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 Pablo, 59, could barely walk from the family room to the bathroom
without growing short of breath, Carmen said.
She looked across the states for hospitals with shorter wait times
until a friend recommended she consider her homeland. Carmen was
hesitant but "gave it a chance."
In December, Pablo received his heart transplant, becoming the first
person to travel from the mainland to the U.S. commonwealth for the
procedure, said Dr. Ivan Gonzalez-Cancel, his surgeon and the
director of the heart transplant center at the Cardiovascular Center
of Puerto Rico and the Caribbean. Pablo is now able to bike about a
mile and climb four to five flights of steps.
Puerto Rico is trying to build its medical tourism industry, from a
current level of about $80 million a year to $300 million by 2017,
as part of efforts to heal its chronically sick economy. A component
of that is to encourage more patients to travel for organ
transplants.
Patients who visit for transplants, and for more common medical
procedures such as orthopedics, dentistry and weight-loss surgery,
spend thousands on hotels, transportation and food.
Puerto Rico's potential as a transplant center is partly based on a
macabre statistic - the Caribbean island had a murder and
non-negligent manslaughter rate of 19.2 per 100,000 people in 2014
compared to 4.5 per 100,000 in the United States, according to
Federal Bureau of Investigation data.
That translates into a pool of donors in the 18-30 age range
unmatched in the mainland, Gonzalez-Cancel said. "The donors (are)
victims of car accidents or gunshot wounds to the head, because
Puerto Rico, sadly, we have a very high crime rate."
High-crime areas certainly exist among the U.S. states, but Puerto
Rico has recently also had organ donation rates higher than expected
by the Scientific Registry of Transplant Recipients (SRTR), which
analyses data on donated organs.
The cost of care is another attraction, at as much as 60 percent
lower than on the mainland, according to the island government.
Because Puerto Rico's transplant centers are part of the national
organ sharing network, U.S. patients can transfer there as long as
doctors admit them, with few other hurdles.
Pablo and Carmen Concepcion moved temporarily to Puerto Rico, and
paid out-of-pocket for Pablo's transplant and extended hospital stay
beforehand. While that cost about $350,000, it was far less than it
would have been on the mainland.
"I'd rather have a debt and he's alive," said Carmen, a teacher.
Pablo, who is now disabled, was a truck driver.
SHORT WAIT
Finding a heart donor match depends on a number of factors,
including blood type, but Puerto Rico's geographically isolated
location within the national organ sharing network can give some
patients shorter wait times.
The United Network for Organ Sharing (UNOS) allocates hearts based
on medical urgency and location of the patients. Because there are
no U.S. transplant centers within 500 miles (800 km) of Puerto Rico,
candidates on the island's waiting list have the first opportunity
at an organ, according to Roger Brown, director of the organ center
at the network.
Patients on the island from 2009 to mid-2014 waited a median of 1.3
months for a heart transplant, versus 8.1 months nationally,
according to the SRTR. For livers, the island had the shortest
median wait time in the country at about three weeks, compared to
over a year nationally, according to the SRTR.
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Dr. Juan Del Rio is one surgeon eager to attract more patients. He
completed Puerto Rico's first liver transplant in 2012, after moving
to the island from New York because of the greater availability of
organs.
He originally projected completing around 100 liver transplants a
year, but is now doing a little less than half that and he sees
attracting people from the mainland United States as one way to
achieve full capacity.
Surgeons prefer to transplant organs from nearby, but since the late
1980s, more than 60 percent of the approximately 4,000 organs
donated in Puerto Rico have been shared off-island, according to
UNOS data. Those are organs surgeons would like to use in Puerto
Rico.
Liver transplant candidates should consider Puerto Rico, Del Rio
said, "instead of waiting in New York and (waiting) to be really,
really sick with a high risk of dying before transplant."
SOME PATIENTS WOULD DRAW LINE
Representatives from Auxilio Mutuo, the hospital that houses the
liver and kidney transplant centers, also suggest mainland patients
enlist in their kidney program, though the waiting time for a
transplant is far longer than for hearts and livers.
The island's government will have spent about $3.3 million on
developing the medical tourism industry by mid 2016. Still, some
people would be reluctant to travel to the island for such serious
surgeries.
"People draw the line at cardiology, (saying) 'I can't see myself on
an operating table in a strange land," said Josef Woodman, the CEO
of Patients Beyond Borders, a medical travel information publisher.
Puerto Rico has to show it can offer quality care to compete for
heart transplant patients, he said.
Island officials say Puerto Rico's status as a U.S. jurisdiction is
an indication of quality. Survival rates for heart transplants match
the national figures, while for kidneys, the numbers are slightly
higher than nationwide statistics, and for livers, the rates are
slightly lower, according to SRTR data.
"Over there, it might be super clean, super sanitized, a little bit
older, maybe things not as renovated as we have over here," Carmen
Concepcion said of her husband's care.
Gonzalez-Cancel, the heart surgeon, said the island should show it
can excel in complicated surgeries like heart transplants to stoke
interest in simpler procedures that are the bread and butter of
medical tourism.
"If you do what is big, then you can do what is small," he said.
(Reporting by Jessica DiNapoli; Editing by Frances Kerry)
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