An undocumented Mexican immigrant in New York City is stuck in a medical Catch-22: He can receive a lifetime of dialysis treatment for a serious kidney condition, but he doesn’t have access to a transplant that would greatly improve his chances of survival—and potentially save the government hundreds of thousands of dollars.
Without treatment to replace his failing kidneys, doctors knew, the man in Bellevue hospital would die. He was a waiter in his early 30s, a husband and father of two, so well liked at the Manhattan restaurant where he had worked for a decade that everyone from the customers to the dishwasher was donating money to help his family.
He was also an illegal immigrant. So when his younger brother volunteered to donate a kidney to restore him to normal life, they encountered a health care paradox: the government would pay for a lifetime of dialysis, costing $75,000 a year, but not for the $100,000 transplant that would make it unnecessary.
The irony of the situation runs deep, since hospitals routinely harvest organs from undocumented immigrants:
“As a physician, it puts you in a real ethical dilemma,” said Dr. Eric Manheimer, Bellevue’s medical director, noting that a transplant would sharply reduce Angel’s risk of death from complications. “The ultimate irony is it’s cheaper to put in a transplant than to dialyze someone for the rest of their life.”
Bellevue performs no transplants but, as a trauma center, often supplies organs harvested, with family consent, from illegal immigrants fatally injured at work.
“Here’s the paradox: he could donate, but he can’t receive,” Dr. Manheimer said, calling the imbalance troubling. Organ registries do not record illegal status, but a study estimated that over a 20-year period noncitizens donated 2.5 percent of organs and received fewer than 1 percent.