Who Should Be First In Line To Receive A Transplant Organ?

fromWBEZ

Organ transplants have become a viable option for a growing number of patients. That has brought increased attention to legal, medical and ethical questions about who should be first in line for organs. Undocumented immigrants and others say they are left off waiting list due to lack of funds and inability to access government health care programs.

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On average, 18 people die in the United States every day while waiting for organ transplants. And the waiting list for most organs is getting longer. Before people can even get placed on those lists, they need approval from a local transplant center - which considers such things as the patient's income, immigration status, and the likelihood of that person following the doctor's orders.

Some immigrants in Chicago say those standards are not fair. They're asking for an equal shot. From member station WBEZ, Shannon Heffernan reports.

SHANNON HEFFERNAN, BYLINE: Blanca Gomez is sitting in her living room with her 2-year-old daughter on her lap. When she was pregnant, she developed a condition called preeclampsia that affected her kidneys. Her doctors said she would need a kidney transplant. But her insurance didn't cover it. And since she's not a citizen, she couldn't access Medicare. Gomez says two different Chicago hospitals told her that meant they couldn't approve her for a transplant.

BLANCA GOMEZ: I remember that day I started crying a lot because I was like, what am I going to do? Am I going to die?

HEFFERNAN: Gomez found a group of other immigrants, here in Chicago, with similar experiences. They've held demonstrations over the last few years and earlier this summer went on a short hunger strike.

Art Caplan is the head of medical ethics at NYU. He says the policies in Chicago aren't different from anywhere else.

DR. ART CAPLAN: Centers are getting pickier. Because the organs are scarce, they start to think, who is going to be able to follow doctors' orders after you get a transplant?

HEFFERNAN: And it's not just immigrants getting denied. A center might consider if someone with a mental disability can follow complex post-surgery instructions that are essential to transplant success; or if someone with a criminal record will follow doctor's orders. Each local transplant center weighs things differently.

CAPLAN: Not only is there not only consistency between transplant centers, sometimes there's not evidence to back up their judgments.

HEFFERNAN: For example, Caplan says with the right family support, someone with mental disabilities will do very well with a transplant. But others, who transplant centers might add, might not.

CAPLAN: A CEO, who is not used to taking instruction, can do things their way - not the doctor's way - after the transplant.

HEFFERNAN: He says one consideration that does predict success is a patient's ability to pay. Medicine to help the body not reject an organ can cost upwards of $30,000 a year.

Gabriel Danovitch heads the Kidney and Pancreas Transplant Program at UCLA. It troubles him to deny anyone a transplant, but he says he has no choice.

DR. GABRIEL DANOVITCH: There is a tremendous shortage of organs and therefore, we must do a rational job of trying to allocate organs in a manner that they'll be successful.

HEFFERNAN: Both Caplan and Danovitch say they want to treat immigrants and the uninsured the same as everyone else. But that's not the health care policy we have. Art Caplan says there is still another consideration. About a quarter of all organs come from people who would likely not be eligible to receive a transplant themselves. If people think the system won't benefit their communities, they are less likely to be donors - making the pool of available organs even smaller.

Blanca Gomez has seen that reaction at demonstrations she's attended.

GOMEZ: They actually told us they were all donators and that they would go and remove it - because how could they accept an immigrant organ, but they don't want to give an organ to an immigrant.

HEFFERNAN: Northwestern Memorial Hospital recently contacted Blanca Gomez for a new evaluation. She says she has five donors lined up, but that doesn't assure a transplant. And time is of the essence. Sarai Rodriguez, one of those demonstrating alongside Gomez, died earlier this month at age 25. Gomez says the group is raising money for post-transplant medication, for those in her group still trying to get on the waiting list.

And that list is growing. Without more organs, rationing will likely remain a harsh reality for the more than 100,000 people now on the transplant list.

For NPR News, I'm Shannon Heffernan.

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