Transplantation in the Context of Migration - Ethical and Practical Challenges

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Language: en

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hi everybody welcome to this episode of


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transplant talks I'm Rachel Davis uh


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psychiatrist and living liver donor and


00:00:30.160 --> 00:00:32.429
here with my co-host Anastasia Henry who


00:00:32.439 --> 00:00:34.150
is executive director of the American


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transplant foundation and today we have


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the pleasure of talking with Dr sio Dy


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and this is his second time on our


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podcast um we're going to talk about the


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fascinating topic of transplantation in


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the context of migration but before we


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get into that Sixto can you tell us a


00:00:51.879 --> 00:00:55.189
little bit about your background and um


00:00:55.199 --> 00:00:57.830
why you were interested in nephology uh


00:00:57.840 --> 00:00:59.470
of course uh first of all thank you for


00:00:59.480 --> 00:01:01.790
having me it's a it's a great pleasure


00:01:01.800 --> 00:01:04.710
to to be here and and talk about this


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interesting topic so um initially what


00:01:07.360 --> 00:01:10.469
red me in uh to nephology or transplant


00:01:10.479 --> 00:01:12.950
nephology was a combination of events uh


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in college I had took a Immunology


00:01:15.040 --> 00:01:17.630
course which I found fascinating at the


00:01:17.640 --> 00:01:20.350
same time my roommate um one of my best


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friends had fsgs and required a


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transplant so I saw the whole Spectrum


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from him being super healthy at 20 years


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old to all of a sudden uh having a big


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change change in his health and and


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obviously uh not doing so well and then


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being able to recover back his life with


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a living donor guine transplant which


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that definitely was uh uh one of the


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turning points then uh in in med school


00:01:45.280 --> 00:01:47.830
my favorite uh course in the first year


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was renal physiology I was very uh uh


00:01:51.439 --> 00:01:53.870
driven or drawn to it by the complexity


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and and and how well it function and


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then ultimately my residency Internal


00:01:58.799 --> 00:02:00.590
Medicine Residency my favorite Mentor


00:02:00.600 --> 00:02:02.190
was in a project so that was the icing


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on the cake so that combination of


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factors led me to uh pursue a career in


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academic transplant


00:02:08.560 --> 00:02:10.510
neology well what I didn't say in the


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beginning is that you're an associate


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professor of medicine at the University


00:02:14.360 --> 00:02:16.589
of Colorado anuts and also director of


00:02:16.599 --> 00:02:19.390
the Hispanic transplant clinic yep


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that's one of my uh uh babies or


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passions as well that that i' like to do


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and we have a very good team uh here uh


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tackling uh the healthcare dispares that


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Hispanics face in in in this country in


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particularly uh when talking about


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kidney transplantation and I imagine


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that's a topic that probably will weave


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throughout our dialogue today yes ma'am


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so tell us why you want to talk about


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this topic transplantation in the


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context of migration first of all what


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does that mean and why is it important


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so uh as part of the of the the role


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that we have with the Hispanic transfer


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program we see a a decent number of


00:02:59.400 --> 00:03:02.270
undocu dou umented citizens that uh that


00:03:02.280 --> 00:03:05.270
come to this country for work Mo mostly


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for work and then for for x or y reason


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they end up in kidney failure so uh most


00:03:10.680 --> 00:03:12.670
of these patients before they were not


00:03:12.680 --> 00:03:14.750
able to receive any any type of care and


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end up just either going back to their


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country uh of origin to just die or try


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to get some help there so with the


00:03:22.200 --> 00:03:25.550
Hispanic trans uh uh program we try to


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uh help these patients that otherwise


00:03:27.200 --> 00:03:30.350
don't have like an alternative uh with


00:03:30.360 --> 00:03:32.309
the provisions that the states put in


00:03:32.319 --> 00:03:34.350
place uh the state of Colorado back in


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2018 or 2019 some of these patients now


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were able to get dialysis and eventually


00:03:39.200 --> 00:03:41.789
transplant so once that happened we were


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able to help this uh patient population


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that was otherwise unattended or or were


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not receiving the appropriate care so


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that's my first connection to uh talking


00:03:52.280 --> 00:03:54.470
about undocumented citizens uh receiving


00:03:54.480 --> 00:03:55.589
organ


00:03:55.599 --> 00:03:58.069
transplantation uh in in last year in


00:03:58.079 --> 00:04:00.710
2024 Dr Peter Scott which is a a


00:04:00.720 --> 00:04:02.949
transplant surgeon at the University of


00:04:02.959 --> 00:04:04.470
of California in San


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Francisco uh gave a gave a talk about


00:04:07.079 --> 00:04:10.390
this same topic so he was part of a of a


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group of leaders which will talk about


00:04:12.079 --> 00:04:15.630
that met back in 2022 to talk about the


00:04:15.640 --> 00:04:19.270
same talk about uh transplanting the uh


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in the context of migration refugees so


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that talk definitely spark more interest


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in me in trying to get to know more


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about the topic and now I feel like I'm


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in a position to try to uh spread the


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word out and try to make sure that more


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people are aware uh of the findings and


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the things that play here so I'm I'm


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curious to hear a little bit more could


00:04:43.600 --> 00:04:45.710
you tell us before legislation was


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passed in you said 2017 or 2018 what was


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this status for people who are


00:04:51.600 --> 00:04:54.390
undocumented and in kidney failure what


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what did that look like for them so not


00:04:56.960 --> 00:04:58.950
so good uh as you're aware we have a


00:04:58.960 --> 00:05:01.590
friend in common Dr Cervantes CIA cantes


00:05:01.600 --> 00:05:04.430
so she was the master of the one that


00:05:04.440 --> 00:05:07.790
fear hit that here uh in in the state of


00:05:07.800 --> 00:05:09.870
Colorado and she has the big example of


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what happened she had a a patient that


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she identified with and that patient


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unfortunately didn't have insurance and


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was just getting emergency dialysis on a


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on regular basis and unfortunately had


00:05:22.039 --> 00:05:24.150
to just go back to her country of origin


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to die so there they did not have many


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options


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unfortunately well just to clarify for


00:05:30.000 --> 00:05:32.150
our listeners who may not be aware of


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what emergency dialysis it means


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basically someone has to wait until


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they're so sick that they're at risk of


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death before they can get dialysis and


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before that legislation was passed


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that's how people who were undocumented


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that was the only way they could get


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dialysis so that's a terrible way to


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live it's a terrible way to live and


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also like let's talk about the cost of


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emergency dialysis yes so uh Dr


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Cervantes has a very nice study that was


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uh published around four or five years


00:06:02.800 --> 00:06:06.110
ago tackling the same topic so first of


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all as you as Dr Davis was mentioning


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it's not a good thing for patient from


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like mortality or quality of life


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perspective usually uh standard uh in


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Center dialysis patients go three times


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a week to get their treatment to a


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center outside of the emergency facility


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on a control scenario where they're more


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comfortable and they they get adequate


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dialysis uh this patient population that


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have or insure and have kidney failure


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as Dr Davis said they have to go to the


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emergency room and pray that they're


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very sick or even have to fake symptoms


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to be able to get the life- saving


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treatment of dialysis that means a huge


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cost to to the state and and and that's


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something that people are might not be


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aware of so although yes we're talking


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about somebody who is


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undocumented by providing regular


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dialysis to this patient population we


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actually save money and and to the other


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perspective too like the we are


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improving the patients quality of life


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and their life expectancy and as we're


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going to talk about later these are are


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individuals that come here to work and


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are able to provide way more in terms of


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uh money to the economy than they take


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out so it's at least for me having that


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information seems like an orb brainage


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right to help uh these patients yeah


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exactly so just to clarify like if a


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person you know receiving regular


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dialysis treatment they are able to work


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you know not everything will be


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available but they still like we know


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police officers that are still working


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while on dialysis or they can just have


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completely no resources to survive and


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once they literally on the edge of dying


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they getting this emergency dialysis


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like it's just such a no-brainer can you


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go back for a second Sixto to that


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particular legislation was it just


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Colorado specific or what was the name


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of it or was it national can you tell us


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more about that so um in terms so uh in


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general so what's what's the access of


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kidney care for undocumented immigrants


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across the United States so we have a


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nice study from Dr isolo that was


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published in 2023 and that study look at


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the whole landscape of that same


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question across the US so as of 2023


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there were 20 States and DC that


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provided Statewide coverage for standard


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outpatient hemodialysis for undocumented


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immigrants


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um so these patients if they meet


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certain criteria including working and


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having lived in in the states for x


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amount of year they were able to be


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included in this thanks to the 1972 uh


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Medicare ESRD uh program that show that


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tell us that US citizens and lawfully


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present immigrant populations with


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access to care should be able to receive


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dialysis as well so in terms of


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transplant as of 2023 there were five


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stat including the state of Colorado


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California Massachusetts that offer


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transplant access uh through like state


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state funding so obviously the um


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Nationwide covered is still not accepted


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but at least in in their certain pockets


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and states that do have Provisions uh


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through their own phone to try to offer


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uh these patients uh insurance so they


