Transplantation Unplugged: First Do No Good?

"A just nation should support that right [decent health coverage] for everyone, regardless of why or how a person is in the country….. The problem of illegal immigration should be solved by immigration policy, not health policy. People who are in this country illegally have broken our laws, but the magnitude of their crime does not justify depriving them of the basic right to health care coverage while they are in our midst.” Ruth Faden, PhD, MPH, Director, Johns Hopkins Berman Institute of Bioethics writing in Kaiser Health News.

I wholeheartedly agree with Ruth Baden, but today there is a shocking story coming out of San Francisco.

Jesus Navarro is a 35 year old Latino man. His kidneys have failed and he has been on home hemodialysis for the past 8 years. He was evaluated at UCSF for a kidney; his wife is willing and able to provide him the kidney he needs, and he has health insurance. Now UC San Francisco Medical Center has rejected him as a candidate because he cannot guarantee that he will be able to receive follow-up care because he is an illegal immigrant.

Says UCSF’s Executive Director of Transplantation Reece Fawley:

“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. Immigration status is among many factors taken into consideration.”

Hannah Dreier who broke the story for the Costa Contra Times "The hospital won't perform the transplant without a guarantee that the drugs and accompanying treatment will be paid for. 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.

"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."

This story should make us question the moral direction this country is taking. What’s next? Should hospitals deny pregnant women care because their illegal status interferes with their ability to guarantee ante-natal follow-up? Should hospitals deny any patient care because they are not sure about adherence with medications or with follow-up?

Let me say this again. Jesus Navarro had insurance and his wife was willing and able to donate a kidney so that he was not even taking a precious deceased donor kidney out of the pool. His only problem was his immigration status.

Hmm. I guess nobody actually pays attention to the Hipocratic Oath any more, but still....

“I WILL FOLLOW that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.” (Hippocratic Oath, original version)

Bottom-line: I hope the UCSF folks will reconsider, and ask the question: "Illegal immigration to the United States started when?"