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What would you do?

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A man named Jesus Navarro, 37, with a wife and a three year old daughter, comes to you and says "My wife will donate her kidney. She is a match. I need a kidney transplant, or I will die. I am an undocumented immigrant."

If you were a doctor, your oath, if not your heart, would demand of you to do the transplant.

I will apply, for the benefit of the sick, all measures [that] are required...

If you were a person on the street, you'd probably, upon hearing of his plight, say that he should have the transplant and throw in a dollar, or two, or twenty if asked.

But if you were Scrooge a zombie vampire squid hospital administrator, you would stamp

DENIED




in huge, red letters across the paperwork because
there is no guarantee he will receive adequate follow-up care, given his uncertain status.

Or would you?

Not all administrators are zombie vampire squid:

...clinics sometimes perform organ transplants on illegal immigrants, especially when the patients are young. In one high-profile case, UCLA Medical Center gave an undocumented woman three liver transplants before she turned 21.

But health administrators also reject patients because of their immigration status, though that usually happens when the patients lack insurance.

The Bay Area, however, is not lacking. Apparently the ones at UC San Francisco, where the transplant was denied, believe that whether or not you might not have health insurance in the future takes precedence over whether or not you are human:

UC San Francisco declined to comment on Navarro's case, but Reece Fawley, executive director of transplantation, said in a statement that the clinic evaluates all patients for 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," she said. "Immigration status is among many factors taken into consideration...

Navarro was caught up in an immigration audit and lost his foundry job this month. His private insurance continues for now, and he is trying to extend it. But he may end up in the state's Medi-Cal program.

That would deepen Navarro's dilemma. Though Medi-Cal will cover his daily dialysis -- which costs $17,000 a month -- because of his illegal status, it will not pay for the immunosuppressive drugs that ward off organ rejection. The drugs cost $20,000 annually. Medi-Cal also won't pay for organ transplants for illegal immigrants.

And you want to know the most ironic thing of all?

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.

That's right. Undocumented workers provided 250% more organs than they receive, and yet administrators cannot find it in them to provide a thirty-seven year old human being -- with a spouse and a dependent -- an operation which will save his life.

There is a special circle of hell reserved...


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Note: There is also the in-the-news case of the a youngster potentially denied a transplant because of her mental disability. It looks like there is some hope that she will get the transplant, but again, people are playing God.

"We are in the year 2012 and my child still does not have the right to live, the right to a transplant, because she is developmentally delayed," Rivera wrote in a blog post on wolfhirshhorn.org. slamming the hospital’s decision.

Doctors say they are worried Amelia, who suffers from a rare genetic disorder called Wolf-Hirshhorn syndrome, wouldn’t be capable of taking the medication she would need to sustain a new organ, according to ABC News...

Now, Rivera, a 35-year-old high school English teacher from southern New Jersey, says Amelia might get the transplant...

Amelia’s parents will meet with doctors again in March.

"They are moving us through the steps," she said. "It is not a ‘yes’ or a ‘no’ at this point. But, yes, I am hopeful."

Originally posted to jpmassar on Tue Jan 31, 2012 at 06:16 PM PST.

Also republished by ClassWarfare Newsletter: WallStreet VS Working Class Global Occupy movement, Occupy Wall Street, SFKossacks, Single Payer: The Fight for Medicare for All, Healthcare Reform - We've Only Just Begun, Progressive Policy Zone, and Invisible People.

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Comment Preferences

  •  I know it's been said many times before... (10+ / 0-)

    but it needs to be repeated ad nauseam if necessary.

    America has lost its moral compass.

    Thanks for reporting on this.

    That men do not learn very much from the lessons of history is the most important of all the lessons of history. ~ Aldous Huxley

    by markthshark on Tue Jan 31, 2012 at 06:27:00 PM PST

  •  There have to be some advocacy groups who (8+ / 0-)

    could move the ball down the field on this.  May they please step forward on behalf of those in need.  Perhaps some of the rabid right-to-lifers could expand their mission to include the post-born.  Like you, I shake my head in despair for what we've become.

