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Who Gets Organ Transplants? Undocumented Give More than They Receive

Dr. McColloster is a volunteer physician at Casa Juan Diego.

G. was dropped off at Casa Juan Diego in July. She had been living under an overpass with her boyfriend but was unable to tolerate the Houston heat. Her eyes were brightly jaundiced and her abdomen was swollen like a woman one week overdue.

She arrived from El Salvador 10 years ago, began working in a cantina to support herself, later married and had four children, and had again been waiting tables at a cantina after her husband was deported, until she was too weak to work. She then resorted to begging on the street. I thought she was just another undocumented alien alcoholic with cirrhosis. I later found out she had Wilson’s Disease- an inborn defect in copper metabolism which slowly scars the liver. She was the mother of 4 U.S. born children who were at risk of having the same disease. G. would definitely die without a liver transplant.

I tried to get Medicaid to cover the fee. However, she was ineligible for complete benefits. None of the local hospitals were willing to give her a free liver.

G. was soon admitted several times to Ben Taub Hospital for esophageal bleeding. Her condition seemed hopeless and I contacted a hospice group to help orchestrate her end of life care. However, I needed to discuss the issue with G. at Casa prior to signing the orders.

When I arrived at the CJD women’s house, I happened to meet Yolanda Ryan – director of the P- 21 foundation. She had providentially come to the House of Hospitality seeking an individual who required an organ transplant. After a brief discussion, Ms. Ryan donated $150,000 towards a new liver for G. I cancelled the hospice request.

Methodist Hospital was initially receptive. However, the transplant team rejected her application after discovering she was an undocumented alien. The chief surgeon said government guidelines limited foreign recipients to 5% per annum. Methodist had already exceeded this figure. Herman Hospital later quoted the same restriction.

I wanted to confirm this claim and contacted the United Network for Organ Sharing (UNOS).

The 5% limit was only a goal. Transplant centers could exceed that figure without being penalized. However, any center with a large number of foreign recipients was subject to a detailed case review. Some institutions were giving out too many livers to affluent patients from abroad.

UNOS also provided surprising demographics on Texan donors and recipients. For every 16 Hispanic undocumented alien livers harvested, only 1 was trans-planted in another undocu-mented alien. The remainder went to U.S. citizens and wealthy foreign nationals.

Dr. Duccini, a liver specialist from Ben Taub, had worked very hard on G.’s case. He tried to appeal Methodist’s decision but was unsuccessful.

We finally reached an agreement with a hospital in New Orleans. Unfortunately, G. bled to death before she could be transported.

Her outcome reveals a flaw in our society. Organs of undocumented aliens are harvested with minimal likelihood of demo-graphic reciprocity. We exploit them at work – and in death.

Houston Catholic Worker, Vol. XXIII, No. 1, January-February 2003.