00:09:22.519 --> 00:09:26.310
can uh get um dialysis and


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Transplant so the legislation that


00:09:28.839 --> 00:09:30.630
passed was not not only dialysis but it


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extended to transplant or was that a


00:09:32.399 --> 00:09:34.389
separate legislation it's not a it's not


00:09:34.399 --> 00:09:36.470
a legislation it's an interpretation of


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the existing group so that was already


00:09:39.200 --> 00:09:41.430
put in place back in 1972 we were just


00:09:41.440 --> 00:09:43.350
or like Dr santes was just smart about


00:09:43.360 --> 00:09:45.910
it going through through the uh trying


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to interpret the actual existing law


00:09:48.240 --> 00:09:50.069
differently so and this is something


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that is Statewide we don't use uh


00:09:51.880 --> 00:09:53.750
National Funds which is uh I think it's


00:09:53.760 --> 00:09:56.550
the key um so we use State funds or


00:09:56.560 --> 00:09:58.829
Statewide funds uh to allocate for this


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patient ation okay do you have any


00:10:02.680 --> 00:10:05.710
statistics since that legislation um


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what are the trends like are you seeing


00:10:07.279 --> 00:10:09.190
the difference just on a personal level


00:10:09.200 --> 00:10:11.150
somebody who grew up in Puerto Rica like


00:10:11.160 --> 00:10:14.030
what are you seeing so uh what what we


00:10:14.040 --> 00:10:16.710
did saw which we when when that started


00:10:16.720 --> 00:10:20.470
after 2019 and forward we see like a big


00:10:20.480 --> 00:10:23.069
uh pool of patients that were sitting 10


00:10:23.079 --> 00:10:24.990
or plus years in dialysis and now all of


00:10:25.000 --> 00:10:26.670
a sudden they were able to get


00:10:26.680 --> 00:10:29.509
transplanted um so we saw like a big bat


00:10:29.519 --> 00:10:31.230
or a big number of patients at least in


00:10:31.240 --> 00:10:33.110
our Center probably from the range about


00:10:33.120 --> 00:10:37.350
50 to 75 during those 2019 and 2020


00:10:37.360 --> 00:10:40.150
period they were waiting uh on emergency


00:10:40.160 --> 00:10:42.910
dialysis and and once they were able to


00:10:42.920 --> 00:10:45.910
uh get insurance they were able to uh


00:10:45.920 --> 00:10:48.389
get transplanted and I still follow many


00:10:48.399 --> 00:10:49.990
of those patients and they're doing


00:10:50.000 --> 00:10:53.069
great um they're uh citizens that are


00:10:53.079 --> 00:10:54.829
contributing they're working they're all


00:10:54.839 --> 00:10:56.710
happy they're raising their families and


00:10:56.720 --> 00:10:58.829
contributing to the economy but I think


00:10:58.839 --> 00:11:01.389
it's a it's a great thing that we able


00:11:01.399 --> 00:11:03.870
to do so uh and we we're going to talk


00:11:03.880 --> 00:11:06.949
about it later but uh we have our own


00:11:06.959 --> 00:11:09.829
internal and National Data that shows


00:11:09.839 --> 00:11:11.949
that these patients in terms of outcome


00:11:11.959 --> 00:11:14.030
they do better than any other population


00:11:14.040 --> 00:11:15.670
so if given the opportunity they're


00:11:15.680 --> 00:11:17.550
going to do great Thrive and and and be


00:11:17.560 --> 00:11:20.350
able to continue contributing to to our


00:11:20.360 --> 00:11:22.750
society so why do why do you think they


00:11:22.760 --> 00:11:28.110
do better so it's a combination of um


00:11:28.120 --> 00:11:30.190
there might be some sele ction bias


00:11:30.200 --> 00:11:31.870
meaning that the patients that get


00:11:31.880 --> 00:11:33.629
through the transplant list or even get


00:11:33.639 --> 00:11:36.230
refer are usually younger and healthier


00:11:36.240 --> 00:11:38.269
and uh one one of the other theories is


00:11:38.279 --> 00:11:40.430
like all these sicker older individuals


00:11:40.440 --> 00:11:42.269
don't tend don't tend to go take the


00:11:42.279 --> 00:11:44.470
risk and migrate to another country


00:11:44.480 --> 00:11:46.030
looking for better opportunities the


00:11:46.040 --> 00:11:50.269
vast majority are young healthy uh


00:11:50.279 --> 00:11:52.389
individuals uh that are ready to work


00:11:52.399 --> 00:11:55.269
and unfortunately uh get sequel being


00:11:55.279 --> 00:11:57.389
here and and end up needing dialysis so


00:11:57.399 --> 00:11:58.790
I think that was that's one of the key


00:11:58.800 --> 00:12:02.150
factors why why they do so well uh there


00:12:02.160 --> 00:12:04.550
there are other potential uh theories


00:12:04.560 --> 00:12:06.310
including like for example Hispanics


00:12:06.320 --> 00:12:08.470
have like a big family Lee so they have


00:12:08.480 --> 00:12:10.350
like a strong family support to get them


00:12:10.360 --> 00:12:13.629
through it um once they are able to


00:12:13.639 --> 00:12:15.389
trust or establish a report with the


00:12:15.399 --> 00:12:17.110
provider or the physician they do very


00:12:17.120 --> 00:12:18.590
well and they're very good patients in


00:12:18.600 --> 00:12:20.949
terms of like following instructions and


00:12:20.959 --> 00:12:23.470
doing what what they ask them to but I


00:12:23.480 --> 00:12:24.949
think that the main reason is what we


00:12:24.959 --> 00:12:26.509
are seeing the patient that actually


00:12:26.519 --> 00:12:28.590
getting to the transplant list other the


00:12:28.600 --> 00:12:30.829
cream of the prop or the healthiest of


00:12:30.839 --> 00:12:32.750
that sub group and that's why I think


00:12:32.760 --> 00:12:34.590
they're doing so


00:12:34.600 --> 00:12:38.350
well I want to ask you Sixto so were you


00:12:38.360 --> 00:12:40.550
the one who studied Hispanic transplant


00:12:40.560 --> 00:12:42.590
program initiative at the University of


00:12:42.600 --> 00:12:45.629
Colorado say again were you the one who


00:12:45.639 --> 00:12:49.269
studied Hispanic transpant program the


00:12:49.279 --> 00:12:51.790
idea came about by Dr grafals and Dr


00:12:51.800 --> 00:12:55.550
Elizabeth P so um both of them they're


00:12:55.560 --> 00:12:57.750
no longer working here but they met back


00:12:57.760 --> 00:13:00.069
in Boston and Monica which is from


00:13:00.079 --> 00:13:02.110
Puerto Rico she's the one that recruited


00:13:02.120 --> 00:13:04.629
me to help with the Hispanic program she


00:13:04.639 --> 00:13:07.230
noticed that need back in in in the


00:13:07.240 --> 00:13:08.990
hospital in Boston and then when Dr


00:13:09.000 --> 00:13:11.670
Pomfrey came here and saw a bigger


00:13:11.680 --> 00:13:14.150
number of Hispanic IR population got


00:13:14.160 --> 00:13:16.590
Monica here to to Kickstart the program


00:13:16.600 --> 00:13:18.150
and then two years after when the


00:13:18.160 --> 00:13:19.710
program kept growing that's when they


00:13:19.720 --> 00:13:22.590
recruited me to try to help and then uh


00:13:22.600 --> 00:13:24.189
they both end up leaving and and I took


00:13:24.199 --> 00:13:27.430
the Von and took over how many


00:13:27.440 --> 00:13:30.629
transplant centers across the country


00:13:30.639 --> 00:13:33.350
have Hispanic transplant program or


00:13:33.360 --> 00:13:35.750
initiative so I I said that the number


00:13:35.760 --> 00:13:37.670
is increasing it's very hard to say


00:13:37.680 --> 00:13:39.990
because most of them will portray that


00:13:40.000 --> 00:13:41.509
they do have a Hispanic transplant


00:13:41.519 --> 00:13:43.110
program but at the same time might not


00:13:43.120 --> 00:13:45.430
have the whole the whole key component


00:13:45.440 --> 00:13:47.230
but I said that at least half of the


00:13:47.240 --> 00:13:48.990
transplant programs now have some form


00:13:49.000 --> 00:13:51.230
of initiative of whether having


00:13:51.240 --> 00:13:53.069
interpreters with the information in


00:13:53.079 --> 00:13:56.030
Spanish or having most of the key pieces


00:13:56.040 --> 00:13:57.590
needed to for you to call like a


00:13:57.600 --> 00:13:59.590
Hispanic transer program per se so the


00:13:59.600 --> 00:14:00.990