  •  I can't believe this statement (8+ / 0-)
    executive director of transplantation, said in a statement that the clinic evaluates all patients for socioeconomic stability.

    Perhaps you can change your title to read

    You're Poor, You Die

    30 years of Thuglicans and this is where we have landed.

    I am ashamed, embarrassed, and enraged that people can be treated (or not treated as the case may be) this way.

    Great diary!

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Tue Jan 31, 2012 at 06:42:02 PM PST

  •  Sad as it is, and it says a lot about our broken (9+ / 0-)

    health care system, but I understand at least part of what the hospital administration was talking about regarding aftercare.  A good friend of mine is one of the best domestic relations lawyers in the country.  His kidneys failed: however, he comes from a huge family and it was easy to find a donor.  He got his kidney transplant.

    Now comes the downside.  I have spent a lot of time with my friend.  You have to see it to believe it.  Every few hours he retrieves a large pill holder from his coat pocket and dumps out, literally, a handful of pills in the palm of his hand.  He observed they cost a fortune, but because he has been very successful in his law practice, can afford them.  The pills run into the thousands of dollars.  

    How is our poor immigrant going to last the first month without his anti-rejection drugs?  Without health insurance to buy his medications, he will die within days of leaving the hospital.

    Damn!

  •  A death panel makes death decisions. (3+ / 0-)
    Recommended by:
    jpmassar, palantir, ladybug53
  •  Wait a minute. So this person has a donor. (3+ / 0-)
    Recommended by:
    palantir, Otteray Scribe, doc2

    There are many, many other people who could also use that kidney.

    Yes, the administrators are playing God, because someone has to.

    There is way, way, way more demand than supply.

    How many outraged commenters would volunteer all or part of their kidney to a stranger? I'm thinking very few, maybe none. If all deaths were ruled donations, with opting out being necessary, things would be a lot better.

    As it is, thousands of people die every year waiting for organs.

    I do not wish this man ill, but think of the person who will die if he gets that kidney. Of course, his wife would not donate it for someone else.

    So maybe people should donate a kidney so they won't be embarrassed.

    If life gives you melons, you may be dyslexic.

    by glorificus on Tue Jan 31, 2012 at 06:53:39 PM PST

    •  No one else will die if he gets that kidney. (3+ / 0-)
      Recommended by:
      Otteray Scribe, palantir, ladybug53

      (His wife's kidney).  That is at least part of the senselessness of this decision.

    •  Let me get this straight (2+ / 0-)
      Recommended by:
      jpmassar, Terranova0

      We're supposed to think of the (unidentified) person who will die if Navarro gets this kidney, but we're not supposed to think of the fact that Navarro will die if he doesn't get this kidney?  I get that you don't have a problem with someone playing God, but you know, Navarro is a person with just as much entitlement to life as anyone else.  

      "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

      by FogCityJohn on Tue Jan 31, 2012 at 10:03:22 PM PST

      [ Parent ]

      •  Ah, leave it to FCJ to say ti far better than I (1+ / 0-)
        Recommended by:
        FogCityJohn

        could express.

        •  As OS said above, the chances are not good (0+ / 0-)

          Navarro will survive even if he gets it.

          If life gives you melons, you may be dyslexic.

          by glorificus on Wed Feb 01, 2012 at 08:27:33 AM PST

          [ Parent ]

          •  Well I guess that settles it then. (0+ / 0-)

            Since the problem appears to be that he can't afford the medications necessary to prevent rejection of the transplanted organ, I guess we're supposed to feel more comfortable writing him off.  Forgive me if I find that a bit unsatisfactory.

            "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

            by FogCityJohn on Wed Feb 01, 2012 at 02:01:27 PM PST

            [ Parent ]

            •  Of course you would. (0+ / 0-)

              Why should we feel any more or less comfortable about Jesus Navarro than about the hundreds and thousands that die all the time from not being gifted with a match? Except we don't know their names and haven't seen their cute kid(s).

