The title of the article in the Journal of Medical Ethics asks this question. The authors from the University of Montreal consider this subject while the topic of “illegal aliens” or foreign nationals (FN’s) has been a hot topic in the United States. They however attempt to answer the problem from an international perspective. The FN that we hear about is usually in the country illegally, but may be in the country as a legal non-citizen, visitor, non-permeant resident, refuge claimant, resettled refugee and in rare cases a person detained by the government.
A patient who arrives at the emergency room requiring hemodialysis would likely rapidly be started on renal replacement therapy. This is an emergency and since this is considered, an emergency there would likely not be a question about the provision of such therapy. What then about transplantation of a kidney? Is renal transplantation an emergency treatment? We usually consider transplantation to be a more economical form of treatment of the acute renal failure in the end, but the lack of long term funding for medical care of the FN puts a different spin on the subject. It is not just the procurement of the organ and the surgery but also provision of and management of the immunotherapy necessary to prevent rejection of the kidney and the technology to manage the therapy. A foreign national that returns to their home country where there is not an infrastructure that can provide the drug therapy or monitoring will reject the kidney. There is a national issue of financing the care and the ethical and national issues of obtaining the organ.
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