Thread: No transplant for dying dad who is illegal alien

No transplant for dying dad who is illegal immigrant

By Hannah Dreier
Contra Costa Times
Posted: 01/30/2012 04:15:22 PM PST
Updated: 01/30/2012 05:15:59 PM PST

Without a new kidney, Jesus Navarro will die.

Although the Oakland man has a willing donor and private insurance to pay for the transplant, he faces an additional hurdle in the race to save his life: He is an illegal immigrant.

That fact prompted administrators at UC San Francisco Medical Center to refuse to transplant a kidney from Navarro's wife because they cannot be sure he will receive adequate follow-up care.

Their decision taps into the tension between health care and immigration policies in the state and the role medical professionals should play in trying to save the lives of undocumented residents.

Though no data are available, anecdotal evidence suggests clinics sometimes perform the transplants on illegal immigrants, especially when the patients are young. In one high-profile case, UCLA Medical Center gave an undocumened woman three liver transplants before she turned 21.

Administrators also reject patients because of their immigration status, though these patients tend to lack insurance. Bellevue Hospital in New York attracted attention last year when it refused to transplant a kidney between brothers because they could not pay for the operation.

Navarro's supporters say they are not asking a hospital to donate care or seeking to take an organ from a legal resident in need. But as an illegal immigrant, the 35-year-old father is ineligible for billions of dollars the federal government sets aside annually to treat patients like him.

Should he lose his private insurance or be deported, his donated kidney could go to waste.

This is the kind of ethical gray area that hospitals hate, said University of Pennsylvania bioethics professor Arthur Caplan.

"It puts the doctors in a very awkward and torn position," he said. "You come into this trying to do good and find yourself stuck in the middle of a fight about immigration."

Immigrant advocates and some scholars say it is wrong for hospitals to withhold health care from the seriously ill, no matter their legal status.

But proponents of tougher border enforcement -- and those fighting to contain ballooning health care costs -- fear that providing such services could lure more undocumented immigrants.

Navarro never thought his survival would hinge on his immigration status. He has had private insurance through Berkeley's Pacific Steel foundry for 14 years.

When his kidneys began to shut down eight years ago, he continued to work full time. Each evening, he would cleanse his blood of lethal toxins using a home dialysis machine.

But the soft-spoken metalworker has been growing sicker. Life expectancy for dialysis patients hovers around six years.

This spring, the family got a call from UCSF's transplant center: Navarro had reached the top of the waitlist.

"We were so happy," recalled his wife, who went with him for the final work-up.

But in their final consultation before the surgery,¿ Navarro says doctors discovered his immigration status and called off the operation.

"I started crying and crying and crying," said his wife, who asked that her name be withheld because she is also in the country illegally. She offered her own kidney -- and was a match -- but administrators again said no.

There are no formal restrictions on illegal immigrants' access to transplants, in part because they are thought to donate more organs than they receive.

UCSF declined to comment on Navarro's case, but Executive Director of Transplantation Reece Fawley said in a statement that the clinic evaluates all patients for socioeconomic stability.

"Immigration status is among many factors taken into consideration," she said.

In January, Navarro was caught up in an immigration audit and lost his foundry job. He is trying to continue his private insurance but may well end up on the state's Medi-Cal program.

Some bioethicists say the hospital should have performed the surgery because Navarro would not be taking resources away from other patients or putting his wife at serious risk.

After all, many legal residents fail to follow their post-surgical plan.

"Why was this patient denied the opportunity to comply?" asked Santa Clara University bioethics professor Margaret McLean.

Other experts suggest that the possibility of saving a life should outweigh concerns about follow-up care. A kidney is a much more scarce resource than a doctor's time, they reason.

"He has the organ -- the critical resource -- if he can get it transplanted," said University of Southern California bioethics professor Michael Shapiro. "That's a serious chance at life."

The immunosuppressive drugs that ward off organ rejection can cost $20,000 annually, not to mention regular checkups with a specialist.

Without these drugs, which Medi-Cal would not cover, Navarro's donated kidney would gradually cease functioning and become riddled with scar tissue. In a minority of cases, the transplanted kidney must be removed.

But the anti-rejection drugs cost considerably less than the $17,000 a month currently being charged to provide Navarro with daily dialysis, raising yet another dilemma.

