27:30] but again, that doesn’t necessarily mean if it’s pretty high, doctor will look at it.

Kathryn:           Um, That’s interesting. Matt, Sorry, I was just gonna jump in there. We actually Yeah, sure. Reminded me that we had, um, somebody once that we were supporting to get insurance and they’ve had to have a medical just cause the amount of insurance it was, and I’m sure it was the kidney that the readings came back outside slightly, slightly outside of what was considered the norm in

Matt:                The Okay. Up or down. Um,

Kathryn:           I can’t remember <laugh>. Okay. [00:28:00] I just remember it was the silent. But, um, what we established and th this random series events as to how we establish how we, we learned about this. But this person, cause obviously we don’t generally see people in person, um, but we, we, we were able to establish that this person, uh, was from uh, African heritage. Yeah. And it meant, and what that can mean is that for people in the black community, their kidney readings can be slightly different to [00:28:30] what we class as, I don’t wanna say normal in the UK cause I don’t want it to ever be took in the wrong context. We’re saying that, what I’m saying is that predominantly white background, normal Caucasian or what’s seen as Caucasian, what is seen as what has been seen as standard in the UK has been predominant if a white background.

Kathryn:           And so those figures have been set upon generally what the, the Caucasian community would show in terms of kidney function and what we were able to do at that point. Um, when we did find out and we, we did obviously talk about it [00:29:00] and, and the fact that this person, um, was of African heritage, um, we were then able to challenge and actually bring forward from our own research how people from the black community do have as standard generally slightly different readings to the kidney function than what um, Caucasian people do. Absolutely. And we were able to get certain decisions overturned in a positive way in terms of the underwriting because we were able to bring that. So it’s always important as well to sort of, I, I wouldn’t sort of advocate [00:29:30] if you’ve got somebody you know straight away who’s getting maybe terms that you don’t like to, to be on the phone to them and just say, Can I just check your ethnicity please? And things like that. You could start going to a, a bit of a background that could be a little bit, um, in intense and not necessarily going down the positive way, but it’s important to be aware of quirks like that as well.

Matt:                Now ab absolutely, I think this is one of the, um, areas, um, where it’s important for the underwriter, but also the, the people like [00:30:00] your good sales and your team who gather information, uh, upfront is reading is fine. Sorry, a, a number is fine, but I, from memory, um, a when somebody, when you have a laboratory test, uh, sheet, in other words all the results on it, okay, the gfr, if it’s being done, will actually caveat it by saying, this is this, you know, uh, ethnicity could [00:30:30] well be throwing, could, could throw this out. So it needs to be taken into account.

Kathryn:           Oh, that’s good that they did that. So, so it would’ve said that on the report and we just have to do lots of extra research and

Matt:                Well, no, no, no, that’s right. I mean it’s just one of those things about taking a number and thinking which exactly is what you are talking about. I believe you know what it is cause you looked at the ethnicity and of course it was absolutely the right thing to do. Yeah. Um, there’s no two ways about it. Um, lots of things can, I mean, I would also say here that GFR association [00:31:00] rate is tested in the 24 hour urine sample. So it’s, it’s taken over 24 hours, which is important because people are gonna produce, um, the kidneys are gonna, um, excrete toxins at different levels during the day. Yes. Okay. So 24 hours is, is therefore pretty important. Um, but yeah, as I say, you, you’ve got a variety of reasons why creat, um, that GFR rather could be a, um, [00:31:30] I say abnormal, but also just, just note as well that um, for instance, um, as you, as you get older, you the rate of of, um, calera filtration absolute drops, but this is actually normal.

Kathryn:           Yes.

Matt:                So 2029 a normal rate would be 116, 40 to 49, it’s only nine. I say only it’s 99. But remember those two figures I gave you early, which was 60 [00:32:00] and 15, those your, um, red flags or an orange flag And a red flag. Yeah. In terms of, um, creatine levels, again, this is very much, um, a function or, or shows, uh, how the kidneys are functioning I should say. And, um, technically creatine is a, is a chemical waste product of something called creatine team and, uh, creatine’s a chemical, um, that’s produced by the body and is used to, [00:32:30] uh, supply energy mainly to the muscles. And as I said, it’s, it’s the creatinine levels, it will show, uh, or given an indication of how those kidneys are functioning. I’ve, I’ve, you know, the, the, the classic here, I would say that in um, given them been around for a few years to say the least, um, I’ve often seen high creatine levels, um, in people, high performance athletes.