number is


00:14:01.000 --> 00:14:04.749
increasing I know that your program your


00:14:04.759 --> 00:14:08.350
team you very much focus on cultural


00:14:08.360 --> 00:14:11.470
education and also cultural education


00:14:11.480 --> 00:14:14.230
related to living donation as I'm


00:14:14.240 --> 00:14:16.310
thinking about different cultures I'm


00:14:16.320 --> 00:14:19.389
thinking like Eastern European culture


00:14:19.399 --> 00:14:22.790
for so many people to ask to donate a


00:14:22.800 --> 00:14:25.389
kidney it's basically like asking like


00:14:25.399 --> 00:14:27.150
hey can you give me like cut out your


00:14:27.160 --> 00:14:29.990
hands right so can you talk about that


00:14:30.000 --> 00:14:31.670
like how what do you how can we address


00:14:31.680 --> 00:14:35.350
that so I think uh education is the key


00:14:35.360 --> 00:14:38.749
to success uh in Hispanics which I can


00:14:38.759 --> 00:14:40.749
uh foresee in other different cultures


00:14:40.759 --> 00:14:42.790
as well the same living donation is kind


00:14:42.800 --> 00:14:46.269
of a taboo and if you as a patient 99%


00:14:46.279 --> 00:14:47.829
of the time from they get go they're


00:14:47.839 --> 00:14:49.310
going to say like no are you crazy no of


00:14:49.320 --> 00:14:51.590
course not but once you start educating


00:14:51.600 --> 00:14:53.550
about what living donation entails what


00:14:53.560 --> 00:14:56.230
are their actual risks to the donor


00:14:56.240 --> 00:14:57.550
which in theory if you have a healthy


00:14:57.560 --> 00:14:59.430
donor that qualifies those those risks


00:14:59.440 --> 00:15:01.350
are minimal so when when when patients


00:15:01.360 --> 00:15:03.550
start understanding what is the actual


00:15:03.560 --> 00:15:06.350
risk versus benefit how the process go


00:15:06.360 --> 00:15:09.069
through and once they are well educated


00:15:09.079 --> 00:15:11.189
they tend to come around and and seem


00:15:11.199 --> 00:15:15.629
way more open to the idea and and and


00:15:15.639 --> 00:15:18.470
one of the key uh pieces


00:15:18.480 --> 00:15:21.590
from from this is that the vast majority


00:15:21.600 --> 00:15:22.430
of


00:15:22.440 --> 00:15:25.189
immigrants so I would say so from


00:15:25.199 --> 00:15:26.470
statistics


00:15:26.480 --> 00:15:29.230
60% of undocumented immigrants might


00:15:29.240 --> 00:15:31.150
have a viable living donor so their


00:15:31.160 --> 00:15:32.749
family members their close family


00:15:32.759 --> 00:15:34.790
members are ready to donate but


00:15:34.800 --> 00:15:38.110
obviously for uh because of citizenship


00:15:38.120 --> 00:15:40.829
status most of them are not able to so


00:15:40.839 --> 00:15:42.470
I've had the cases here in which we have


00:15:42.480 --> 00:15:45.069
a viable living donor undocumented but


00:15:45.079 --> 00:15:46.590
I'm not sure about their


00:15:46.600 --> 00:15:49.710
followup so sometimes we are not eager


00:15:49.720 --> 00:15:51.670
to accept those because yes although the


00:15:51.680 --> 00:15:53.430
patient is healthy we are concerned


00:15:53.440 --> 00:15:54.949
about that potential donors in the


00:15:54.959 --> 00:15:57.389
future if they are not able to uh have


00:15:57.399 --> 00:16:00.790
proper medical uh uh uh care


00:16:00.800 --> 00:16:03.910
afterwards so how do you make that


00:16:03.920 --> 00:16:06.790
decision so for the most part I


00:16:06.800 --> 00:16:10.670
ultimately try to steer them through uh


00:16:10.680 --> 00:16:14.150
how to get care so in here up until I


00:16:14.160 --> 00:16:16.189
mean as of now I know that obviously


00:16:16.199 --> 00:16:17.710
things might be changing in the country


00:16:17.720 --> 00:16:20.189
but taking that into a side the state of


00:16:20.199 --> 00:16:24.110
Colorado does does offer uh so far like


00:16:24.120 --> 00:16:27.230
12,000 spots a year for uh medical


00:16:27.240 --> 00:16:29.189
insurance for anybody including


00:16:29.199 --> 00:16:31.990
undocumented citizens so if I have a


00:16:32.000 --> 00:16:33.790
case similar to that I try to steer


00:16:33.800 --> 00:16:36.269
those patients uh for them to get


00:16:36.279 --> 00:16:37.710
insurance so they can actually get


00:16:37.720 --> 00:16:40.990
proper care after and and and I feel


00:16:41.000 --> 00:16:42.389
like comfortable saying okay right now


00:16:42.399 --> 00:16:44.389
you're a good donor and then I am


00:16:44.399 --> 00:16:45.990
comfortable after you have insurance or


00:16:46.000 --> 00:16:48.269
have established medical care you can


00:16:48.279 --> 00:16:49.990
have some for of followup after that


00:16:50.000 --> 00:16:51.870
first year post donation and you should


00:16:51.880 --> 00:16:52.910
be


00:16:52.920 --> 00:16:56.110
okay and in the current state are they


00:16:56.120 --> 00:16:58.670
usually able to get insurance through


00:16:58.680 --> 00:17:01.829
that so as of now yes so obviously the


00:17:01.839 --> 00:17:03.749
the spots for for example the omnis


00:17:03.759 --> 00:17:05.549
Salud or the initiative the Colorado


00:17:05.559 --> 00:17:07.309
State initiative should have already


00:17:07.319 --> 00:17:10.189
filled the spots by uh January 1 before


00:17:10.199 --> 00:17:14.230
like the change in um in in in policy


00:17:14.240 --> 00:17:15.949
and in government so those spots are


00:17:15.959 --> 00:17:18.429
filled and they're going to be uh


00:17:18.439 --> 00:17:21.110
fulfilled at least for the next year


00:17:21.120 --> 00:17:22.870
things can change but I I don't forese


00:17:22.880 --> 00:17:24.829
seee that changing in our state so I'm


00:17:24.839 --> 00:17:27.189
hopeful that that provision will stay in


00:17:27.199 --> 00:17:29.270
place


00:17:29.280 --> 00:17:31.470
now you were part of a workshop looking


00:17:31.480 --> 00:17:33.549
at this topic right can you tell us


00:17:33.559 --> 00:17:34.990
about that workshop and what the point


00:17:35.000 --> 00:17:39.150
of that Workshop was so at least I


00:17:39.160 --> 00:17:42.430
participated in the in the state


00:17:42.440 --> 00:17:45.630
initiative uh and Dr Cervantes also


00:17:45.640 --> 00:17:47.350
spoke and we just trying to advocate for


00:17:47.360 --> 00:17:49.669
our patient population so the


00:17:49.679 --> 00:17:52.190
insurance uh you had to renew each each


00:17:52.200 --> 00:17:54.710
year and then you started from zero next


00:17:54.720 --> 00:17:58.310
year so My my point was like hey we are


00:17:58.320 --> 00:18:00.230
transplanting these patients if they


00:18:00.240 --> 00:18:02.230
don't have insurance they and they


00:18:02.240 --> 00:18:03.430
cannot pay their medications they're


00:18:03.440 --> 00:18:05.750
going to lose their their transplant


00:18:05.760 --> 00:18:07.029
their transplant so they're they're


00:18:07.039 --> 00:18:08.830
going to be back probably worse than


00:18:08.840 --> 00:18:10.990
they uh than they started because


00:18:11.000 --> 00:18:12.190
they're going to be sensitized they're


00:18:12.200 --> 00:18:13.430
going to be harder for them to get like


00:18:13.440 --> 00:18:15.669
a second transplant center might say


00:18:15.679 --> 00:18:17.510
like oh you're non compliant so my ask


00:18:17.520 --> 00:18:19.950
was for make to give priority to these


00:18:19.960 --> 00:18:22.590
patients and uh we were successful and


00:18:22.600 --> 00:18:24.230
as of this year all of our transplant


00:18:24.240 --> 00:18:25.590
patients and patients with chronic


00:18:25.600 --> 00:18:27.909
disease like cancer as well were given


00:18:27.919 --> 00:18:30.149
priority on the opportunity to to get


00:18:30.159 --> 00:18:33.029
reinsured without having to uh wait in


00:18:33.039 --> 00:18:35.510
the que online or RIS not getting


00:18:35.520 --> 00:18:38.230
Insurance the the other important like


00:18:38.240 --> 00:18:40.390
uh at least like on a on a nationwide


00:18:40.400 --> 00:18:43.390
perspective which was like the uh the


00:18:43.400 --> 00:18:46.510
topic that uh doctors uh stock talked


00:18:46.520 --> 00:18:48.549
about the the veil controversies meeting


00:18:48.559 --> 00:18:52.750
so it was like a a a world meeting for


00:18:52.760 --> 00:18:55.430
different countries uh people from from


00:18:55.440 --> 00:18:58.230
