Recent media reports about one of UCSF’s kidney transplant candidates have contained confusing and incorrect information about the University's policy for evaluating kidney transplant candidates, in particular for undocumented individuals.
Protecting patient privacy is paramount at UCSF, but today Jesus Navarro has authorized release of a joint statement with UCSF Chief Medical Officer Josh Adler, MD.
UCSF is dedicated to providing the highest quality, safest treatment for all of its patients. The University has tremendous compassion for patients, and their families, who face the very difficult issues related to kidney failure. While for some of these patients transplants can be lifesaving, transplant surgery is the starting point of a lifetime of medical care and treatment, including daily use of costly anti-rejection drugs.
UCSF does not reject transplant candidates based on their immigration status and has performed transplants on undocumented individuals. These patients are not refused treatment. Rather, UCSF refers them to community-based and other external services that can help them address issues related to specific access-to-care hurdles faced by non-citizens. Of particular concern is their lack of easy access to the health insurance necessary to receive proper post-transplant follow up. Follow-up care is critical to transplant patients, who otherwise may lose the organ and become less healthy than they were on dialysis.
While the patients resolve those problems, they remain on the transplant waiting list.
Joint Statement from Jesus Navarro and Josh Adler, MD, chief medical officer, UCSF Medical Center
Joshua Adler, MD
February 8, 2012
UCSF is committed to helping Jesus Navarro and all kidney transplant candidates achieve their goal of a transplant. On Tuesday, we jointly developed a plan that we hope will secure for Mr. Navarro the health coverage he needs for his care during transplant surgery and beyond, including costly anti-rejection medications. While that plan is pursued, he will remain on the transplant list, as was always the case, and will continue to accrue time toward a transplant.
Last May, Mr. Navarro met with UCSF medical, social work and financial staff in preparation for a potential kidney transplant. Like many others, he had been on the UNOS (United Network for Organ Sharing) waiting list for a long time, in his case more than six years. Mr. Navarro still had one year or more until he would reach the top of the UNOS list and UCSF’s standard procedure calls for reviewing patients at that time to ensure they are still good candidates for a future transplant.
As of today, he still is not at the top of the list, but is expected to reach the top in three to six months.
During the May visit to UCSF, Mr. Navarro met with UCSF financial counselors who asked about his immigration status. Mr. Navarro responded that, in fact, he was undocumented. Due to the complexities of the current health insurance industry, this was a concern for UCSF because it increases the risk that Mr. Navarro will not be able to continue to be insured and therefore not receive the follow-up care and medication needed to stay healthy after a transplant.
Per UCSF practice, Mr. Navarro’s status on the waiting list was changed to “inactive” as a result, which means that he would maintain his place on the waiting list, but would not receive a transplant even if he reached the top unless he had a reasonable coverage plan in place. The counselors also referred Mr. Navarro to two community assistance organizations that specialize in resolving immigration issues, as part of our effort to increase the likelihood of transplanted patients maintaining their health coverage for the surgery and critical post-transplant care.
Mr. Navarro has told UCSF that, to him, this meant he would not get a transplant until he resolved his immigration status; this was not what UCSF was trying to convey. Instead, UCSF was following its policy to make sure Mr. Navarro would continue to have the health insurance necessary to receive proper post-transplant follow up. Follow-up care is critical to transplant patients, who otherwise may lose the organ and become less healthy than they were on dialysis.
UCSF regrets the misunderstanding and is committed to reviewing its processes to make sure that communication is consistent and clear with all patients, including Mr. Navarro. UCSF does not and will not discriminate on the basis of immigration status.
The road to a kidney transplant is long, and it may still take Mr. Navarro months to continue through the process. In the meantime, he continues to maintain his health through dialysis, as he has for the past 6 1/2 years.
This situation underscores the many obstacles all transplant candidates face securing the long-term coverage they need because of the patchwork nature of the health care system. These obstacles can be more difficult for undocumented individuals to overcome.
UCSF Medical Center operates one of the world’s largest kidney transplant programs, with more than 5,240 patients on the list waiting to receive a kidney. Sadly, only 350 of those patients will receive a kidney transplant this year, mainly because of a shortage of organs, either from deceased patients or living-related donors.
For more information about how to save lives through organ and tissue donation, go to California Transplant Donor Network.