Docking the undocumented: (im)migrant transplants and treatment
Once again, the news dispenses a bevy of stories about undocumented immigrants facing bleak circumstances in their fight for transplantation and treatment.
In a cross-post with Access Denied, I’ve discussed at length questions of equitable organ allocation and the added challenges undocumented immigrants like Jesus Navarro face in financing a transplant and post-operative treatment. That post-op treatment includes very expensive immunosuppressant drugs, and the cost is prohibitive enough that insufficient funding is sometimes framed as akin to a death sentence. While this may be a roadblock to being considered a suitable transplant candidate, it may be just as disheartening when a patient has received a transplant and changing circumstances render them unable to afford those anti-rejection medications later on.
Not undocumented, but in limbo
This is exactly what seems to have happened to a Nigerian immigrant in the UK, Roseline Akhalu. According to a petition started on her behalf, she immigrated to the UK as a student and whilst there was diagnosed with end stage renal failure in 2004. She was able to receive a kidney transplant in 2009. Since then,
Roseline has applied for leave to remain in the UK but has been refused. Roseline’s consultant has stated that unless Roseline is able to continue taking immunosuppressant drugs which are costly and unavailable in parts of Nigeria, her transplanted kidney will fail and she would have to resort to dialysis again –a treatment she could not afford. Without this she will die.
The case received coverage from major UK news outlets, and along with ongoing Facebook activity. True to his Mark Darcy human rights lawyer alter ego, even actor Colin Firth has publicly supported her plight. She was supposed to be returned to Nigeria June 7, but her lawyers have won an injunction against deportation and her release from detention. Her renewed application will undergo judicial review on July 24. In this case, it isn’t just about someone who’s undocumented, but in fact someone who is facing difficult odds because the documentation status is in question.
A different hunger afflicts Chicago
Stateside, the upsurge of transplantation pleas hit critical mass as a group of women went on a hunger strike until their undocumented loved ones were put on the transplant waitlist. This is a markedly different approach to all of the social media mobilizing, which seems to be on everyone’s mind since the Facebook App went live. It is interesting to note that this may be because this particularly community believes good old fashioned protest is the best way to get institutions to recognize their demands, whereas online petitions seem to be the most effective strategies for both Jesus Navarro and Roseline Akhalu. How do these different forms of mobilization reflect the social context of those making appeals?
For some, repatriation and palliative care is all that’s left
A newly minted article in the New England Journal of Medicine traces the experiences of a Houston physician, Dr. Ricardo Nuila, which prompted him to advocate for the dignity and palliative care of undocumented immigrants through a return to their “home” country. In a sign that undocumented immigrants are often reluctant to seek care in the U.S., he sees patients that disproportionately come to the hospital at the time when their illnesses are terminal or end-stage. And
For many undocumented immigrants, terminal illness is a revolving door: they are admitted from the emergency department with severe pain or organ failure, we stave off death well enough for them to be discharged, and very soon, they return . . . until the day they don’t.
While Nuila does have a clear sensitivity to his patients, he does not make the argument that the U.S. must shoulder all the palliative responsibility. In fact, Nuila asserts:
in a system in which emergency care for immigrants is being limited and adequate palliation for dying patients is not possible — a system in which dying people feel compelled to return to the hospital immediately after discharge — sending the right patients home may be ethically necessary.