Kathryn:           Yes.

Matt:                Because creatinine noting [00:33:00] what I was just said before was used to supply energy mainly to the muscles, right? So high performance athletes could have at certain times of the day a higher level of creatinine than the man or woman in the street. So again, it’s, you know, these things need to be taken into account, certainly be taken into account by the doctors, the medics, um, and also should just be thought of by the, uh, by the underwriters as well. You’re absolute classic on creatinine is your body builder.

Kathryn:           Yes.

Matt:                Um, [00:33:30] they are, they are using muscle so much, um, that in fact their kidneys can be impacted.

Kathryn:           Isn’t there some kind of, because Alan’s, obviously Alan’s not a body builder, um, but Alan’s really much into his exercise and he takes different things. I think there’s some kind of, you can actually take creat some, is it? Yes. You can take experiments of it, can’t you?

Matt:                You can, yeah. Yep. It’s a body, certainly a bodybuilding supplement. Yeah. Um, and I’m sure, um, you know, people who are um, you know, [00:34:00] doing a lot of exercise, et cetera, et cetera, can take creatinine as well. So again, it, if you’re gonna take cine, what a surprise, your creatinine levels are probably gonna be high.

Kathryn:           Yeah.

Matt:                So therefore that needs to be taken into account when you’re um, uh, looking at this from an underwriting perspective. And, and more importantly from a, from a medical perspective, the doctor, how are you going to treat this person? Is it, is it an orange flag or is it something really that’s down to their, um, lifestyle, [00:34:30] the positive lifestyle in this particular case? So does that give you a heads on creatine and geo and there Yeah. Filtration rates. Is that okay?

Kathryn:           Yeah, no, I think that’s really useful. Thank you. So, and so I’m sorry we’ve done all that. We’ve got our research and we’ve spoken to obviously an underwriter and we are wondering what’s gonna be available. So I think the next stage is, so I always said that probably people would need to be maybe recovered from the [00:35:00] surgery for them if they’ve received a donation. Um, so I was wondering kind of how long would you say on average, I know this will change per organ, but what kind of like postpone periods should people be generally thinking about? So what kind of terms are we gonna be expecting? Um, after, after sort like the postpone period is over.

Matt:                Yeah. Okay. If I, if I can go back to kidneys, if I may. Um, as I of transplants in the UK kidney, then again [00:35:30] the underwriting terms, um, are split between relative living, um, member of, of the public living and cadaver. So you, so you know, differentiate between those three, excuse me again, in terms of close relative, the post period, um, at least from one of the major uh, manuals out there in the UK is is three years.

Kathryn:           Right?

Matt:                Okay. [00:36:00] That’s close relative cadaver, um, ISP five years. So that’s harsh in um, what terms are uh, out there in the market when you compare it with other medical disorders. If you think some of the worst cancers have postpone five years, then you can kind of see how serious, how serious this, uh, this [00:36:30] organ transplantation is.

Kathryn:           I think it’s key as well for just quickly pop sorry that No, no, um, I was gonna say the um, that that’s the standard personal market. Yes. So there are specialist route sometimes and I will talk about a case where I was trying to help somebody down a specialist route and what we were potentially seeing, um, and at later on. Um, but the specialist routes and there’s also, it’s very different if people are, um, covered by the insurances that have offered [00:37:00] through their employer. It can be a very different situation at that point. Um, so if anybody who is listening, you know, don’t, please don’t assume that it’s an absolute no. There are usually options for most people. It just means that there’d need to be some very specific choices, at least in those first three years.

Matt:                Indeed. No ab absolutely, absolutely. Um, in terms of, uh, the kind of the, the next step down if you like in terms of the um, the detail [00:37:30] of the underwriting loading, I’ll just take one. Um, cause it does vary, um, between the three categories that we’ve mentioned. Um, so if you’re living, living donor, sorry if you were Yes, don’t eat, don eat. I got this right. The person who’s receiving the transplant, let me get, let me, let me just speak Don change. Um,

Kathryn:           They are the don. I know it’s,

Matt:                Yeah, [00:38:00] you dunno. Anyway, sorry about that guys. Um, under the, under the age of 40, under the age of 45, at the time of the uh, transplant you would attract loading a seven pounds per meal. Just to remind people who maybe not listen to some of the uh, previous podcasts. That is seven pounds per 1000 pounds worth of some assured per annum.

