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For Undocumented Immigrant in Brooklyn, Heart Transplant Is a Longshot

Posted July 6, 2010 by Ted Hesson
Categories: Federal Immigration Policy

A recent cover story in The Village Voice tells the story of Julia Amparo-Alvardo, a Guatemalan immigrant in need of a heart transplant, but facing hurdles that might delay the surgery until it’s too late.

The article recounts how Julia fell ill seven years ago, only to learn that she needed a heart transplant that would be difficult—though not impossible—to get:

Julia admitted herself to Woodhull Medical Center a few weeks later. “I walked to the hospital alone,” she says. “There was no one who could come with me—everyone was busy working.” At Woodhull, few staffers knew Spanish. Julia’s English was limited to “I don’t know.”

To the staff who did speak her language, Julia divulged her illegal status. “I was not afraid to tell them I didn’t have papers,” she says. “A lot of people in the hospital were illegal. I knew they weren’t going to deport me because I was sick.”

Julia was at Woodhull for a month, suffering from severe chest pains and shortness of breath. She was eventually transferred to Bellevue Hospital to see a cardiologist, but it was a bewildering experience. “Everyone was speaking in English,” she says with a shrug.

She was at Bellevue for two months before she met Danielle Ofri, a physician and professor at NYU’s medical center. One day, Ofri brought around a new team of residents to Julia’s room.

Ofri says she looked at Julia’s chart and felt overwhelmed.

“I felt . . . entirely defeated,” Ofri says today, remembering that day when she first met the Guatemalan woman, who, at 36, was near her own age. “The whole premise of medicine is that you can always work harder to help your patients, but here was a situation that I could not do anything about.”

When Ofri looked at the chart, she could see that Julia’s battered and enlarged heart was not pumping enough blood. Her diagnosis of dilated cardiomyopathy was a death sentence, but only because of her legal status.

“I know if she gets the transplant, there is a 95 percent chance of a full recovery,” Ofri says. But an intern quietly informed the doctor that Julia was in the country illegally. Undocumented immigrants, Ofri knew, don’t get on a transplant list.

As the article later explains, it is possible for undocumented immigrants to receive organ transplants in New York State. But without insurance, post-transplant costs would be exorbitant, and an organization that monitors organ sharing tries to limit the organ transplants given to undocumented immigrants.

From The Village Voice:

As this week began, there were 324 patients waiting for heart transplants in New York. The United Network for Organ Sharing (UNOS), which controls the policies associated with transplants, says it doesn’t disqualify transplant patients based on immigration status. But, UNOS spokesman Joel Newman writes in an e-mail, “The presumption is that most non-resident foreign nationals have legal documentation—a visa or a work permit—and I believe that’s true for the vast majority of non-residents listed for a transplant. That said, we have no mechanism to track or enforce legal residency status.”

Undocumented immigrants have received transplants—the best known was 17-year-old Jesica Santillan from Mexico, who died in 2003 when her heart-lung transplant at Duke University Medical Center failed because doctors gave her organs from someone with a different blood type. It’s assumed that transplants to illegal immigrants are rare, but UNOS does take note of hospitals that perform transplants to non-residents. “If a transplant program happens to transplant more than 5 percent of its recipients in a year who are non-residents, they will get a review letter from UNOS asking them to provide more information about the circumstances. If a transplant program appears to have a pattern of listing and transplanting an undue number of non-residents, we could issue a membership sanction, but the two most serious and public sanctions we can give have never been applied for this issue.” Newman also states there is no hierarchy on the transplant list when it comes to legal status.

Julia is trying to get her name on the list. She and her husband—a legal resident in the U.S.—are working with a social services lawyer at Bellevue to get the necessary paperwork processed. But it has already been nine months since they began the effort.

Eric Manheimer, Bellevue’s Director of Medicine, learned about Julia’s case a year ago. He’s assisted her with financial issues and has expedited her paperwork so she can get Medicaid.

“Look, what isn’t rare is that, as an immigrant, all your organs can be harvested. But you can’t receive any? We don’t have the statistics, but a lot of our patients end up being donors,” he says. “I think there’s controversy: Why should undocumented patients give an organ, when they can’t they get an organ?”

Her doctors are not certain that she’ll live out another year without a transplant.

Tags : health care, organ transplants, undocumented immigrants, village voice

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