LOS ANGELES – Ana Puente was an infant with a liver disorder when her aunt brought her illegally to the U.S. for medical care. She had two liver transplants at the University of California, Los Angeles Medical Center as a child in 1989 and a third in 1998, each paid for by the state.

But when Ms. Puente turned 21 last June, she became too old for state-funded health insurance and could not continue treatment at UCLA.

This year, her liver began failing again, and she was hospitalized at County-USC Medical Center, affiliated with the University of Southern California. In Ms. Puente's Medi-Cal application, a doctor wrote, "Her current clinical course is irreversible, progressive and will lead to death without another liver transplant."

The application was denied.

Late last month, Ms. Puente learned of a little-known option – if she notified U.S. Citizenship and Immigration Services that she was in the country illegally, state health officials might grant her full coverage through Medi-Cal, the state health services assistance program for the poor. Ms. Puente reported herself, her benefits were restored and she is awaiting a fourth transplant.

Ms. Puente's case highlights two issues: Should illegal immigrants receive liver transplants in the U.S., and should taxpayers pick up the tab?

Some people say that immigration status should play a role in allocating organs and that illegal immigrants should return to their home countries for care rather than receive costly transplants ahead of legal residents and U.S. citizens.

"All transplants are about rationing," said Roy Beck, executive director of NumbersUSA, which favors stricter controls on immigration. "I just don't think the public ought to be funding any kind of benefits for people who are breaking the law."

Larry Gonzalez, a U.S. citizen who has hepatitis C, has known for a decade that he needs a new liver but was placed on the transplant waiting list only last week.

"Why do we have to get in line behind immigrants, foreigners, when we have enough people here to fill the hospitals?" said Mr. Gonzalez, 54.

But Dr. Michael Shapiro, vice chairman of the ethics committee for the organ sharing network, said illegal immigrants have just as much right to receive organ transplants as U.S. citizens. He said it is likely that more illegal immigrants donate organs than receive them.

"People are people, and when you make an incision in an organ donor, you don't find little American flags planted on their organs," he said.

Ms. Puente was transferred from County-USC back to UCLA this month after getting approved for Medi-Cal.

If illegal immigrants can establish that U.S. immigration services "is aware of their presence and does not plan to deport them," then they could be eligible for full-scope Medi-Cal, said Norman Williams, spokesman for the state health department.

But Citizenship and Immigration Service officials said the agency does not respond to patients or make any promises about their immigration status.

Anna Gorman,

Los Angeles Times