Kathryn:           [00:38:30] So yeah, I

Matt:                Did you want Yeah, add anything more that

Kathryn:           I just add such like a little bit of an explanation um, to that if that’s okay. So the re what we’re saying with that is that, so it’s seven pounds. So what’s what you might also hear that is cash extra. Yes. Um, per 1000 pound that’s taking out, So what that would mean is for, say someone who’s taking out a hundred thousand pounds worth of cover, they would have this 100 extra seven pounds added on and it’s all done technically in the background. [00:39:00] Um, so that would be what someone would have. But say if someone were to take 200,000 pounds worth of life insurance, they would have 200 of those extra seven pounds. So in a lot of instances that can mean that it’s becomes a pricier option than some of the other ways that insurers might change the premiums depending upon someone’s health or occupation or different aspects.

Kathryn:           So what you would always ideally want if you were gonna have this per mill or cash extra was to find somewhere that has the [00:39:30] lowest number possible. And what you might also find sometimes as well, and it’s this comes down as quite a bit of times to advise the knowledge and what we can maybe do and debate sometimes with what’s on offer with the insurers is that it might be that somebody, as you say Matt might have seven per mill, um, but it might be for a certain period of time. So there might say it’s gonna be seven per mill for the first three years of the policy. After that the policy premiums will reduce to this amount and they’ll take off that. But that [00:40:00] increases. So sorry Matt, I just, I’d come in with the next bit of number

Speaker 5:        Probably help

Matt:                Mean you are far more used to explaining um, seven cash extras sevens and what they actually mean

Kathryn:           To do the calculations though it’s,

Speaker 5:        I definitely don’t wanna do that <laugh>,

Matt:                Funnily enough, I’m probably more used to that. But how we said

Speaker 5:        <laugh>, I was gonna say I’m happy. Explain it. Not doing,

Matt:                It’s not, what I would say there is a bit of a surprise particularly for, for the advisors out there is that um, [00:40:30] I believe I have seen this change a little bit, but just be aware that that figure doesn’t include commission seven per mill is assuming that no commission is paid on that part of the premium. If commission is to be paid that seven per mill is grossed up to take it count of the commission. So you can get some quite odd looking figures coming back from insurers. Now I have [00:41:00] seen recently, I’m pretty sure of it, some insurers actually, uh, coming back with loaded premiums, cash extras that actually do take into come out, uh, into account the commission loading. But just be aware of that, that seven per mill won’t necessarily, well it won’t full stop unless the unless the advisor is taking no commission won’t translate into seven pounds per thousand pound per

Kathryn:           Yes.

Matt:                It actually be more

Kathryn:           And it’s, it [00:41:30] can be very strange as well because there’s as well there’s a couple of insurers. So when we, when we’re talking about these extras, um, they’re usually to do with the annual premium. So there’s a certain, the way that it’s figured out is that the increase is done over an annual period and then it’s kind of divided by 12. So then get the monthly amount. There are however, a couple of insurers who will tell you a per mill figure that you think that sounds a lot better than everyone else. Yeah. But then it actually ends up being on [00:42:00] the monthly premium so it can end up being an equivalent just as high as the others. So don’t don’t be caught out if one of them seeming if, I always think as well though, if one insurer, if you, if you are speaking to eight insurers and one or two of them are looking amazing Yeah. Price wise in terms wise compared to others, double check, you’ve definitely understood what they’ve said. Yeah. Then also may be potentially on what you’re doing with or not you have dedicated underwriters or if you’re just speaking to gen generally reaching [00:42:30] out and speaking to underwriters and it’s more Marvin unusual situation, uh, maybe just ask your account manager at the um, insurer just to double check that it has actually been looked at and um, and the, the risk has been properly assessed before you’ve been given that indication.