the States from Poland Colombia Spain


00:18:58.240 --> 00:19:02.070
Australia Qatar Lebanon they the all uh


00:19:02.080 --> 00:19:04.230
experts in organ transplantation they


00:19:04.240 --> 00:19:07.430
met in Argentina in 2022 um the meeting


00:19:07.440 --> 00:19:09.510
was called the Declaration of Istanbul


00:19:09.520 --> 00:19:11.230
uh or organ traffic and Transplant


00:19:11.240 --> 00:19:14.230
tourism so that Workshop they try to


00:19:14.240 --> 00:19:16.510
focus on on discussing the the


00:19:16.520 --> 00:19:18.590
vulnerability of these migrant and


00:19:18.600 --> 00:19:21.350
refugees in terms of trafficking organs


00:19:21.360 --> 00:19:23.870
and then the finan financial coercion


00:19:23.880 --> 00:19:26.510
that some of them were suffering they


00:19:26.520 --> 00:19:28.710
also discussed like the access of care


00:19:28.720 --> 00:19:30.470
for migrants and refugees and and


00:19:30.480 --> 00:19:32.110
particularly for those with endstage


00:19:32.120 --> 00:19:34.590
organ disease needing transplant for


00:19:34.600 --> 00:19:35.990
transplant recipients and then


00:19:36.000 --> 00:19:37.710
ultimately they try to discuss about


00:19:37.720 --> 00:19:40.430
potential strategies about the Fallout


00:19:40.440 --> 00:19:42.510
of offering transplant to these migrant


00:19:42.520 --> 00:19:44.870
refugees on uh take it into account that


00:19:44.880 --> 00:19:46.510
they were potentially using the


00:19:46.520 --> 00:19:48.990
resources of availability of available


00:19:49.000 --> 00:19:51.830
organs um to local citizens and try to


00:19:51.840 --> 00:19:56.149
mitigate that follow so um overall so in


00:19:56.159 --> 00:19:58.270
in that in that Workshop each of the


00:19:58.280 --> 00:20:00.830
repres from each country gave like a


00:20:00.840 --> 00:20:02.789
quick overview of what were the status


00:20:02.799 --> 00:20:07.029
of their country to try to compare um so


00:20:07.039 --> 00:20:08.950
the big big picture of the meeting is


00:20:08.960 --> 00:20:10.549
that they realize that yeah there's a


00:20:10.559 --> 00:20:13.029
disparate access to transplant Service


00:20:13.039 --> 00:20:15.029
uh for these migrants and but it was


00:20:15.039 --> 00:20:17.510
dependent on the resources and access to


00:20:17.520 --> 00:20:19.549
transplant for care citizen in each


00:20:19.559 --> 00:20:23.230
region so region with greater resources


00:20:23.240 --> 00:20:24.789
had potentially more willingness to


00:20:24.799 --> 00:20:27.029
allocate organs to these migrants and


00:20:27.039 --> 00:20:29.510
refugees uh compared to others that


00:20:29.520 --> 00:20:32.549
don't have the the resource But


00:20:32.559 --> 00:20:34.110
ultimately that willingness was


00:20:34.120 --> 00:20:36.110
compromised by the natural concerns that


00:20:36.120 --> 00:20:38.149
the citizens might be negatively


00:20:38.159 --> 00:20:40.510
impacted uh because of the scarce


00:20:40.520 --> 00:20:43.590
resources that we talked about and then


00:20:43.600 --> 00:20:46.669
also regions where the access uh was


00:20:46.679 --> 00:20:51.549
scare scarce um and in some places even


00:20:51.559 --> 00:20:54.149
the the natives were not able to pursue


00:20:54.159 --> 00:20:55.950
organ transplantation so in those cases


00:20:55.960 --> 00:20:59.230
we actually uh not feasible uh the best


00:20:59.240 --> 00:21:01.350
example and most relevant I would say is


00:21:01.360 --> 00:21:05.070
like the Poland which was uh Dr jolanta


00:21:05.080 --> 00:21:09.029
malis spoke about so they they received


00:21:09.039 --> 00:21:13.310
um as of 2022 uh more than 8 million


00:21:13.320 --> 00:21:16.190
Ukrainian uh citizens across the Polish


00:21:16.200 --> 00:21:20.470
border um so ultimately like about six


00:21:20.480 --> 00:21:22.070
six more million were able to return but


00:21:22.080 --> 00:21:24.230
in Poland at least 2 million arcan


00:21:24.240 --> 00:21:28.750
refugees uh remain so uh Poland did


00:21:28.760 --> 00:21:30.350
something very nice and generous and


00:21:30.360 --> 00:21:32.310
they were able to provide like a Polish


00:21:32.320 --> 00:21:35.390
uh polish ID identification um number


00:21:35.400 --> 00:21:37.430
which gave them access to the basic


00:21:37.440 --> 00:21:40.230
drugs and and health care and ultimately


00:21:40.240 --> 00:21:42.029
the Polish national health established a


00:21:42.039 --> 00:21:44.029
fund which were able uh which helped


00:21:44.039 --> 00:21:45.669
these patients cover for dialysis


00:21:45.679 --> 00:21:48.149
service in public and nonpublic units


00:21:48.159 --> 00:21:50.350
and be able to provide reimbursements of


00:21:50.360 --> 00:21:52.350
renal replacement therapy and Transplant


00:21:52.360 --> 00:21:54.870
for these refugees so that's Quon call


00:21:54.880 --> 00:21:58.789
like a great model about what about how


00:21:58.799 --> 00:22:01.789
how we should we should do things um to


00:22:01.799 --> 00:22:03.870
put in contrast for example in Colombia


00:22:03.880 --> 00:22:06.070
which you have close to three million


00:22:06.080 --> 00:22:07.430
Venezuelan


00:22:07.440 --> 00:22:11.710
immigrants um in 2004 there was a a a


00:22:11.720 --> 00:22:16.110
law or a decree called number 2493 um


00:22:16.120 --> 00:22:18.110
that made it almost impossible for a


00:22:18.120 --> 00:22:19.669
foreigner to get a deceased donor


00:22:19.679 --> 00:22:22.830
transplant but living organ donation was


00:22:22.840 --> 00:22:25.190
still permitted uh now the caveat is


00:22:25.200 --> 00:22:27.549
that um if you're able to stay or live


00:22:27.559 --> 00:22:29.630
there long enough event eventually you


00:22:29.640 --> 00:22:32.549
would become um a legal resident so of


00:22:32.559 --> 00:22:34.430
close of the 3 million immigrants from


00:22:34.440 --> 00:22:36.990
Venezuela to Colombia after three to


00:22:37.000 --> 00:22:39.430
four years close to 70% of them were


00:22:39.440 --> 00:22:41.149
legal residents and they were able to


00:22:41.159 --> 00:22:44.190
actually after enter the the local pool


00:22:44.200 --> 00:22:47.710
for deceased uh donation so with that


00:22:47.720 --> 00:22:50.549
being said Dr Mercia which gave the talk


00:22:50.559 --> 00:22:52.870
about Colombia did says that uh the


00:22:52.880 --> 00:22:54.149
Colombia was facing like major


00:22:54.159 --> 00:22:56.630
Healthcare reform and he was not certain


00:22:56.640 --> 00:22:58.830
that this organ transplantation


00:22:58.840 --> 00:23:00.350
was going to be able to


00:23:00.360 --> 00:23:03.549
continue um other places spoke like from


00:23:03.559 --> 00:23:05.669
Lebanon for example in Lebanon there was


00:23:05.679 --> 00:23:09.230
like a from the C Syrian Civil War in


00:23:09.240 --> 00:23:12.950
2011 to multiple conflicts made like a


00:23:12.960 --> 00:23:18.190
disaster uh or kind of like um overall


00:23:18.200 --> 00:23:19.590
like a pretty bad


00:23:19.600 --> 00:23:21.990
picture H most more than half of this


00:23:22.000 --> 00:23:24.669
transplant centers closed uh they were


00:23:24.679 --> 00:23:27.750
able to um to not do as many transplant


00:23:27.760 --> 00:23:29.950
they were doing about 80 transplant per


00:23:29.960 --> 00:23:32.830
year in terms of across the the number


00:23:32.840 --> 00:23:35.029
so that's that's that's a typical case


00:23:35.039 --> 00:23:37.230
scenario of of things not going well


00:23:37.240 --> 00:23:40.110
when there's ongoing conflict uh other


00:23:40.120 --> 00:23:42.470
places like Australia and Qatar which


00:23:42.480 --> 00:23:44.390
had decent number of immigrants to were


00:23:44.400 --> 00:23:46.830
able to have some provisions and then


00:23:46.840 --> 00:23:50.149
another good example was Spain uh they


00:23:50.159 --> 00:23:52.789
also had like a royal degree back in 200


00:23:52.799 --> 00:23:56.029
18 that provided universal access to the


00:23:56.039 --> 00:23:58.430
National healthc care system as long


00:23:58.440 --> 00:23:59.630
long as they were able to live three


00:23:59.640 --> 00:24:01.710
months there or to prove that they were


00:24:01.720 --> 00:24:03.110
there in Spain for at least three months


00:24:03.120 --> 00:24:05.269
they were able to get this uh health


00:24:05.279 --> 00:24:08.510
