Conceptions of Reciprocity: The Navarro Transplant Case, Organ Allocation and Undocumented Immigrants – Emily Avera

Emily Avera
TransplantInformers

Organ donors give the gift of life, but the sheer volume of patients hoping for transplants far outstrips donor generosity. How should we make decisions to ensure the equitable distribution of a limited supply of organs? In a system that depends on the goodwill of donors and public trust, this question becomes further complicated when undocumented immigrants seek transplants – especially in the United States, where undocumented immigrants consent to donate organs more often than they receive them. In light of this fact, should citizenship be a substantial consideration? Or should allocation decisions be made according to a claim of reciprocity – i.e., that individuals or groups who are willing to donate are more entitled to receive organs than others?

When the Ward is Your Mooring: The Human and Economic Costs of Long-Term Acute Care for Undocumented Immigrants in the U.S. – Nora Kenworthy

Nora Kenworthy
Columbia

A recent New York Times article by John Leland recounted the lengthy medical history of Raymond Fok, an uninsured and undocumented immigrant who ended up marooned at New York City’s Downtown Hospital for 19 months after surviving a stroke. Although suffering from chronic health problems, including kidney failure, and initially in need of acute care, Mr. Fok remained in the hospital long after his initial emergency because he had no other place to go.

Without insurance or public benefits, numerous immigrants in the U.S. find similar fates in public hospitals, learning that without chronic or community-based services to assist them in recovery, they cannot be discharged. Rather than qualifying for a home health aide, or getting transferred to a nursing home, Mr. Fok’s status left him in the expensive care of an already cash-strapped public hospital. As Leland writes: “Mr. Fok’s immigration status never kept him from receiving treatment, but it helped make sure that his care would be delivered in the most expensive setting possible and in a place no one wants to spend more time than necessary.”

The Psychiatric Hospital as Safe House? Strange Asylum for Undocumented Immigrants with Mental Health Needs – Nora Kenworthy

Nora Kenworthy
Columbia

Over the past few years, stories have trickled into the U.S. national media about hospitals struggling to cope with the burden of caring for undocumented immigrants who lack insurance and are ineligible for benefits. These reports, including a recent series by New York Times reporter Kevin Sack and an even more recent NYT piece by Sam Roberts, feature accounts of chronically-ill patients being removed from dialysis, or ‘repatriated’ to their countries of origin in comas, to be cared for by long-lost and poorly-equipped relatives. As Luis Plascencia wrote on this blog a few years ago, these rare glimpses into hospital decision-making processes indicate that rising costs and non-existent legal protections for immigrants have led to a ‘privatization’ and ‘outsourcing’ of deportation by health care institutions.

To date, this meager public attention has focused exclusively on hospitals treating physical illnesses. Virtually no mention has been made of how psychiatric and mental health institutions handle undocumented immigrants.