Matt:                Yeah. Wholeheartedly. Um, when I, when I was in corporate world, um, but issue, um, if you took a a percentage of cases where cash extras were provided to an [00:43:00] advisor, that issue probably caused the most complaints of the, that particular type of rating. It’s

Kathryn:           Not, I have to say insurers on US insurer. So listen, think you really don’t make it easy for advisors. I was gonna say, none of us. Yeah. What we do understand it, we can calculate it, but the fact that they don’t all do the exact same way of do, cause even if it is an insurer, whether it does it annually instead of the monthly, quite a few of them still do their own way of calculating it anyway. So it’s it’s not on impossible. No,

Matt:                I I I I agree and [00:43:30] of course it’s just alluded, excuse me, alluded to it there Kathryn, but it’s not sure I’ll do it one way and another will do it another it is and another will do it a completely different way again.

Kathryn:           Yeah. It’s,

Matt:                It’s, it’s certainly doesn’t need to in ofs

Kathryn:           We usually turn around and we will a cure usually turn around. We, we do have some ways of calculating it to a, a general approximation Yeah. For each insurer. [00:44:00] But a lot of the time and, and you know, I often find that underwriters incredibly helpful if you say to them, what does that actually mean? If the base premium’s this, they will often give you that information and help you out with it, which is really, really nice.

Matt:                Good. I’m glad to hear that.

Kathryn:           Absolutely. Um, so what are

Matt:                We, Sorry. Yes, go on. We just, uh, just, just to delve a little bit further down to kind of complicate matters even further, um, what we have here. So we were on the living close relative set of loadings [00:44:30] under 45 7 per this particular underwriting, again, it’s a major underwriting manual suggests, um, between 45 and 60 rating plus 400.

Kathryn:           Right.

Matt:                So it’s changed from per mill to a percentage loading. Yeah. And then 60 over 60 plus uh, plus two 50.

Kathryn:           Yeah.

Matt:                So you know, again it’s, it’s um, not necessarily the easiest thing to understand for advisors how the rate, the rating is actually being applied, [00:45:00] but just, just please be aware that that’s what I would really say. And as Kathryn is quite rightly said, um, you know, the cheapest often aren’t. So it’s, it’s a matter of trying to get a a a, a commonality in your own calculations about from what insurer is offering what.

Kathryn:           Yeah, absolutely.

Matt:                Is that okay Kathryn, on that particular point?

Kathryn:           No, that’s absolutely brilliant. So I was gonna say we’re coming so towards the end of the podcast, so I’ve got some cases I just wanted to quickly check with you, what are you expecting in terms [00:45:30] of differences potentially between what an insurer will offer again if we use kidney transplant is sort at the key one. So for life insurance we’re gonna be expecting that postpone for a bit and then some per mills for critical illness cover. Are we gonna be able to get that? Are we gonna be able to get income protection

Matt:                On somebody who’s received a transplant? I don’t believe you will. No.

Kathryn:           On the personal side,

Matt:                On the per absolutely. You’re absolutely right. Purely on the personal [00:46:00] protection side yet, as you quite, quite rightly, I presume you’re gonna allude to again, is that there are other avenues that can be looked at.

Kathryn:           Yes, there are always specialist options and there are, um, group options as well. So in the specialist options people tend to get options that could have, um, a uh, an exclusion for preexisting conditions. So even though somebody’s maybe had a transplant from a long time ago, they’ll still probably have some kind of monitoring some kind [00:46:30] of medication, which mean that there would still be exclusions for anything linked to the kidney transplants. Sometimes obviously I think it’s a bit, it’s a bit hit and miss as to what people feel about that and it’s also be a bit hit and misses how you feel about it as an advisor. And it’s as with anything, it’s to each their own in some ways and well obviously to each their own within the realms of what your compliance people will allow you to do. Um, but you get some people who when they’re looking at the specialist policies, especially at the specialist critical illness contracts, [00:47:00] they’re very happy to just think, you know what, I’m actually just having this as more of like cancer cover. Now it’s, it’s certainly more than cancer cover, but that cancer is the thing that people are very scared about. So if you can give them an option that covers that, I mean then turning around and saying you can have the can potentially, as long as the cancer isn’t linked to the kidney transplant, which I don’t think it will do math, but I, that could be a lack of my medical knowledge. Um,

Matt:                So it, it’s not unheard of but um, it’s rare. It’s very rare.

