Kidney transplants are more cost-effective than long-term dialysis for undocumented migrants: NPR

Undocumented and undocumented immigrants often go to emergency for treatment. Since 1986, the federal government has required emergency room patients to receive care regardless of their immigrant status or ability to pay.

But treating chronic diseases such as kidney disease or cancer in the emergency room is expensive. Some States are therefore discreetly expanding the access of undocumented migrants to medical treatment beyond emergencies.

Washington is one of those states. An undocumented immigrant named Gonzalo lives with his wife Ricarda.

Gonzalo is really sick.

"I can not enjoy the day – go out – because I'm always sick," he said in an interview in Spanish.

Gonzalo emigrated from Mexico to the United States about 30 years ago. He is 60 years old. We do not use his last name because of his immigrant status.

Ten years ago, Gonzalo's kidneys were out of order. Since then, he has become increasingly sick. Five years ago, he had to quit his job as a painter.

"I had a habit of paying rent, I paid for everything, and we did not miss anything," he said. "But I got sick and everything changed."

Now, Gonzalo and his wife are living with one of their daughters in his apartment south of Seattle.

According to the National Institutes of Health, about 6,500 undocumented immigrants are suffering from kidney failure. The type of care they receive depends on where they live.

In most states, they can only be dialysed in emergency rooms in hospitals.

This means that every two weeks they go to the hospital when so many toxins have accumulated in their bodies and their lives are in danger. Usually they have to stay overnight to be dialysed twice. It costs nearly $ 300,000 per person each year.

So seven states, including Washington, have a different system.

"The state of Washington has something called AEM," said Seattle nephrologist Leah Haseley. She talks about Alien Emergency Medical, which is part of Medicaid in Washington.

"AEM ​​pays for two things," she explained. "They pay dialysis for undocumented people, as well as chemotherapy for cancer treatment of undocumented people."

Regular dialysis costs about a quarter of what emergency dialysis does – but it is controversial.

"The first time you report to a hospital with kidney failure, it's an emergency," said Matthew O. Brien, of the Federation for American Immigration Reform. , a group that advocates stricter immigration laws. "After that, it's a chronic illness, and we do not think it's appropriate to reward offenders with benefits at the expense of American taxpayers."

But others believe that even regular dialysis is not enough: undocumented immigrants who meet the requirements should have a kidney transplanted because the cost of a transplant is lower than the cost of regular dialysis or emergency. But, without health insurance, few undocumented immigrants can afford a transplant.

In 2015, Illinois became the first state endowed with a payment system for undocumented immigrant organ transplants.

Dr. David Ansell was an important advocate for change.

"In about a year and a half, the cost of a transplant will be amortized," he said, "but people can also return to work and contribute to the state."

Until now, more than 200 undocumented immigrants in Illinois have had access to organ transplants, their insurance premiums being paid for by a non-profit organization. Now, Dr. Ansell and other public health advocates hope to see a similar program at the national level.

Many who oppose this, with limited organs available, should be reserved for citizens and legal immigrants.

But Dr. Ansell explained that in Illinois, 75% of kidney transplants of undocumented immigrants came from donations from their own families – a rate much higher than the rest of the population.

"If you are undocumented in Illinois, you can get a driver's license and, disproportionately, the Latin American community pledges to donate their organs," added Dr. Ansell. "It's a simple matter of ethics and fairness."

He added that since Illinois began paying for transplants, the total number of organs available has increased because many other Latinos have enrolled for organ donation.

In the United States as a whole, studies have shown that undocumented immigrants give 2 to 3% of all organs.

Back in the Seattle area, Gonzalo said his three daughters were willing to give him a kidney, but he had no way to pay for the transplant.

This is why his wife, Ricarda, says that she is taken to buy lottery tickets.

She said in Spanish: "I told my husband:" If I win the lottery, I will not think twice about it, I'll make you a kidney. "