Ruth Villalta has end-stage renal disease. Her husband’s kidney could be a match for her — but the Long Island, New York clinic where she gets her dialysis treatment won’t allow her to receive a kidney transplant. That’s because both Villalta and her husband are undocumented immigrants.
As the New York Daily News reports, “doctors at her dialysis clinic in Lindenhurst, run by Good Samaritan Hospital, initially discussed a transplant with her, but stopped the process when she said she was here illegally.” A Good Samaritan Hospital spokeswoman told ThinkProgress that officials could not comment on the case because, as of January 2015, a different organization took over responsibility of the dialysis center.
Villalta came to the United States in 2009 with her husband and worked at a pharmaceutical factory before she became sick. When she had a miscarriage when she was five months pregnant in 2013, she discovered that she had renal failure in both kidneys. She’s been dependent on dialysis treatment ever since.
Like Villalta, about 6,000 undocumented immigrants have end stage renal disease (ESRD). But there is a lack of uniform national policy when it comes to their dialysis treatment, varying even within cities in the same state and hospitals in the same city.
New York State, for instance, extends regularly scheduled dialysis treatments to undocumented immigrants. But individuals living in states like Texas sometimes only qualify for emergency dialysis. In Dallas, patients can only receive emergency dialysis treatment; in San Antonio, patients can receive scheduled dialysis.
The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 requires emergency rooms to medically stabilize patients, regardless of legal status, before discharge or transfer. Many hospitals interpret the EMTALA by practicing “emergent dialysis” on undocumented immigrants by evaluating the patient in the emergency room and only giving treatment if a life-threatening symptom presents itself, like shortness of breath, feeling poorly, or a high potassium level, according to a 2014 Texas Med report. In contrast, scheduled dialysis happens regularly either at home or at a center.
In New York State, emergency Medicaid and charity care is available for undocumented immigrants like Villalta. Emergency Medicaid coverage includes a twice-weekly dialysis treatment needed to flush out toxins and remove excess salt and water from the body. The treatment “may end up costing the state and federal government far more than the price of transplant surgery. Costs vary, but the federal government’s Medicare program spends about $106,000 for a kidney transplant per patient and $72,000 each year on someone getting dialysis,” New York Daily News stated, using data from the U.S. Renal Data System.
Especially when immigrants have to wait until they’re seriously sick to get help, dialysis often isn’t enough. As Claudia Calhoon, the Director of Health Advocacy at the New York Immigrant Coalition, told ThinkProgress, the treatments are “not sufficient to help someone be healthy” because immigrants aren’t able to access primary care providers or get follow-up care on an ongoing basis.
This approach also isn’t good for the health care system in the long run. The Texas Med report found that emergent dialysis is 3.7 times more expensive than scheduled dialysis because of the costs associated with emergency room care. Calhoon stated that Villalta’s case presents “a really good example of how not having coverage for undocumented immigrants creates these cost inefficiencies because it would really be, in the end, much cheaper to the health care system for her to have a transplant than for her to have dialysis for years to come.”
Villalta isn’t the only undocumented immigrant caught up in this healthcare paradox. Angel, an undocumented waiter in New York City was denied a transplant in 2011 despite his brother qualifying as a donor.
And Jesus Navarro, an undocumented immigrant taken off a kidney transplant waiting list was only put back on under heavy media pressure. The hospital initially justified denying him a transplant because “immigration status is among many factors taken into consideration,” the University of California at San Francisco Medical Center director of transplantation told the Contra Costa Times in 2012. UCSF also didn’t think that Navarro could afford the drugs and aftercare associated with his organ transplant.
Navarro had private insurance, but likely would have also lost his insurance coverage after losing his job. He would have rolled over to California’s Medi-Cal program, which would have paid for his dialysis, but not the transplant and the drugs needed after the surgery.
Some critics believe that granting undocumented immigrants the ability to receive transplants would take “precious organs away from American citizens waiting for a kidney transplant,” a 2014 Health Affairs report commented. But undocumented immigrants still make up a tiny portion of people receiving organs overall. A 2008 American Medical Association Journal of Ethics report found that undocumented immigrants made up less than one percent of all transplants between 1988 and 2007.
And there’s some evidence that immigrants pay into the donor system. The same American Medical Association Journal of Ethics report found that during the same time period, about 2.5 percent of all organ donations came from people of unknown citizenship or with unreported citizenship status. And according to a 2014 Chicago Tribune report, about 45 percent of all undocumented immigrants who signed up for driver’s licenses also signed up to be organ donors.
A few states are attempting to make progress in this area. Just last year, Illinois passed a state law that would provide funding for kidney transplants and associated drugs needed to maintain the organs for immigrants, regardless of legal status.
“You have many good protections to help a lot of people, but even with that, you have these enormous gaps that play themselves out in these tragic ways,” Calhoon said. “Transplants are one of the toughest areas.”