Kathryn:           So it would be a case of saying to them, right, where you [00:47:30] certainly can’t claim on major organ transplants, you know, because you’ve already had that and you know, it depends on, there’s an, if there’s another one that starts to not be okay, if that’s potentially linked to what’s going on with the kidney and the medications, then that won’t pay out. If he develops certain cancers that might not pay out it, it gets a little bit tricky, a bit messy ideal world situation. Um, we would be looking more towards the group side of things, but again, they would also come with a certain degree of, [00:48:00] um, exclusions for preexisting conditions. Um, ideally in that kind of an instance you’d be looking more towards the, um, the income protection side in the group space. So for anybody who isn’t familiar group is, um, is anything from life, uh, critical discover income protection that’s arranged by a company for its employees and it will come with a certain amount of free medical underwriting.

Kathryn:           So that would mean up to a certain amount of, some assured that person’s, uh, medical history does not come into [00:48:30] play when it comes to them being able to have eligible for the color or the pricing for the cover. Either it’s a, it’s a little known beauty is group insurance. Um, I also, so I did say I was gonna chat about some case studies, so I’ve got a couple of case studies that span a few different areas. I’ll try and be as quick as I can. So the first one, um, was, um, a wonderful, um, woman that I spoke to. She was in her mid twenties now when she was in her early teens just starting to very early teens, [00:49:00] she needed a heart transplant. Now this was a very emotional situation for, for, for her herself and for me when I was speaking to her because on the standard market at the moment, there is no possibility of getting her a personal life insurance critical and discover income protection and the, the feedback that I had from all the underwriters was this is just not going to be able to happen ever.

Kathryn:           Now I never say ev forever because [00:49:30] things change we did and that was really, really difficult, but it didn’t mean that we couldn’t have options. So that beautiful thing I was just mentioning there, the group, she wasn’t in a position where she worked for a company where they offered something like that, but it was saying to her, well at some point if you ever do change jobs, if you are looking to change jobs, maybe there’s a job where there’s a company that does offer all these brilliant benefits and you might actually get insured. I didn’t want to leave her with, you know, obviously I didn’t want to say to her [00:50:00] specifically target her company to get on their insurances, but I didn’t want to leave her this mid twenties woman who has a family who has a mortgage just feeling like she just couldn’t ever get the insurance that she needed and she wanted.

Kathryn:           Um, so it’s saying to her like, you know, these are options. They’re also specialist options as well. Now to give you an idea of one of the specialist options, because I could do, uh, a very specialist option for her and it would’ve been a personal life insurance policy and I can’t [00:50:30] re I can’t remember the exactly the summer should I think we kind of just to test out the figures, I think we’re about a hundred thousand pounds and the way that insurer works, it’s maximum 10 years and the premium was about 450 pounds per month for her, which is just not affordable for people. Um, it’s just not within the realms of what the majority of people would be able to, to sort like t Italian in their mind is going, this is actually, yes, I should do that. It almost comes to a stage of well [00:51:00] how long would you need to save that form in a bank account?

Kathryn:           I can’t obviously go into that realm, but please don’t assume that I’m saying that. I certainly did not say that to her. That would be beyond outside of my permissions. But you know, you do get to a stage sometimes with the pricing where you do think this is getting a bit, this is getting a bit silly and there needs to be some real thoughts taken there. Um, so that’s just an example that I wanted to give about as, as an example about the heart transplant side of things. Some, so my research that I did uh, not too long ago, um, [00:51:30] was that it just would never be available. Um, which I understand, but I also, it’s hard, it’s really, really hard to, to accept that at the same point when you speaking to someone the needs something. But I suppose that’s, um, that comes down to the difference between sort of that um, that ability to make rules.

Kathryn:           Like obviously I’m a compliance person and sometimes I’ll make rules and it’s just a case of sort of I’m gonna make this rule but I’m not gonna look at the faces of any of my team because, so they’re [00:52:00] all gonna be very annoyed at me and upset cause I’ve brought in a new rule. And I suppose that can sometimes be kind of the distinction that we can have between underwriters and reinsure as an everybody else can first versus advisors. And obviously we are very frontline, we’re seeing people talking to them and generally a lot of underwriters and people who make these decisions. It’s, it’s, as with anything, it’s on statistics. That’s how the business works and it’s just, it can be quite difficult. But anyway, um, I’m gonna move on to some other options that I can explain as well. And one of them is to do with a kidney transplant and one of them is a [00:52:30] little bit different just cause I thought why not bring something a little bit different to him?

