Friday, February 17, 2012

WHY SHOULD IMMIGRATION STATUS AFFECT A TRANSPLANT?

CALIFORNIA FOCUS
FOR RELEASE: FRIDAY, MARCH 2, 2012, OR THEREAFTER


BY THOMAS D. ELIAS

“WHY SHOULD IMMIGRATION STATUS AFFECT A TRANSPLANT?”


Let’s make one thing clear: Even if Jesus Navarro doesn’t get the kidney transplant he was about to receive when doctors at the University of California-San Francisco Medical Center discovered his undocumented immigration status last month, his death probably is not imminent.


Insurance would continue covering dialysis treatments for him costing more than $100,000 per year for at least several more years. With help from blood-cleansing artificial kidney dialysis machines, patients average more than eight years survival, but with the equivalent of barely 15 percent of normal kidney function. Only about one-fourth of those under 50, however, feel well enough to work full-time.


So some protests that have cast the debate over Navarro’s celebrated case in terms of immediate life and death have been slightly off the mark. The real issues are fairness, morality, finances and the Hippocratic Oath sworn by all physicians. For the 35-year-old Navarro, a Mexican native who has lived in this country 16 years and worked for a Berkeley steel foundry the last 14, the question always was whether he will have to continue feeling only marginally healthy and being tethered regularly to a machine or can regain his health and freedom of movement.


The transplant Navarro could get would cost his insurance company somewhat less than one year of dialysis. After getting it, he would go an indefinite, but probably long, period of needing immunosuppressant drugs to keep his new kidney functioning. Until recently, the drugs presented huge financial obstacles for the poor or the uninsured, but key formulations like cyclosporine, tacrolimus, mycophenolate mophetin and prednisone all are now available as generics at much reduced costs.


(Full disclosure: columnist Thomas Elias received a kidney transplant from a live donor in 1997, after undergoing dialysis for a substantial time.)


That means much of the objection initially presented by UCSF financial officers never held water. “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 a statement from Reece Fawley, executive director of transplantation. UCSF has since backtracked a bit, saying it will perform the transplant after all, once it is certain Navarro’s insurance will remain in effect afterward.


In checking the financial abilities of potential organ recipients, UCSF is like all other transplant centers. But many individuals receive transplants with far less assured insurance coverage than what’s available to Navarro – at least 18 months of eligibility for Cobra coverage from the health insurance he held for the 14 years before an immigration check cost him his job. He currently pays $1,100 monthly for that coverage.


“Even if his insurance ran out, he’s covered by the union for 18 months,” Oakland City Council President Ignacio De La Fuente, who also is international vice president of the Glass, Molders, Pottery, Plastics, and Allied Workers International Union, told a reporter. “He has a willing donor (his also-undocumented wife), he has private health care. This has been ridiculous.”


In fact, many transplant recipients have far less certainty of health coverage than Navarro, whose insurance could continue even if he were deported.


So a transplant would be good for Navarro, regardless of where he might live, and would save his insurance carrier hundreds of thousands of dollars. It also would not “rob” any U.S. citizen of a donated organ, thus mollifying most anti-illegal immigrant activists.


Then there’s the issue of fairness. In conversations with hundreds of transplant recipients of many ethnicities, none has reported to this column any queries about immigration status. Why, then, should it ever have been an issue for Navarro? And there’s the fact that while illegal immigrants nationally donate about 2.5 percent of all transplanted organs each year, they receive fewer than 1 percent of all transplants. Given that inequity, simple fairness dictates that doctors should perform the needed twin surgeries on Navarro and his wife, a well-matched donor.


There’s also the Hippocratic Oath taken by all doctors, which says, “I will prevent disease whenever I can…” That oath implies a willingness to help all comers, regardless of background or life circumstance. It’s one reason doctors give emergency treatment to murderers and rapists when needed. It’s why convicts have received organ transplants. And it’s one reason Yemeni President Ali Abdullah Saleh was allowed into this country last month for urgent medical care even though many of his countrymen hold him responsible for thousands of killings. How moral would it be to deny Navarro care while giving it to violent criminals and Saleh?


So the alleged moral, financial and medical reasons raised when Navarro’s transplant was delayed could never stand up to careful examination. Which makes the real question this: While UCSF may now deny immigration status was ever an issue here, why did UCSF doctors and administrators ever allow immigration status to become relevant in this case?


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Email Thomas Elias at tdelias@aol.com. His book, "The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It," is now available in a soft cover fourth edition. For more Elias columns, visit www.californiafocus.net

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