              I'm sure there have been studies, but I imagine for every viable organ there is more than one match.

              How would you decide? The youngest, the oldest, the richest, the poorest? The smartest, the wittiest, the prettiest? The healthiest, the one nearest death, the one who has been on the list longest?

              And what of his wife? I worked with a man who donated a kidney to his wife. It was a much more difficult and lengthy convalesence for him. I knew a woman who was born with a single kidney. She did all right, married and had a son, but would not dare try a second pregnancy.

              Just make your snide comments, and don't worry about reality.

              If life gives you melons, you may be dyslexic.

              by glorificus on Wed Feb 01, 2012 at 02:21:27 PM PST

              [ Parent ]

              •  Why? (0+ / 0-)

                Maybe because the reason cited for denying this man a transplant is his poverty.  If he could afford his meds, he might qualify.  I generally don't think a person's wealth should matter in a decision like this.  

                You can deride that as snide for as long as you like.

                "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

                by FogCityJohn on Wed Feb 01, 2012 at 03:51:42 PM PST

                [ Parent ]

                •  No, it could be because he is not in this (0+ / 0-)

                  country legally. "uncertain status" could refer to him being deported.

                  As to your feelings about undocumented persons, I don't care. I didn't make this decision, but I can see reasons why it was decided this way.

                  If you can't, you can't.

                  If life gives you melons, you may be dyslexic.

                  by glorificus on Wed Feb 01, 2012 at 08:21:30 PM PST

                  [ Parent ]

    •  Of the eight people who volunteered kidneys to me (4+ / 0-)

      Seven were Kossacks and only one had ever met me before volunteering. You'd be surprised at what good souls people are.

      Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

      by Kitsap River on Wed Feb 01, 2012 at 12:12:16 AM PST

      [ Parent ]

  •  Medi-Cal covers his dialysis (14+ / 0-)

    Unlike other organ transplants, being denied a kidney transplant if you are on dialysis is not life-threatening. I lived for over three years on dialysis. Not everyone on dialysis can get or even wants a kidney transplant. You can actually live well on dialysis, depending on the kind you do. Navarro may well be on peritoneal dialysis, since I caught a key phrase in your article excerpt: "daily dialysis". That's PD, which is the easuest and gentlest form of dialysis there is. People can and do work and/or go to school if they're on PD. Navarro can easily go for years on PD.

    The criteria by which he was evaluated at UCSF are the same as the criteria I had to meet at UW. I had to be able to demonstrate an ongoing ability to afford my medical care and anti-rejection drugs. My need for both is lifelong and the U wanted to ensure that I wiuld be able to guard and protect the gift that gave me my life back. Note that in my case the transplant was lifesaving because hemodialysis turned out to be extraordinarily bad for me; my exoerience is the exceotion and not the rule. Before receiving The Call, I had already spoken to my GP about using our state's Death With'Dignity option. But I don't say "lifesaving", I say "gave me my life back" and enabled me to live more like a normal person.

    Quite honestly, f I were to emigrate illegally to the country in the world with the best socialized medicine, where none of their citizens or legal immigrants goes without, and needed a kidney transplant or dialysis, that country would deport me and send me right back here, because while they can plan for the needs of their cutizens, legal immigrants, visitors, etc., they cannot and should not have to plan for life-sustaining treatment that requires a high ongoing expense for an undocumented person who entered the country by breaking the law. There's no way any country can plan for that sort of unexpected charity care, and if they did, they'd be flooded with the world's sickest of the sick until there remained no resources to care for their own legal citizens and immigrants.

    There are grim realities here that must be faced. One is that a kidney transplant at an equivalent university hospital cost $188,000 a year ago, not including all the billed time for specialists, clinic visits afterwards, and my ongoing prescriptuon refills. Another is that if Navarro had followed proper procedures to enter the country, his Medi-Cal, should he need it, would cover his anti-rejection drugs. See the previous paragraph about planning for a country's or a state's legal residents versus those for whom nothing can be planned because they remain unknown until there is an emergency. California, or Washington state for that matter, does not have an unlimited supply of money and must take care of its legal residents first.

