In the debate discussion the following needs to be kept in mind: The understanding that in the organization's market, the health system cannot become the lone willing provider of such services. To take on such a role would place the health system at a large competitive fiscal disadvantage: "No margin, no mission."

There are two goals:

(1) To be sure that undocumented immigrants are discussed with respect for their situation and that biases (e.g., referring to them as "illegals") do not color any decisions regarding the potential use of charity care funds.

(2) To get the health system to make a commitment of some magnitude to assist this patient population regarding transplantation and begin to develop appropriate supporting criteria. Although the hospital cannot "do every-thing," it can make a commitment to doing some level of this kind of work.