insurance and be able to provide care so


00:24:08.520 --> 00:24:10.510
uh that's another great example of


00:24:10.520 --> 00:24:13.870
things uh that can go


00:24:13.880 --> 00:24:15.710
well


00:24:15.720 --> 00:24:19.470
great you um you briefly mentioned organ


00:24:19.480 --> 00:24:21.590
trafficking and I think for most people


00:24:21.600 --> 00:24:22.669
that's something they've only heard


00:24:22.679 --> 00:24:24.630
about like in a bad movie or something


00:24:24.640 --> 00:24:26.149
and so can you tell us more about the


00:24:26.159 --> 00:24:29.789
reality of that and the implications


00:24:29.799 --> 00:24:32.909
so the so the reality is that at least


00:24:32.919 --> 00:24:35.630
in um third world countries it it it's


00:24:35.640 --> 00:24:38.750
way more common than than we would think


00:24:38.760 --> 00:24:42.110
and and and and for example the in in


00:24:42.120 --> 00:24:43.990
Lebanon which is like a humanitarian


00:24:44.000 --> 00:24:46.870
crisis we're talking about people that


00:24:46.880 --> 00:24:50.269
don't have resources to eat and live and


00:24:50.279 --> 00:24:52.350
then you have wealthy individuals going


00:24:52.360 --> 00:24:55.470
to these places to try to buy some some


00:24:55.480 --> 00:24:57.870
some organs so Lebanon went from being


00:24:57.880 --> 00:25:00.190
called a s land of Middle East a place


00:25:00.200 --> 00:25:02.830
where the same Dr barbari mentioned that


00:25:02.840 --> 00:25:04.789
he doesn't see like any


00:25:04.799 --> 00:25:07.909
U any Improvement in the foreseeable uh


00:25:07.919 --> 00:25:09.870
future and it's like a he called it like


00:25:09.880 --> 00:25:12.990
hopeless human tragedy and at least in


00:25:13.000 --> 00:25:14.549
Lebanon there was a pretty high


00:25:14.559 --> 00:25:16.630
propensity of of people being taken


00:25:16.640 --> 00:25:19.830
advantage of and and and getting paid


00:25:19.840 --> 00:25:22.990
for Gan donation so it's not about the


00:25:23.000 --> 00:25:25.110
payment per se but obviously taking


00:25:25.120 --> 00:25:27.230
advantage of somebody in need who is


00:25:27.240 --> 00:25:29.830
donating uh which for example in the


00:25:29.840 --> 00:25:31.310
state that's something I've heard of or


00:25:31.320 --> 00:25:32.870
something that we're very Sous and the


00:25:32.880 --> 00:25:34.510
living donor Advocate is looking for


00:25:34.520 --> 00:25:37.430
that always but these patients don't


00:25:37.440 --> 00:25:38.870
have their proper followup after


00:25:38.880 --> 00:25:41.110
donation and they're taking advantage of


00:25:41.120 --> 00:25:46.310
and so it's a sad situation very sad and


00:25:46.320 --> 00:25:48.630
on the subject of organ trafficking


00:25:48.640 --> 00:25:52.310
usually does it take place at some


00:25:52.320 --> 00:25:54.470
proper medical facility or it's not even


00:25:54.480 --> 00:25:57.470
under yeah yeah that that's another


00:25:57.480 --> 00:25:59.430
great point it's not in the in the


00:25:59.440 --> 00:26:02.549
cleanest place or or in a place where um


00:26:02.559 --> 00:26:05.470
you should get ever operated on so


00:26:05.480 --> 00:26:07.669
another another potential risk for that


00:26:07.679 --> 00:26:11.070
uh for that potential donor in which you


00:26:11.080 --> 00:26:13.710
are doing a major medical procedure in a


00:26:13.720 --> 00:26:16.430
place where you should not be dealing


00:26:16.440 --> 00:26:18.669
with with with human life and livelihood


00:26:18.679 --> 00:26:21.070
like that definitely so another good


00:26:21.080 --> 00:26:24.470
point yeah you might get some money but


00:26:24.480 --> 00:26:26.510
then you will end up dying for there's


00:26:26.520 --> 00:26:28.789
so many complications


00:26:28.799 --> 00:26:30.870
so so much that can go wrong it's just


00:26:30.880 --> 00:26:33.389
terrible as we were preparing for the


00:26:33.399 --> 00:26:35.430
podcast you send us some research


00:26:35.440 --> 00:26:36.950
information I thought it was very


00:26:36.960 --> 00:26:39.830
interesting um when it says that


00:26:39.840 --> 00:26:42.750
noncitizen organ donors in the United


00:26:42.760 --> 00:26:44.310
States of America the number of


00:26:44.320 --> 00:26:48.029
non-citizen organ donors far exceeds the


00:26:48.039 --> 00:26:51.789
number of non-citizen recipients so more


00:26:51.799 --> 00:26:54.630
people donate organs versus receive can


00:26:54.640 --> 00:26:57.070
you like explain and when you mean


00:26:57.080 --> 00:26:59.350
non-citizens versus is non-documented


00:26:59.360 --> 00:27:01.990
that also would be great of course so um


00:27:02.000 --> 00:27:04.549
to start with as of 2012 the United


00:27:04.559 --> 00:27:06.710
Network for organ sharing or unas which


00:27:06.720 --> 00:27:10.549
is the uh um agency that is in charge of


00:27:10.559 --> 00:27:12.389
regulating and overseeing transplant in


00:27:12.399 --> 00:27:15.990
the US as so 201 12 they actually


00:27:16.000 --> 00:27:19.350
started asking citizenship for all


00:27:19.360 --> 00:27:22.470
potential um organ recipients that were


00:27:22.480 --> 00:27:23.830
listed in the states and and the


00:27:23.840 --> 00:27:25.789
classifications were US


00:27:25.799 --> 00:27:29.310
citizen non- US citizen us resident non


00:27:29.320 --> 00:27:32.190
US citizen non- us resident uh that


00:27:32.200 --> 00:27:34.990
traveled for the US for reason other


00:27:35.000 --> 00:27:37.990
than transplant and then ultimately non


00:27:38.000 --> 00:27:41.389
US citizen non- us resident that travel


00:27:41.399 --> 00:27:45.029
to the US for for transplant and and and


00:27:45.039 --> 00:27:47.750
at least the last one for those who who


00:27:47.760 --> 00:27:49.590
come here for organ transplantation it's


00:27:49.600 --> 00:27:51.230
like a different story they


00:27:51.240 --> 00:27:53.350
require it's like a a different


00:27:53.360 --> 00:27:55.509
requirement uh they need to put their


00:27:55.519 --> 00:27:57.149
country of origin and that's the the


00:27:57.159 --> 00:27:59.430
least of the cases so but for the most


00:27:59.440 --> 00:28:02.630
part we have citizenship citizenship


00:28:02.640 --> 00:28:05.110
classification since then and we were


00:28:05.120 --> 00:28:06.549
able to distinguish if they're US


00:28:06.559 --> 00:28:10.870
citizens or non non US citizens so um in


00:28:10.880 --> 00:28:14.630
terms of um how many undocumented cases


00:28:14.640 --> 00:28:17.909
in the US So based on the organ OPN


00:28:17.919 --> 00:28:19.830
which stands for organ procurement and


00:28:19.840 --> 00:28:22.230
Transplant Network they did a study back


00:28:22.240 --> 00:28:24.870
in 2018 and they estimated that


00:28:24.880 --> 00:28:27.470
approximately 1% of the of the kiny


00:28:27.480 --> 00:28:29.909
transplant res iens in the US were


00:28:29.919 --> 00:28:32.190
non-citizens and and and and they were


00:28:32.200 --> 00:28:34.149
comp composed most of them from


00:28:34.159 --> 00:28:36.389
undocumented immigrants and permanent


00:28:36.399 --> 00:28:39.230
residents with legal uh with legal visas


00:28:39.240 --> 00:28:42.430
meaning non uh US citizen but us


00:28:42.440 --> 00:28:45.029
residents so in terms of the waiting


00:28:45.039 --> 00:28:46.990
list there was an average of


00:28:47.000 --> 00:28:51.149
s% uh non US citizens that compromised


00:28:51.159 --> 00:28:53.509
the waiting list as of 2021


00:28:53.519 --> 00:28:56.870
so most importantly they contribute


00:28:56.880 --> 00:28:58.549
close to three


00:28:58.559 --> 00:29:02.190
3.3% at least uh of the organ pool so


00:29:02.200 --> 00:29:04.870
meaning of all the organ donors that we


00:29:04.880 --> 00:29:07.669
have uh on the United States at the very


00:29:07.679 --> 00:29:12.350
least 3.3% of them are considered non us


00:29:12.360 --> 00:29:14.950
uh US citizens or undocumented uh


00:29:14.960 --> 00:29:17.029
citizens and we think that that number


00:29:17.039 --> 00:29:19.830
is bigger because there's 10% of organ


00:29:19.840 --> 00:29:23.470
donors that don't have citizen ship uh


00:29:23.480 --> 00:29:26.149
status in place I thought that that's


00:29:26.159 --> 00:29:28.549
that's a really high number 10% like we


00:29:28.559 --> 00:29:30.389
