San José, Costa Rica, since 1956

Foreigner struggles to receive kidney in Costa Rica

Most immigrants wouldn’t stand a chance. Wait-listed behind thousands of cedula-carrying Ticos in a public health system on the verge of bankruptcy, what hope does a 47-year-old laborer from Nicaragua have for a surgery that could save his life?

For Eduardo Ramón López, the response is “not much.”

It doesn’t matter that López has already found a willing kidney donor that could save his life, nor that he’s paid his voluntary insurance.

“He’s getting worse every day,” said his wife, Eloisa Alvarado de López, who has tried to stretch the $60 she makes each week as a lottery ticket vendor to cover trips back and forth from the hospital and the couple’s $130 rent. “Every day, he could be losing functioning in his brain or in his legs, which he might never get back.”

Holding her husband’s hand while sitting next to him on the bed in their humble home in La Carpio, an impoverished neighborhood in western San José, for Alvarado, life has become an unbearable waiting game. “How long will it take? That’s what we don’t know. It’s not just one person waiting for this surgery; it’s thousands,” she said.

Nevertheless, compared to other Latin American countries, Costa Rica’s rate of kidney transplants is high, says Carlos Chaverri, head of Hospital México’s nephrology unit. Costa Rican doctors perform more transplants per million residents than any other country in Latin America except Brazil, he says.

“We transplant 30 patients for every million residents every year,” Chaverri said. “Nicaragua sees one or two patients per million residents and countries like Argentina and Mexico see about 25. From this point of view, we are doing a good job.”

Last year, Hospital México hit a benchmark, performing 1,000 kidney transplants, the first hospital in Central America and the Caribbean to do so.

With his hands folded on his desk, Chaverri promised to press on. “We are still concerned that this is not enough,” he said.

The biggest obstacle to kidney transplants at the western San José hospital is that doctors are scheduled to use a single operating room only once a week. Because of that limitation, doctors can only operate on 55 patients a year.

Chaverri said he’s trying to convince hospital directors to allow them to perform one surgery at night, which would double the number of patients each a year, but like most things in Costa Rica, it’s taking time. As patients wait in line, many are on dialysis, a blood-cleansing treatment that costs as much as $80,000 a year.

Only five years ago, computer micro-processor maker Intel donated badly needed equipment, including computers and an upgraded database, to Hospital México’s Dialysis Unit. Before the donation, nurses and physicians kept handwritten records in stacks of notebooks (TT, Sept. 15, 2006).

The hospital’s official waiting period for kidney transplants is six months. But López has been on dialysis for more than seven months, and his stomach is bruised by all the shots required during the procedure. Despite the fact that he pays into the state-run health insurance program, known as the Caja, his immigration status makes him a second choice, passed over by Costa Rican patients.

“We can’t turn them away,” said Chaverri. “The law says we have to see them, but we’ve learned to limit the cases we see.”

Chaverri has been told of cases in which Nicaraguan doctors, seeing no hope for treatment within their own system, tell patients to go to Costa Rica on Tica Bus, a regional transport company, and ask the bus driver to drop them off in front of Hospital México, where they can walk straight into the emergency room.

In the nephrology unit doctors have made a separate list for Nicaraguans, in which they are moved through the treatment and transplant process, but at a slower rate than Costa Rican residents.

Chaverri said that cases involving Nicaraguan patients are complicated by the fact that many don’t have donors in Costa Rica. Friends and family live hours away, with limited opportunity to legally enter the country and give up one of their kidneys.

Some donor-less patients benefit from the ‘Good Samaritan’ program in which strangers walk into the clinic, offer a kidney and let doctors decide who will receive it. Since the program started, the nephrology unit has received eight kidneys this way.

Roughly 15 percent of transplanted kidneys come from people who have died in accidents, according to a March 2010 press release from Hospital México. Most donated kidneys come from friends or family members.

Still, for many the wait isn’t due to a lack of donors, but rather a lack of operating rooms. With the recent closures of operating rooms at San José’s San Juan de Dios Hospital, patients may now have to wait even longer for transplants (TT, April 15).

Meanwhile, Alvarado worries that each day she becomes closer to losing her husband. He can no longer walk, his memory is failing, and there are days when he is completely unresponsive.

“We don’t know if we will ever get him back like he once was,” Alvarado said, stroking her husband’s forehead.

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