Kathryn:           So for the first month we were arranging life insurance, it was for mail and he was in his early fifties and he had a kidney transplant one year before the insurance started. So this is just one year before. Um, and um, just when I said the pricing, bear in mind for anybody who’s listening that it is very, very, as Matt has said, he would be expecting postpone for at least three years. So, and well five years cause this was also from a cadaver. [00:53:00] Um, but we’re able to, to do what we needed to do and get the insurance in place. So, um, can you transplant one year before the insurance started? The underlying cars had been nephritis that have been initially diagnosed 15 years prior to our conversations. Now with this one, this is kind of as phone too. Earlier, this person’s had a preemptive transplant from a cadaver.

Kathryn:           There’d been no rejections. We were only a year ahead, but no rejections and those important things that I would always want to know as an advisor. Before to my research, the GFR and creatinine [00:53:30] levels were all good. There was the medications following this and preventative, uh, medications for blood pressure too. So for this person, uh, it was 150,000 pounds over 19 years. The monthly premiums 140 pounds per month. Uh, I want to give an example of income protection now as well. So I had somebody, well we, we had somebody at Kira, it was a female life in her mid forties and she’d had leukemia approximately eight years before the application. She’d had a bone [00:54:00] marrow transplant, uh, at the same time as well as chemotherapy. So I know this isn’t like an organ transplant, but we are talking a transplant of some sort. I think it’s, uh, it is classed as a transplant. So there we go.

Matt:                It is very much so, yeah, bone marrow. Yeah,

Kathryn:           Fantastic. And she’d been fully recovered, um, for all that time. So for, for her we did 1500 pounds worth of, uh, monthly income benefit. Well, yeah, monthly income benefit. It was after a [00:54:30] 13 week deferred period, so that’s known as the waiting period before the financial aspect of a claim would be considered by the insurer. And there was a maximum two year claim period per successful claim on the policy. Now that came to a premium of 27 pounds and 30 pins per month and there were no exclusions relating to the cancer, which I think was pretty, pretty good.

Matt:                I, I I would say both of those cases are incredibly good.

Kathryn:           I’m glad you think that matters. Well, it’s, uh, it is showing people what [00:55:00] we can do, isn’t it? What like get it out there. If we just have, if we have the right route to the insurances, the right insurers in place, lots and lots of different insurers, that’s what we have lots and lots of different ones. They all have their own different quirks and uniqueness that we can do things with. And it’s just trying to always with these podcast is to help people to understand that there’s often options even if we can’t see them necessarily ourselves. So there we are, we’re at the end. Thank you everybody for listening and thank you Matt, as always for your insights.

Matt:                My pleasure. [00:55:30] As I said, it’s, it’s, it’s lovely to be back and it’s also, it’s also great for me, um, to hear those two fantastic success stories at the end.

Kathryn:           Next time we’re gonna be back with an early in between episode for the podcast, this series with Sue Clarkson and she’s gonna be talking to us about some recent insights into small medium enterprises and employee benefits. Um, if you’d like reminder of the next episode, please drop me a message on social media or visit the website practical and protection dot code uk. And as always, don’t forget if you’ve listened to this as part [00:56:00] of your work, you can claim a CPD certificate on the website too. Thanks to our sponsors, the <inaudible> members and uh, I’m sure this number will change by the time of this girl’s life. But just so that people know who are listening, um, we have at the moment just within the systems that I have, I know that this is recorded as CPD elsewhere too, but just in the systems that I have we have reached over 1200 CPD certificates being issued for, for the podcast, which is just absolutely phenomenal. I’m very, very happy and I’m very touched that people who are listening to this are finding [00:56:30] it useful and are collecting those, um, certificates. And they are, they are official, they are structured cpd and it all goes towards your professional learning. So thank you very much everybody, and thank you, Matt,

Matt:                My pleasure. Look forward to next time.

Kathryn:           Look forward speaking to you too. Bye

Speaker 3:        Bye.