don't know the citizenship setup so we


00:29:30.399 --> 00:29:32.029
assume that at least half of them


00:29:32.039 --> 00:29:35.669
probably also that category when as when


00:29:35.679 --> 00:29:38.149
the opo procurements were asked about


00:29:38.159 --> 00:29:40.230
why is that they thought that they were


00:29:40.240 --> 00:29:42.470
like non US citizen and they feel


00:29:42.480 --> 00:29:45.190
comfortable asking because of fear that


00:29:45.200 --> 00:29:47.230
people might decide not to donate or


00:29:47.240 --> 00:29:49.389
that the actual uh family of the


00:29:49.399 --> 00:29:51.389
potential uh donor would say like hey I


00:29:51.399 --> 00:29:54.750
don't want to I don't want so yes we


00:29:54.760 --> 00:29:58.509
estimate that the percentage of of of


00:29:58.519 --> 00:30:01.389
organs that come from non- US citizen is


00:30:01.399 --> 00:30:03.070
more but at the very least documented


00:30:03.080 --> 00:30:06.750
3.3% so that's a surplus of organs if


00:30:06.760 --> 00:30:09.230
they're taking close to 1% and and they


00:30:09.240 --> 00:30:11.230
they're donating close to 4% they're


00:30:11.240 --> 00:30:14.029
actually contributing more toan pool


00:30:14.039 --> 00:30:16.070
than than they're taking and is that


00:30:16.080 --> 00:30:18.710
both deceased and living donors that's


00:30:18.720 --> 00:30:20.470
that's only deceased only deceased


00:30:20.480 --> 00:30:22.190
wellow yes don't deceased so yeah as I


00:30:22.200 --> 00:30:26.110
said there's a big chunk of of of non uh


00:30:26.120 --> 00:30:28.549
US citizens that are willing to donate


00:30:28.559 --> 00:30:31.070
we do have multiple cases but the vast


00:30:31.080 --> 00:30:32.789
majority are constrained by the lack of


00:30:32.799 --> 00:30:36.269
insurance and proper followup so if


00:30:36.279 --> 00:30:37.909
we're able to accept this patient we


00:30:37.919 --> 00:30:40.070
even have more donors so they contribute


00:30:40.080 --> 00:30:43.070
to both to to the living donor pool and


00:30:43.080 --> 00:30:45.029
the diseased donor pool but that


00:30:45.039 --> 00:30:48.750
statistics are mainly from the disease


00:30:48.760 --> 00:30:51.149
donors I'm reading this book it's called


00:30:51.159 --> 00:30:53.310
the elephant in the room so I'm


00:30:53.320 --> 00:30:54.590
challenging


00:30:54.600 --> 00:30:57.990
myself it's like my experiment like in


00:30:58.000 --> 00:30:59.750
every conversation and every podcast


00:30:59.760 --> 00:31:01.310
like what's the elant in the room and


00:31:01.320 --> 00:31:04.230
how can I ask that question without


00:31:04.240 --> 00:31:06.750
being you know thrown stones in my face


00:31:06.760 --> 00:31:08.149
but you know at the American transplant


00:31:08.159 --> 00:31:11.110
Foundation we work with just people of


00:31:11.120 --> 00:31:12.909
all walks of life from all over the


00:31:12.919 --> 00:31:17.149
world and sometimes like we do ask we


00:31:17.159 --> 00:31:19.110
are ask this question my mom has been


00:31:19.120 --> 00:31:21.070
waiting for kidney transplant for five


00:31:21.080 --> 00:31:23.430
years we are concerned that if it will


00:31:23.440 --> 00:31:26.310
be easier for undocumented immigrants to


00:31:26.320 --> 00:31:28.830
get a kidney transplant like she will


00:31:28.840 --> 00:31:30.909
never get a transplant it will be even


00:31:30.919 --> 00:31:33.190
worse like what would be your response


00:31:33.200 --> 00:31:37.590
to that so uh my response would be that


00:31:37.600 --> 00:31:40.750
uh undocumented citizens will not affect


00:31:40.760 --> 00:31:42.789
their waiting time or their chances of


00:31:42.799 --> 00:31:45.430
uh of receiving a transplant so


00:31:45.440 --> 00:31:47.990
everybody will have to wait the same in


00:31:48.000 --> 00:31:51.110
terms of so the same criteria for


00:31:51.120 --> 00:31:52.269
somebody


00:31:52.279 --> 00:31:54.230
waiting so it's going to be the same


00:31:54.240 --> 00:31:56.470
either you're a citizen or a non- US


00:31:56.480 --> 00:31:59.509
citizen so with that being said we have


00:31:59.519 --> 00:32:01.789
to take it into account that yeah there


00:32:01.799 --> 00:32:03.230
there is like a said


00:32:03.240 --> 00:32:08.430
7% of of patients being um be being on


00:32:08.440 --> 00:32:10.830
the weight list that are non- US citizen


00:32:10.840 --> 00:32:13.269
so you would say like oh but that 7%


00:32:13.279 --> 00:32:14.950
might affect my chance but if you take


00:32:14.960 --> 00:32:17.909
into account the removal of those


00:32:17.919 --> 00:32:19.549
patients on the waiting list you will


00:32:19.559 --> 00:32:22.549
also take take out those 3.3% of of


00:32:22.559 --> 00:32:24.789
organs that are being donated so at


00:32:24.799 --> 00:32:27.029
least three point and it's more so if


00:32:27.039 --> 00:32:28.549
you take one you're going to the other


00:32:28.559 --> 00:32:32.190
so I think that is better if this uh if


00:32:32.200 --> 00:32:33.990
this if we are allowed for non US


00:32:34.000 --> 00:32:35.870
citizen to participate in the Oregon


00:32:35.880 --> 00:32:37.750
pool because they're going to yes take


00:32:37.760 --> 00:32:38.870
some more guns but they're actually


00:32:38.880 --> 00:32:40.509
giving more so it's better for them to


00:32:40.519 --> 00:32:42.710
participate so I I don't think it it


00:32:42.720 --> 00:32:45.669
takes into effect having non- US citizen


00:32:45.679 --> 00:32:47.909
on on our weight list just for those


00:32:47.919 --> 00:32:50.669
reasons um and more importantly which is


00:32:50.679 --> 00:32:52.870
a topic that when I discuss it most of


00:32:52.880 --> 00:32:55.269
the people are like what is like one of


00:32:55.279 --> 00:32:57.509
the other arguments against people are


00:32:57.519 --> 00:33:00.230
like on documented citizens receiving


00:33:00.240 --> 00:33:03.269
transplant is that they say like oh but


00:33:03.279 --> 00:33:07.149
um if if the if non us if non-citizens


00:33:07.159 --> 00:33:08.870
don't contribute economically to the


00:33:08.880 --> 00:33:11.470
system why should they get access and


00:33:11.480 --> 00:33:14.470
there's multiple studies tackling this


00:33:14.480 --> 00:33:17.509
uh but there was a nice study uh


00:33:17.519 --> 00:33:21.590
published by Salman and it was back in


00:33:21.600 --> 00:33:24.950
2013 that that studied how much


00:33:24.960 --> 00:33:26.990
immigrants contributed to for example


00:33:27.000 --> 00:33:29.870
the Medicaid Trust F and what we found


00:33:29.880 --> 00:33:32.190
is actually they contribute more they


00:33:32.200 --> 00:33:35.470
have an excess or Surplus so uh they


00:33:35.480 --> 00:33:38.629
actually contribute more to the to the


00:33:38.639 --> 00:33:41.950
medic trust fund than than us born


00:33:41.960 --> 00:33:44.990
people so they actually leave a surplus


00:33:45.000 --> 00:33:47.830
the the immigrants because as many


00:33:47.840 --> 00:33:50.750
people might not be aware these


00:33:50.760 --> 00:33:53.789
immigrants pay taxes they work and and


00:33:53.799 --> 00:33:56.070
they pay pay taxes and most of them are


00:33:56.080 --> 00:33:58.190
young and healthy so they actually don't


00:33:58.200 --> 00:34:00.389
use as much from that Medicare funding


00:34:00.399 --> 00:34:02.629
so that explains why they actually have


00:34:02.639 --> 00:34:06.190
a surplus so H in


00:34:06.200 --> 00:34:09.550
2009 the immigrants made close to 15% of


00:34:09.560 --> 00:34:11.909
the Medicaid trust fund contribution but


00:34:11.919 --> 00:34:14.109
only accounted for 7% of the


00:34:14.119 --> 00:34:16.710
expenditures and that led to a net


00:34:16.720 --> 00:34:20.829
surplus of close to4 billion if you put


00:34:20.839 --> 00:34:22.869
that in contrast with the US born people


00:34:22.879 --> 00:34:24.950
they actually generated a 30 billion


00:34:24.960 --> 00:34:27.869
deficit so these immigrants have a


00:34:27.879 --> 00:34:31.669
Surplus and one of the uh key points of


00:34:31.679 --> 00:34:34.710
of this study says like hey uh we need


00:34:34.720 --> 00:34:37.990
policies that restrict uh so that help


00:34:38.000 --> 00:34:39.550
immigrants because if we keep putting


00:34:39.560 --> 00:34:41.550
