Visa Process Makes It Difficult for Some Patients to Receive Transplants

By Jacqueline Baylon

The clock is ticking for Dr. Gabriel Danovitch’s patient. Danovitch, a transplant surgeon at the David Geffen School of Medicine at the University of California, Los Angeles, is treating an immigrant from Mexico in his 40’s whose kidneys have failed. The patient is a good candidate for a transplant and has a donor, his brother.

But there is a big problem: His brother is a Mexican citizen and his application for a visa to come to the United States was not granted.

Doctors who perform transplants say patients who need organ donations from their families or other close matches outside the United States face hurdles that are often hard to surmount.

Difficulties obtaining visas leave many potential donors frustrated and force their sick relatives in the U.S. to wait months or even years on a list for organs like a liver or kidney.

In other cases, poor families cannot afford to pay for the donors to travel to the United States and undergo organ-removal operations that can require hospital stays of up to three weeks. In some states, Medicaid does not cover any of a donor’s expenses, and private insurance policies vary greatly in how much they will cover.

Medical authorities say the problems have gotten worse in recent years after officials tightened visa policies following the terrorist attacks in 2001. And with the slowdown in the economy, some states have been cutting back financial aid to transplant patients and donors, making it even harder for some families to scrape together the money to deal with what can be life-threatening problems.

“It concerns me that there are living donors who are good enough candidates, but there is some kind of procedure they have to go through, and the person in need does not end up receiving their organ,” said Bryan Stewart, a spokesman for One Legacy, a nonprofit that deals with organ, eye and tissue donations in the seven-county greater Los Angeles area.

“If there is someone living, and willing and compatible, it’s concerning that, because of so much protection, they end up not being able to help a desperate person in need,” Stewart said.

Dr. Giselle Guerra, medical director of the Living Kidney Donor Program at the University of Miami Miller School of Medicine, has similar concerns. “I wish I can get rid of all the bureaucratic red tape, and it would be nice for every donor to fit the criteria so we can stop adding to the waiting list,” she said.

That list had 110,172 people who were waiting for an organ from a cadaver as of Wednesday, according to the United Network for Organ Sharing, a private, nonprofit that manages the nation’s organ transplant system under contract with the federal government.

More than 60,000 of those on the list are black, Hispanic, Asian, American Indians, Pacific Islanders or describe themselves as multiracial, according to UNOS. Of those, 6,229 are resident aliens in the U.S., 4,172 of whom are Hispanic. Illegal immigrants are prohibited from the list.

Living individuals can donate organs such as the kidney, lung, and parts of the liver and the intestines if they match the recipient.

“When patients need a transplant, most of the time, the first people they turn to is their families,” said Dr. Juan Carlos Caicedo, a transplant surgeon and director of the Hispanic Transplant Program at Northwestern Memorial Hospital in Chicago. “It becomes complicated when their families are not in the U.S., which in a lot of instances, that is the case.”

The State Department does not have a medical visa category and persons traveling to the U.S. have to qualify for the B-1/B-2 visa, which is a non-immigrant visa, mostly known as the tourist visa.

“Our embassies and consulates around the world do their best to assist visa applicants who are dealing with life or death situations in order to expedite their cases,” a State Department official in the bureau of consular affairs said in an e-mail.

The official, who spoke on condition of non-attribution, said individuals applying for a visa for medical reasons need to undergo the same application process as everyone else. There is a form that can be filled out requesting that the application be expedited.

But some doctors say that they’ve contacted State Department officials on behalf of patients and even that has not sped up the process.

“When I call the consulates or embassies, they’re not very cooperative,” Guerra said. “We try to be as concise as possible, but also explaining the urgency in the letters that we write, but it just continues to be a waiting game.”

Dr. Linda Chen, a transplant surgeon at the University of Miami Miller School of Medicine, said that for about the last five years, the State Department has required foreign donor candidates to get preliminary testing done in their home country.

Blood-collection tubes are mailed overseas to candidates so they can get blood drawn. The tubes are mailed back for testing. If the donor has the same blood type, there is a possibility that he or she can be a match with the patient and the State Department will take that into consideration, Chen said.

“They did not ask us to prove with blood before,” Chen said. “But even with blood work, they don’t give people visas sometimes.”

Chen said she writes letters on a monthly basis. The only patients she can’t help or do anything for are patients whose donor relative is in Cuba.

“Since the U.S. does not have a relationship with Cuba, we cannot help them by writing a letter or sending tests over,” Chen said.

The cost of applying for a visa and traveling to the U.S. can be expensive. Patients who are under Medicare or are insured have their donor’s testing and transplant costs covered, but travel, meals and housing expenses must be paid for by the donor or patient. Testing for compatibility can take as little as one day or up to a few weeks. And when the donor is not a match, the money is wasted.

If patients can’t get a donor into the United States, their names go on the UNOS list to receive an organ from someone who has died. Waiting times for patients vary, and among the factors is what state a person lives in. Patients in New York, for example, wait 7 to 9 years, while people in Florida wait 3 to 5 years.

When a kidney is the organ needed, patients go through dialysis – the most common method for treating advanced kidney failure.

Medicare spent $8.6 billion in 2007 on dialysis patients, from babies to the elderly, according to the Medicare Payment Advisory Commission’s March report to Congress.

Martha Escamilla-Arias, a social worker at Northwestern Memorial Hospital, argues that dialysis is costing the state more than a kidney transplant would in the long run.

“In Illinois, two-and-a-half years of dialysis pays for one kidney transplant,” Escamilla-Arias said. “Some people are in dialysis for 5 to 7 years, and if things were easier for foreign donors, it would help.”

People get sicker and weaker as they continue dialysis.

“It prevents people from dying, and that’s about all it does,” Chen said. “You still feel very fatigued and you can’t be active and you can’t travel without arranging dialysis appointments where ever you are going to travel.”

Jean Viera, 34, a Cuban immigrant on the UNOS list, has been going through dialysis for six years.

His left arm is disfigured with two large purplish protrusions where he is connected to a dialysis machine.

“I wish I did not have to go through this,” Viera said. “This is just not the best way to live.”