UCSF does not reject potential transplant patients based on their immigration status. Our priority is to provide the highest quality, safest care for our patients. For kidney transplant patients, surgery is just the starting point of a lifetime of treatment that is complicated and expensive. All patients who move near the top of the kidney transplant wait list are evaluated for any issues that might prevent a successful long-term transplant and sustainability of the organ. Criteria include clinical, psychosocial and financial factors.
The review process is the same whether the patient is a legal resident or not, whether they are rich or poor, whether there is a living or deceased donor, because the long-term concerns relate to the sustainability of health coverage to assure access to follow-up care and necessary drugs. If during the extensive review that precedes surgery, we find problems we believe could affect the patient's ability to care for the donated organ throughout his or her lifetime, we create a plan of action for the patient to address those issues prior to transplant. While these issues are addressed, the patient remains on the waiting list.
Because it is essential that transplant recipients receive post-transplant care for the rest of their lives, including costly immunosuppressive drugs, the Centers for Medicare and Medicaid Services (CMS) require that facilities establish fair and non-discriminatory patient selection guidelines to help ensure good patient outcomes. These outcomes, including survival of the patient and of the transplanted organ, are monitored by CMS. Each transplant program must continue to meet these requirements to remain designated by CMS as a transplant center.
Medicare is a critical link in the safety net for kidney transplant patients. Individuals who cannot access Medicare or the state Medi-Cal program because of immigration status are at risk of being unable to sustain the organ. Under current laws, patients who are not legal residents have no access to Medicare and limited access to Medi-Cal.
We have more than 5,000 patients waiting for kidney transplants at UCSF, yet are only able to perform 350 each year. The unfortunate reality is that there is a critical shortage of organs, and the costs to sustain them are high. UCSF, like other transplant centers, is vigilant about ensuring that the few available organs are transplanted into patients with the best opportunities for long-term care and survival.