Alan Checca's frail left arm is tangled in tubes connected to a home dialysis machine. His 107-pound frame slumps in a recliner. He types on his laptop to distract himself during the more than three-hour process.
"This stuff is permanently here until I get transplanted ... or die," said Checca, 43, of Derry, who undergoes dialysis three times a week while he waits to get on a kidney transplant list.
His wife and 21-year-old son are willing to donate a kidney, but there's one obstacle between him and admission to the list: He must pass a dental exam.
Checca had two kidney transplants — in 1986 and 1998 — but needs a third.
His gum disease and other dental problems put his body at risk of rejecting the kidney, said Dan Laurent, spokesman for Allegheny General Hospital. Checca said one of his doctors at AGH estimated the dental surgeries he needs will cost $10,000. Because he doesn't have dental insurance and can't afford the dental surgery, Checca can't get on the transplant list.
Allegheny General's pre-kidney transplant guidelines require a dentist to verify the patient has healthy gums and teeth before he or she is placed on the waiting list for transplant surgery. Laurent said officials followed standard protocols for kidney transplant evaluation in Checca's case.
The procedures to get on a kidney transplant list are the same for everybody, Laurent said, and doctors make a "clinical decision" whether a patient is eligible.
University of Pittsburgh Medical Center hospitals have similar guidelines requiring patients to pass dental exams before getting on the transplant list, said Dr. Ron Shapiro, director of the kidney, pancreas and islet transplant programs at the Thomas E. Starzl Transplantation Institute at UPMC.
"You don't want to transplant someone with a dental abscess," Shapiro said. "But once you treat the infection, then you can go ahead and transplant them."
Checca said his damaged gums and teeth are the result of taking anti-rejection drugs twice a day for 24 years, since his first transplant. Shapiro said some anti-rejection drugs have been found to cause gum disease.
"That's a lot of money in dental work, and I can see where it can be very expensive; I can see where health insurance wouldn't cover it," Shapiro said.
Shapiro said he doesn't think such cases are common and that most patients get dental clearance.
But Anne Paschke of the United Network for Organ Sharing has heard stories like Checca's.
"He's definitely not alone," she said.
Paschke suggested that transplant centers hire financial coordinators to help patients figure out ways to defray costs.
"If I were on welfare and not working at all, I bet the fees would be covered," Checca said. "... There's no help for the middle class."
An option is the Catholic Charities Health Care Center of Pittsburgh, founded two years ago. Sister Carol Blazina said the center has no limit to financial help it will give to people without dental insurance, as long as they meet guidelines. A few patients needed assistance before transplants, Blazina said.
To qualify for assistance there, a person must fall under 200 percent or less of the federal poverty guideline, which changes depending on the number of people in the household, Blazina said.
Western Pennsylvania Donated Dental Services in Pittsburgh also helps those who can't afford pre-transplant dental work, said Marcia Thomas, the state coordinator. Qualifications for its services are based on a person's combined monthly income and the number of people in the household.
"We've been successful in getting dental needs taken care of, but we have had a high percentage of people who weren't eligible," Thomas said.
Checca plans to explore both possibilities.
"Every day I'm not on the list is a day I could die," he said.