policies that will restrict this IM that


00:34:41.560 --> 00:34:43.909
immigrant from participating we might


00:34:43.919 --> 00:34:46.310
deplete uh Medicare Financial Resources


00:34:46.320 --> 00:34:48.829
so it's actually better for us to have


00:34:48.839 --> 00:34:50.389
these people working and pay taxes


00:34:50.399 --> 00:34:51.990
because they're contributing


00:34:52.000 --> 00:34:54.069
more which is something that if you


00:34:54.079 --> 00:34:55.790
think about it it's like oh okay this


00:34:55.800 --> 00:34:57.470
makes sense why why we should consider


00:34:57.480 --> 00:34:58.150
this


00:34:58.160 --> 00:35:01.109
uh these patients in transplant and


00:35:01.119 --> 00:35:02.990
another like important point that I find


00:35:03.000 --> 00:35:05.069
very interesting is that


00:35:05.079 --> 00:35:08.030
95% of these undocumented immigrants are


00:35:08.040 --> 00:35:11.069
working citizens so we're talking about


00:35:11.079 --> 00:35:13.750
that they the vast majority of them come


00:35:13.760 --> 00:35:16.390
here to work and another point that came


00:35:16.400 --> 00:35:18.349
out is like oh and what if the people


00:35:18.359 --> 00:35:20.230
come here just to get transplant and


00:35:20.240 --> 00:35:23.829
that was this proven by uh


00:35:23.839 --> 00:35:26.829
also a study from pediatric K transplant


00:35:26.839 --> 00:35:29.030
recipients that show that on average


00:35:29.040 --> 00:35:31.349
patients are here in the state for more


00:35:31.359 --> 00:35:33.190
than five years be before they seek


00:35:33.200 --> 00:35:34.910
medical care for kidneys so they're not


00:35:34.920 --> 00:35:36.190
moving here because they need a


00:35:36.200 --> 00:35:37.710
transplant or medical here they're


00:35:37.720 --> 00:35:39.790
they're moving for because they're


00:35:39.800 --> 00:35:40.950
looking for a better life they're


00:35:40.960 --> 00:35:43.109
looking for work they want to be able to


00:35:43.119 --> 00:35:44.349
provide for their families and


00:35:44.359 --> 00:35:45.870
unfortunately they get sick while being


00:35:45.880 --> 00:35:51.270
here so if if someone is an undocumented


00:35:51.280 --> 00:35:53.710
immigrant and they have kidney problems


00:35:53.720 --> 00:35:56.270
and they're not connected with healthc


00:35:56.280 --> 00:35:58.470
care what would would be your general


00:35:58.480 --> 00:36:00.510
advice say across the United States I


00:36:00.520 --> 00:36:03.069
know that's hard to answer generally but


00:36:03.079 --> 00:36:05.950
so it it's hard so


00:36:05.960 --> 00:36:08.790
ideally I try to to look for some way


00:36:08.800 --> 00:36:10.790
where we can get insurance so in the


00:36:10.800 --> 00:36:13.230
ideal scenario if you're not able to


00:36:13.240 --> 00:36:16.150
qualify for some form of like state


00:36:16.160 --> 00:36:18.390
funded initiative or state funded


00:36:18.400 --> 00:36:20.550
insurance I would try to get private


00:36:20.560 --> 00:36:24.150
insurance but that's very expensive but


00:36:24.160 --> 00:36:26.150
uh ideally just try to get some form of


00:36:26.160 --> 00:36:28.589
insurance to try to get uh transplanted


00:36:28.599 --> 00:36:30.790
so for example in here we have the


00:36:30.800 --> 00:36:32.910
hospital care discount which we use for


00:36:32.920 --> 00:36:34.470
patients that we know that don't don't


00:36:34.480 --> 00:36:36.069
have insurance and don't


00:36:36.079 --> 00:36:38.670
qualified uh for the state approv the


00:36:38.680 --> 00:36:40.190
state funding initiative but we still


00:36:40.200 --> 00:36:42.270
try to help them out for the same reason


00:36:42.280 --> 00:36:43.349
knowing that it's going to be more


00:36:43.359 --> 00:36:45.349
expensive for the state to keep these


00:36:45.359 --> 00:36:47.430
patients on dialysis


00:36:47.440 --> 00:36:49.550
and it's going to be better for them


00:36:49.560 --> 00:36:50.910
because they're going to go back to work


00:36:50.920 --> 00:36:53.109
and contribute to society so ideally try


00:36:53.119 --> 00:36:55.550
to uh move to a state where you can get


00:36:55.560 --> 00:36:59.309
provided better care


00:36:59.319 --> 00:37:02.630
as we're talking about like long-term


00:37:02.640 --> 00:37:06.309
Solutions it's obvious that we need more


00:37:06.319 --> 00:37:07.470
living


00:37:07.480 --> 00:37:11.230
donors what needs to happen that more


00:37:11.240 --> 00:37:13.790
undocumented living donors are able to


00:37:13.800 --> 00:37:16.109
step forward knowing that there are


00:37:16.119 --> 00:37:18.190
certain guarantees for them in the


00:37:18.200 --> 00:37:21.550
future if they need medical followup if


00:37:21.560 --> 00:37:23.270
they have medical complications that


00:37:23.280 --> 00:37:26.030
they're not going to be just left alone


00:37:26.040 --> 00:37:28.829
struggling so


00:37:28.839 --> 00:37:31.589
that's a very uh complex or or hard


00:37:31.599 --> 00:37:34.510
question to to to answer my my


00:37:34.520 --> 00:37:37.190
simplistic answer would be like we have


00:37:37.200 --> 00:37:39.230
to do better as a medical community what


00:37:39.240 --> 00:37:41.030
can we do to try to help the steing


00:37:41.040 --> 00:37:44.150
donors can we try to uh push for the


00:37:44.160 --> 00:37:45.910
recipient insurance to cover this


00:37:45.920 --> 00:37:49.069
patient for longer because right now the


00:37:49.079 --> 00:37:50.870
recipients insurance cover you for like


00:37:50.880 --> 00:37:53.030
basic complications for that first month


00:37:53.040 --> 00:37:55.589
to a year but what if we offer coverage


00:37:55.599 --> 00:37:57.630
for at least three years or or what if


00:37:57.640 --> 00:38:01.630
try to uh legislate for potential living


00:38:01.640 --> 00:38:03.750
donors if you're a living donor then


00:38:03.760 --> 00:38:05.550
might then then after that you might be


00:38:05.560 --> 00:38:06.950
able to qualify for Medicare and


00:38:06.960 --> 00:38:10.230
Medicaid so we have to work through the


00:38:10.240 --> 00:38:12.870
system with the ongoing resources to


00:38:12.880 --> 00:38:14.589
make it easier for them to donate so I


00:38:14.599 --> 00:38:16.109
think it's not on them it's it's on us


00:38:16.119 --> 00:38:18.430
like as a medical community what can we


00:38:18.440 --> 00:38:21.630
do and obviously from a simplistic way


00:38:21.640 --> 00:38:23.550
that will be one of the things that I


00:38:23.560 --> 00:38:25.790
would consider like how how can we get


00:38:25.800 --> 00:38:27.990
these patients better care how can we


00:38:28.000 --> 00:38:29.510
ensure that they have proper followup


00:38:29.520 --> 00:38:31.630
after which is the main limiting factor


00:38:31.640 --> 00:38:34.950
that I see right now happening yeah and


00:38:34.960 --> 00:38:37.870
as an immigrant just the the cultural


00:38:37.880 --> 00:38:39.950
barriers the language barriers let alone


00:38:39.960 --> 00:38:42.750
insurance right just like to trying to


00:38:42.760 --> 00:38:45.470
put the system of really sophisticated


00:38:45.480 --> 00:38:47.750
us transplant system it's overwhelming


00:38:47.760 --> 00:38:49.870
so I just want to to remind everyone


00:38:49.880 --> 00:38:51.150
that at the American transplant


00:38:51.160 --> 00:38:53.109
Foundation we have an incredible


00:38:53.119 --> 00:38:55.470
mentorship program that is available in


00:38:55.480 --> 00:38:57.589
12 languages


00:38:57.599 --> 00:39:00.470
and like that is such a great resource


00:39:00.480 --> 00:39:03.190
to be connected to someone who can be


00:39:03.200 --> 00:39:05.150
there and just like explain the basics


00:39:05.160 --> 00:39:06.630
and then take you like through the


00:39:06.640 --> 00:39:09.430
Journey and help you out with different


00:39:09.440 --> 00:39:12.150
resources that's a great Point yeah I


00:39:12.160 --> 00:39:13.630
think that you guys do a very good job


00:39:13.640 --> 00:39:15.470
in education and and


00:39:15.480 --> 00:39:18.109
advocating uh for potential donors which


00:39:18.119 --> 00:39:20.630
we need more so definitely that's a very


00:39:20.640 --> 00:39:22.870
good point Anastasia and and the the


00:39:22.880 --> 00:39:24.950
reason you know that our founder Steve


00:39:24.960 --> 00:39:27.510