    I sympathize with Navarro and his family, I really do. I've walked part of the path they're walking. In an ideal world, everyone would get all the care he or she needs. If there were some back door that could be created for Mr. Navarro to get the transplant and follow-up care and meds he will need for as long as the graft lasts, I'd pressure the state to open it for humanitarian reasons. And then there'd be another Mr. Navarro, and another, and another, until one day a young, poor American mother is pleading with you to save her toddler, who was born without kidneys and needs a transplant, and there's a match available (maybe she's the match), only because you've used up all your resources on folks for whom you couldn't plan, there is nothing left to help this tot for wgom plans could have been made had the resources not already been used.

    I hate hate hate coming off like this. I sound like a fracking Republican. But I live with the harsh medical realities of ESRD (end stage renal disease) daily, and this is what I see from the perspective of someone who's been through the system and discussed t with those whose job it is to provide the care and/or make the decisions.

    Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

    by Kitsap River on Tue Jan 31, 2012 at 07:15:14 PM PST

    •  Thank you, KR, I know you have actual experience (5+ / 0-)

      with this. Hope you continue to do well for a long, long time.

      If life gives you melons, you may be dyslexic.

      by glorificus on Tue Jan 31, 2012 at 07:28:19 PM PST

      [ Parent ]

    •  The article says (2+ / 0-)
      Recommended by:
      FogCityJohn, Terranova0
      But the soft-spoken metalworker has been growing sicker. Life expectancy for dialysis patients hovers around six years.

      and that his kidneys started to fail eight years ago.

      You said

      Unlike other organ transplants, being denied a kidney transplant if you are on dialysis is not life-threatening.
      •  Yes, I did. Here's why. (2+ / 0-)

        First off, Mr. Navarro is indeed on PD, as I recognize the cycler shown in the second picture. I had one next to my side of the bed for two and a half years, probably one identical to his. It uses no blood and no needles and is really pretty easy to set up, run, and clean up. Like most PD patients with a cycler, he almost certainly runs it while he's asleep. Set up (less than fifteen minutes on a bad day), connect up, go to sleep, and when you awaken, your cycler time is over. He may have to dô a fluid exchange at mid-day, which is easy and doesn't take more than twenty minutes. You can do it in a car. I have, on many occasions.

        Second, that statistical average includes all dialysis patients, most of whom are older, a lot sicker with more comorbidities, and in hemodialysis three times a week, barely getting enough dialysis to survive. PD helps you stay a lot healthier, and it's the easiest and most gentle method of all. He's chosen a good method. He's very much on the younger side of the spectrum of adult dialysis patients. I know patients, boththose who go to a center and those who dialyze at home, who have been living well with dialysis for as long as two decades. A lot of how healthy you stay has to do with how well you take care of yourself and mind what you're supposed to do with dialysis treatment, technique, diet and exercise, fluid restrictions, and caring for any other fluid restrictions you may have. He could very well go for seven or more years on PD, then switch to home hemidialysis and do that in his sleep, getting even better dialysis and clearances as good as those from a cadaver donor transplant like mine.

        You can travel with PD easily. I've done it at two NNs. You can live a rich and full life with dialysis. One guy I know, Bill Peckham, has even gone river rafting and dialyzed doing "home" hemodialysis during the trip. There are dialysis cruises for people on home dialysis. I went to school fulltime while on dialysis (had to give up because bronchitis laid me up for months and then I lost my funding). He can be a present, involved, loving father and husband on dialysis. I have had sex plenty of times while doing a dialysis run. (Only on PD, though.)

        Dialysis is not a death sentence. ESRD is fatal if not treated, but a transplant is only another form of treatment. And the six-year life expectancy includes a lot of people who are sick senior citizens getting barely-adequate dialysis in the statistic; in fact, that's most of the dialysis population. Mr. Navarro is an outlier and I am not his physician, but there's not necessarily any reason to think he might die soon if he keeps getting his dialysis.

        Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

        by Kitsap River on Wed Feb 01, 2012 at 12:07:30 AM PST

        [ Parent ]

      •  Typo. Should read... (2+ / 0-)

        "caring for any other medical conditions you may have", not "any other fluid restrictions". Fluid rextrictions on the brain is not ubcommon when thinking about dialysis. And with PD, he should have few to no dietary and fluid restrictions, except sodium.

        Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

        by Kitsap River on Wed Feb 01, 2012 at 12:21:34 AM PST

        [ Parent ]

  •  Way more complex than that. (12+ / 0-)

    The transplant committees are made up of the top docs and bio-ethics folks.  Figure they care MORE than you do since they are the ones who are face to face with the life and death decisions they make. They have to be able to live with hundreds of transplant decisions.

    The transplant system is about the fairest it could possibly be.  It's 100% based on medical facts.  The socio is more important than the economic, strong family support is biggest factor, but there is no doubt that eco plays a role in the decision. Not the transplant committees fault.  There have been cases where the person was denied because their health insurance was not going to cover the transplant drugs after 90 days.  It's a fact the committee has to deal with.

    The economic realities of US in 21st century mean with a great deal of certainty that people without family and eco resources are going to lose the transplant and likely their lives costing others their lives.  It's not just the organ itself but the time and resources.

    The transplant committees have to make their decisions in the real world have to live with them, literally as they are the health care providers who will see the people for the rest of their lives.

    Don't blame the transplant committees for state of US health care.

  •  So yes, not having single payer sucks for yet (6+ / 0-)

    another reason.  On the other hand, until we do get such, the doctors are correct that there isn't a lot of point in transplanting organs into people who will not be able to afford to pay for anti-rejection medications.  And, btw, yours is the third diary to mention that 3 yr old girl whose mother interpreted what was said to her as discrimination against the mentally challenged.  Again, the situation is more complex.

    Like Kitsap, I know this sounds harsh, but the men and women of the transplant committees are not cruel and heartless, do not deserve your scorn or 'a circle of hell'.  They're simply doing the best they can within the broken medical system we've got to make sure that organs will actually go to people who will be able to continue to live with them.

    You want folks like Jesus to get the kidney?  Work your ass off for single payer, so that he won't have to worry about paying for rejection drugs.  Your circle of hell is better reserved for the politicians who didn't even let single-payer advocates at the table when the 'ACA' was being created.

    •  I just did work my ass off for single payer. (2+ / 0-)
      Recommended by:
      glorificus, FogCityJohn

      Or have you not noticed my multiple diaries over the last several days and back in the summer when the bill was before the Health Committee? It still failed in the California Senate.

      As for

      organs will actually go to people who will be able to continue to live with them.

      that is the essence of playing God.  Making decisions about the future that no one can predict with any reasonable certainty.

       

      •  jpm, I read your many diaries on the single (1+ / 0-)
        Recommended by:
        Kitsap River

        payer fight and was very disappointed (ok, probably not so much as you) that it did not pass. I thought if California could make it work, anywhere could. You did an excellent job of covering it.

        However, back to this issue, even with single payer the shortage of viable organs will remain.

        If life gives you melons, you may be dyslexic.

        by glorificus on Tue Jan 31, 2012 at 08:33:17 PM PST

        [ Parent ]

        •  Absolutely. (1+ / 0-)
          Recommended by:
          FogCityJohn

          Until science can figure out how to induce cells to grow new organs a shortage of viable organs will probably be with us.

          But that doesn't mean anyone should be treated as less than human, less than someone else, because of their immigration status, their insurance status, or their mental status.  That's what this diary is about.

          •  Mr. Navarro is NOT being treated as less than (0+ / 0-)

            human. Plenty of humans do not get transplants. If there was a way you could get a look into the deliberations, you might be outraged at the choices made, but that is not your call.

