Organ and Tissue Transplantation (General Donor and Recipient Information)

This policy covers medically necessary organ and tissue transplantation—including solid organs (heart, lung, kidney, liver, pancreas, small intestine), corneal and other tissue transplants (eg, hand, face, skin, islets, hematopoietic stem cells), related inpatient/outpatient services, pre‑transplant evaluation and testing, donor acquisition/transportation, short‑term organ storage, prescription immunosuppressives, and bridge devices (VADs/total artificial heart). Coverage applies to transplant recipients accepted by an approved transplant center and actively listed for transplant (multiple listing permitted) and may extend to living donors only when donor services are specifically included in the member’s benefit plan; major limits include plan/contract and state regulation governance, transportation limited to the U.S./Canada, storage capped at 60 days, exclusion of services not covered by the member’s contract, and specific prohibitions (eg, Texas restrictions on transplants involving organs procured via forced organ harvesting).