In Chicago, a small group of undocumented immigrants and advocates have made headlines for undertaking a now seven-day hunger strike to protest what they claim is a policy by Northwestern Memorial that bars undocumented immigrants from receiving organ transplants.
The Chicago Tribune reports that the group of protestors includes 14 undocumented immigrants in need of transplants, who have been denied the potentially life-saving procedures; the protestors argue the denials were due to their immigration status, but the hospital and the United Network for Organ Sharing, which oversees the national organ transplant system, say the denials were due to factors other than immigration status — namely, a lack of the ability to pay for the procedure.
The UNOS operates the Organ Procurement and Transplantation Network, which was created in 1984 as part of the National Organ Transplant Act that banned the sale of organs. The law came about more due to a lack of clarity about organ property rights than in response to the actual sale of organs. Yet, one enterprising Virginia physician, H. Barry Jacobs, did propose the idea of selling organs back in 1983, and the passage of the Act a year later was no coincidence.
Who puts patients on the recipient list?
While the UNOS regulates who on the national recipient wait list receives an organ donation once one becomes available, each of the 200 or so individual transplant programs in the country have their own criteria for accepting candidates for transplant and putting them on the wait list. In most cases, the ability to pay is a factor.
But don't hospitals have to treat all people regardless of need?
The Emergency Medical Treatment & Labor Act of 1986 requires all Medicare-certified hospitals, which is just about every hospital in the nation, to treat patients in need of emergency care, regardless of their ability to pay. But, this does not apply to patients with chronic conditions that have stabalized, even life-threatening ones, such as organ failure. Many hospitals, especially nonprofit ones, offer charity care programs to reduce the cost of services, but with the cost of a transplant running in the hundreds of thousands of dollars, the cost generally exceeds the hospital's financial ability to waive patient costs.
Hospitals with transplant programs assess the likelihood of a patient's transplant being successful before placing them on a transplant list, and money, the programs say, is a factor. The anti-rejection medications recipients must take, for example, cost in the tens of thousands of dollars. Many individuals without health insurance are often unable to afford the medications, decreasing the likelihood that they can adhere to a treatment plan.
An ethical dilemma
While their reasoning is sound, most hospitals, many of which operate on thin margins, really can't afford to waive the cost of transplants to patients, even if they are very much in need. Performing costly procedures without a the likelihood of reimbursement puts the financial stability of the hospital in jeopardy, as well as the access to care it provides for others.
Yet, barring people from a transplant because they can't afford it is certainly an ethical dilemma.
David Ansell, MD, chief medical officer at Rush University Medical Center in Chicago summarized the dilemma well in a Fox News report:
"One the one hand, the intent of the national transplant registry is to base transplants on who needs them most, but there are indeed a whole group of people who find themselves shut out…And these are people who are uninsurable, and it creates an ethical dilemma of doing the right thing against the extreme cost of doing a transplant."
"These are people who contribute to the community. The answer can't be no access, but it's going to require calling together all the transplant centers in the region, as well as politicians and members of the community to find an equitable solution…The other thing to note is that 20 percent of organs come from uninsured people, but around 1 percent of organs go to uninsured people who need them. These people donate the organs, but mostly don't get access to them."
So, illegal immigrants donate their organs, but in many cases, they can't receive them. It's a sad reality, but one that so far, has been financially unavoidable.
How do you think hospitals should respond to claims that transplant rules unfairly limit access to undocumented immigrants? Share your comments below or email Lindsey Dunn at ldunn@beckershealthcare.com.