            If life gives you melons, you may be dyslexic.

            by glorificus on Wed Feb 01, 2012 at 03:45:55 AM PST

            [ Parent ]

      •  Shrug. I simply disagree with you. (1+ / 0-)
        Recommended by:
        Archival Footage

        The Navarro case is a bit more unusual than the run of the mill organ transplant case, in that a kidney might be available (except, of course, do we even know the person who wants to donate is a match?  Sometimes not even your closest relatives actually are suitable donors.)  

        But your 'no one can predict with any reasonable certainty', is where you and they disagree.  They're apparently reasonably certain what will happen.  Now if Jesus wins the lottery, and suddenly can afford the rejection drugs, I would imagine they'd revisit their decision.

        And again, I'm getting a bit tired of people writing 'outrage diaries' vilifying bioethicists, who are simply doing the best they can to see that as many people get a chance to live longer, better lives as they can, making hard and unpopular decisions at times to do so.  And not throwing close to 200k at a single case when it seems extremely likely that the actual result would be organ rejection within a very short timeframe.  An organ is only one type of resource that is a limiting factor.

        •  This is just so wrong... (0+ / 0-)

          "Now if Jesus wins the lottery, and suddenly can afford the rejection drugs, I would imagine they'd revisit their decision."

          Sorry but really?

          Is it all about the drug companies making a decent profit?

          I wonder how many pills expire each year while sitting on the shelves.

          I guess I better start buying my Lotto tickets since there is a very real possibility that I will need a transplant one day.

          “The most important trip you may take in life is meeting people halfway” ~ Henry Boye~

          by Terranova0 on Wed Feb 01, 2012 at 08:10:16 AM PST

          [ Parent ]

  •  Even with a single payer there will be (1+ / 0-)
    Recommended by:
    jpmassar

    decisions like this one though I can imagine this one wouldn't happen but I don't know for sure.  The point being that there will be and are denials at the single payer level.  Transplant protocols are strict.  This denial seems rather harsh.  I'm glad I don't have to make these decisions. I don't envy anyone that does.  They are forced to make an economic decision.  It shouldn't be that way.  

    Rick Perry is George Bush without brains.

    by thestructureguy on Tue Jan 31, 2012 at 10:18:05 PM PST

  •  But that's okay with Republicons. (0+ / 0-)

    It's okay for doctors, hospitals, insurance companies, and rich adjusters to deny ordinary Americans the care they need to survive. It's not okay for the government to make sure they have that care. They want Americans to die. These people are fucking evil, and I'm seriously considering following the Newt plan and exporting every last soulless bastard of them to the moon.

  •  It is called capitalism (1+ / 0-)
    Recommended by:
    Terranova0

    That's an example of how unethical system capitalism is.   It all comes down to money and payments.   Hopefully though this man will be able to get the transplant at another hospital.  

  •  this happens more often than people know (2+ / 0-)
    Recommended by:
    Terranova0, glorificus

    "Politics is like driving. To go backward put it in R. To go forward put it in D."

    When I look at the economy, I think Obama can't win; when I look at the Republicons I think he can't lose. And the economy is getting better. h/t Paul Begala

    by TrueBlueMajority on Wed Feb 01, 2012 at 06:25:20 AM PST

    •  Yup, it does (1+ / 0-)
      Recommended by:
      glorificus

      And not just to illegal immigrants.  A family member was almost denied a transplant because she was on COBRA by the time she reached end stage and they were not sure if she would have adequate medical insurance to cover the  follow-up care. The follow-up care is required for the rest of her life.

      I have mixed feelings about transplants. They are a privilege, not a right.

      “The most important trip you may take in life is meeting people halfway” ~ Henry Boye~

      by Terranova0 on Wed Feb 01, 2012 at 07:55:26 AM PST

      [ Parent ]

  •  The bean counters control the death panels today (0+ / 0-)

    Single Payer will put doctors and administrators in charge.

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Fri Feb 03, 2012 at 09:53:20 PM PST

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