The hospital won't perform the transplant without an aftercare guarantee, and the state guarantees only dialysis.

California has made the calculation that it costs more to cut off illegal immigrants with kidney failure than to treat them.

Patients without regular dialysis frequently end up in emergency rooms. At that point, federal law requires that they receive enough treatment to be released -- usually only to cycle back to the ER within weeks.

Critics say that providing any long-term care to illegal immigrants is irresponsible and discourages home countries from investing in an adequate health system.

"You just cannot provide care for illegal aliens without getting into uncompensated care," said Bob Dane of the Federation for American Immigration Reform.

Navarro has considered returning to Mexico, where the transplant would cost about $40,000. But there would be no guarantee of pre-surgery dialysis there.

Navarro says that two of his friends have died in the past few years making the same journey. They never reached the operating table because they had no way of cleaning their blood.

He says his chief concern is finding a new job, not the quest to save his life. But he also worries for his family and takes anti-anxiety pills to sleep.

If transplant doctors working with illegal immigrants are in a bind, so are the Navarros.

"We don't know what to do," said Navarro's wife, watching her husband chase after their 3-year-old daughter. "It's like we're on a ledge -- we can't go here or there."

Contact Hannah Dreier at 510-262-2787. Follow her at Twitter.com/hannahdreier

Increased regulation on the horizon
The nonprofit group that manages the nation's organ transplant system is considering increasing its oversight of transplants to noncitizens.
The United Network for Organ Sharing currently does not limit on the percentage of organs that clinics can transplant to immigrants. That is partly because nonresidents donate more organs that they receive.
Over a 20 year period, illegal immigrants donated 2.5 percent of organs and received fewer than 1 percent, according to a 2008 study published by the American Medical Association.
The Network does reserve the right to audit the rare clinic that gives more than 5 percent of organs to nonresident patients. The concern is that a transplant center might start bringing in wealthy "transplant tourists" from other countries to make money.
"Regardless of our policy, it is always the decision of any transplant center," said network spokesman Joel Newman.
The organization is considering a new rule that would require clinics to provide detailed accounts of the immigrants they serve and allow the organization to review all nonresident transplants.
The goal would be to differentiate patients traveling to the U.S. for a transplant from those noncitizens who live in the country and thus are more likely to donate organs to U.S. citizens.

No transplant for dying dad who is illegal immigrant - San Jose Mercury News

RELATED

http://www.alipac.us/f12/undocumente...splant-249934/

Jan 31, 2012

Kidney transplant refused to Calif. father in U.S. illegally

By Michael Winter, USA TODAY

Because a 35-year-old father is not in the country legally, a San Francisco hospital is refusing to perform a life-saving kidney transplant, the Contra Costa Times reports in an article highlighting a clash between immigration law and medical ethics.

Administrators at the University of California-San Francisco Medical Center won't transplant a kidney from Jesus Navarro's wife because they said there is "no guarantee he will receive adequate follow-up care, given his uncertain status," the paper writes.

Navarro, who lives in Oakland with his wife and their 3-year-old daughter, "was caught up in an immigration audit" and last month lost his job at a steel foundry after 14 years, the paper writes. He still has private insurance to pay for the transplant.

Navarro's kidneys began shutting down eight years ago, and he uses a home dialysis machine every night. Doctors now say that without a transplant he will die.

UCSF, one of the top kidney transplant centers, would not comment on Navarro's case, but the head of transplantation issued a statement saying all patients are evaluated for what the paper calls "socioeconomic stability."

"UCSF's policy for financial clearance requires candidates to present evidence of adequate and stable insurance coverage or other financial sources necessary to sustain follow-up care long after transplant surgery," said Reece Fawley, executive director of transplantation. "Immigration status is among many factors taken into consideration."

The CoCo Times writes, "Though no data are available, anecdotal evidence suggests clinics sometimes perform organ transplants on illegal immigrants, especially when the patients are young."

A bioethicist said Navarro's case is a difficult gray area for hospitals.

"It puts the doctors in a very awkward and torn position," said Arthur Caplan of the University of Pennsylvania. "You come into this trying to do good and find yourself stuck in the middle of a fight about immigration."

Kidney transplant refused to Calif. father in U.S. illegally