Farber when he was going through his


00:39:27.520 --> 00:39:30.390
transplant Journey uh right next to him


00:39:30.400 --> 00:39:32.870
there was this Hispanic family and he


00:39:32.880 --> 00:39:34.750
was looking at them like it's so hard


00:39:34.760 --> 00:39:37.670
for me and and they have to jump through


00:39:37.680 --> 00:39:39.589
even all these additional barriers and


00:39:39.599 --> 00:39:42.109
that is simply not fair so that was one


00:39:42.119 --> 00:39:45.190
of the one of the reasons to even start


00:39:45.200 --> 00:39:47.670
the American trustman Foundation 20


00:39:47.680 --> 00:39:48.630
years


00:39:48.640 --> 00:39:51.550
ago which is like a very very valid


00:39:51.560 --> 00:39:53.790
point and that similar or in line to


00:39:53.800 --> 00:39:55.390
what we try to do with our Hispanic


00:39:55.400 --> 00:39:57.990
trans program uh that we're actually


00:39:58.000 --> 00:40:00.069
trying to expand to


00:40:00.079 --> 00:40:03.150
uh to like different cultures as well


00:40:03.160 --> 00:40:05.589
like under the same umbrella so we're


00:40:05.599 --> 00:40:07.750
hopeful that over the next um three to


00:40:07.760 --> 00:40:10.550
four years we can roll out as well and


00:40:10.560 --> 00:40:12.630
we are doing the same We're translating


00:40:12.640 --> 00:40:14.630
um all of our educational material in


00:40:14.640 --> 00:40:16.790
the top like top five language spoken


00:40:16.800 --> 00:40:19.470
one of them is Russian uh in in our


00:40:19.480 --> 00:40:22.150
hospital so having having this


00:40:22.160 --> 00:40:23.710
initiative will definitely help our


00:40:23.720 --> 00:40:26.109
population our patient population and


00:40:26.119 --> 00:40:27.870
speaking of new initiative like are


00:40:27.880 --> 00:40:30.069
there any research projects or like any


00:40:30.079 --> 00:40:31.950
new initiatives that you personally


00:40:31.960 --> 00:40:37.190
excited about so um yes so part of our


00:40:37.200 --> 00:40:39.470
work in terms of uh investigation and


00:40:39.480 --> 00:40:41.069
research is trying to prove that these


00:40:41.079 --> 00:40:44.589
patients do well so on another very good


00:40:44.599 --> 00:40:46.349
reason which is in the same line of why


00:40:46.359 --> 00:40:48.829
we should consider these patients like I


00:40:48.839 --> 00:40:51.190
mentioned they do their outcomes are


00:40:51.200 --> 00:40:55.030
great so we have pediatric kidney adult


00:40:55.040 --> 00:40:58.990
kidney uh an adults heart liver and lung


00:40:59.000 --> 00:41:00.829
all of these organ recipients have


00:41:00.839 --> 00:41:02.630
excellent outcome they have comparable


00:41:02.640 --> 00:41:06.030
to actually better outcomes in terms of


00:41:06.040 --> 00:41:08.670
uh how well that organ does and how long


00:41:08.680 --> 00:41:10.230
this patient live when compared to the


00:41:10.240 --> 00:41:13.190
typical US citizen so one of the ongoing


00:41:13.200 --> 00:41:15.670
uh uh research that we have that the


00:41:15.680 --> 00:41:17.349
manuscript is on the revision is


00:41:17.359 --> 00:41:20.829
tackling the same we're proving uh that


00:41:20.839 --> 00:41:23.430
the Hispanic uh recipient irrespectively


00:41:23.440 --> 00:41:25.589
of the citizenship status which we


00:41:25.599 --> 00:41:28.990
included 30% non US citizen did better


00:41:29.000 --> 00:41:32.470
than the typical uh non-h hispanic white


00:41:32.480 --> 00:41:34.349
on that same analysis we did found that


00:41:34.359 --> 00:41:36.069
they were more propense to being lost to


00:41:36.079 --> 00:41:38.750
followup so now we're trying to uh come


00:41:38.760 --> 00:41:40.670
up with ideas of how we can improve the


00:41:40.680 --> 00:41:43.030
post transplant followup on this patient


00:41:43.040 --> 00:41:46.230
population uh uh working with with Dr uh


00:41:46.240 --> 00:41:48.470
Cervantes she has also several ongoing


00:41:48.480 --> 00:41:50.710
projects which I'm trying to help her


00:41:50.720 --> 00:41:52.910
the same trying to improve access to


00:41:52.920 --> 00:41:56.510
care uh for this uh undocumented


00:41:56.520 --> 00:41:58.750
Hispanic in uh recipients that are


00:41:58.760 --> 00:42:01.390
looking for dialysis care and Transplant


00:42:01.400 --> 00:42:06.190
care so um we also have like data from


00:42:06.200 --> 00:42:08.069
from like a Statewide initiative this is


00:42:08.079 --> 00:42:09.470
like something new or something novel


00:42:09.480 --> 00:42:12.069
we're used to uh using like National


00:42:12.079 --> 00:42:14.190
Data like the srtr which is stands for


00:42:14.200 --> 00:42:17.030
the scientific transplant recipient


00:42:17.040 --> 00:42:19.829
registry so we have now Statewide data


00:42:19.839 --> 00:42:21.309
that we're trying to compare on the same


00:42:21.319 --> 00:42:23.790
trying to look for uh what are the cost


00:42:23.800 --> 00:42:25.390
resources of these patients that are not


00:42:25.400 --> 00:42:27.990
getting proper care which


00:42:28.000 --> 00:42:29.829
similar to what we talked about we know


00:42:29.839 --> 00:42:31.750
that if we provide the appropriate gear


00:42:31.760 --> 00:42:33.990
it's going to be cheaper for us as a


00:42:34.000 --> 00:42:35.390
society and it's going to be better for


00:42:35.400 --> 00:42:37.069
patient we're trying to to model the


00:42:37.079 --> 00:42:41.109
same on a Statewide uh


00:42:41.119 --> 00:42:43.309
analysis well you've certainly covered a


00:42:43.319 --> 00:42:45.150
lot of things today that are I think


00:42:45.160 --> 00:42:46.829
very interesting and eye opening are


00:42:46.839 --> 00:42:48.950
there other points that you would hope


00:42:48.960 --> 00:42:52.710
to get across or share with our audience


00:42:52.720 --> 00:42:54.349
so


00:42:54.359 --> 00:42:57.510
um basically so I think like more or


00:42:57.520 --> 00:42:59.750
less like in a summary we know that uh


00:42:59.760 --> 00:43:01.829
just try to educate people for example


00:43:01.839 --> 00:43:04.750
like we said like hey why we should


00:43:04.760 --> 00:43:06.910
consider these patients when uh they


00:43:06.920 --> 00:43:08.870
don't contribute we know that the actual


00:43:08.880 --> 00:43:10.990
non-citizens provide a surplus to the


00:43:11.000 --> 00:43:12.510
Medicaid trust fund and then they


00:43:12.520 --> 00:43:14.870
provide more money than they take same


00:43:14.880 --> 00:43:16.630
as like the organs important to say


00:43:16.640 --> 00:43:18.349
people say like how why why we should


00:43:18.359 --> 00:43:21.270
include this uh non-citizens in the


00:43:21.280 --> 00:43:23.230
organ pool they actually provide more


00:43:23.240 --> 00:43:25.150
more organs than they


00:43:25.160 --> 00:43:27.910
take they have better out outcomes as we


00:43:27.920 --> 00:43:30.470
said so it's very uh so it's not like


00:43:30.480 --> 00:43:32.910
we're wasting organs away and we know


00:43:32.920 --> 00:43:34.470
that these patients are not coming here


00:43:34.480 --> 00:43:35.910
just to get transplanted they're coming


00:43:35.920 --> 00:43:39.790
here to work and be able to uh to be


00:43:39.800 --> 00:43:42.990
part of like a productive Society so I


00:43:43.000 --> 00:43:44.870
think those are the main key points that


00:43:44.880 --> 00:43:47.069
that I wanted to uh drive across today


00:43:47.079 --> 00:43:50.150
particularly in the ongoing uh climate


00:43:50.160 --> 00:43:52.630
which again things might change but we


00:43:52.640 --> 00:43:55.390
have very good data stating otherwise


00:43:55.400 --> 00:43:57.390
that it's actually better for them to


00:43:57.400 --> 00:43:58.990
stay and it's it's actually very


00:43:59.000 --> 00:44:01.549
feasible and realistic to to to get


00:44:01.559 --> 00:44:03.230
these patients


00:44:03.240 --> 00:44:05.510
transplanted I really appreciate your


00:44:05.520 --> 00:44:07.349
willingness to talk about a topic that


00:44:07.359 --> 00:44:09.190
might be difficult and controversial to


00:44:09.200 --> 00:44:12.549
some but so important and um really


00:44:12.559 --> 00:44:14.430
grateful for your time today so thank


00:44:14.440 --> 00:44:17.230
you thank you thank you thank you it was


00:44:17.240 --> 00:44:22.040
a pleasure and thank you for having me