NEW ORLEANS (WVUE) - At a time when many people in our country want "America first", one local hospital may be doing something different. And it could be costing Louisianans their lives.
"Everybody loved Bubba," says Theresa Greenlee-Jeffers of her brother. "He had a heart as big as Texas."
Greenlee-Jeffers' brother had a big heart, but a bad liver. Days before Christmas in 2015, Ochsner Hospital admitted Bubba Greenlee to their transplant floor. Heavy alcohol use had caught up with Bubba.
"But I also know that, for the last year of his life, he wasn't drinking," his sister tells us. "He was pulling himself up, he was pulling himself out, he was in a better place."
Doctors told Bubba he needed a transplant or he'd die within two weeks. But five days after Christmas, Ochsner sent him home.
"His last Christmas, he was given false hope that he was going to get a transplant," Greenlee-Jeffers tells us. "That's not OK. You don't play with somebody's emotions like that."
According to hospital records, Ochsner denied Bubba a liver transplant because of "poor insight" and the "need to get rehabilitation." They advised him to "seek another liver transplant opinion" and suggested "Tulane or Jackson, Mississippi."
"The cirrhosis, OK, he did that to himself," his sister says. "But I'm not happy that his opportunity to get a liver was denied because they didn't want to bother with him, for whatever reason."
Bubba Greenlee, who died in early 2016.
It's unclear if Bubba would have ever qualified for a liver. 17 days after his release, Bubba Greenlee died, killed by cirrhosis at the age of 45.
"I don't have anybody left to share and say, 'Remember when we were kids?' or, 'Remember growing up?'" Greenlee-Jeffers says. "They're all gone."
Bubba Greenlee's name never made it on the waiting list. But in 2015, 1,476 people died while officially waiting for a liver transplant in our country.
Not known to Bubba and many others is the fact that organs donated in the U.S. are sometimes given to patients flying in from other countries - and many pay a premium.
Foreign patients are not normally entitled to private insurance or Medicare discounts. Federal data from 2015 show the cash price for a liver transplant at Ochsner was $393,619. But the cost to Medicare patients is much less, just $100,521.
Across the U.S., the majority of foreign recipients come from countries in the Middle East, including Saudi Arabia, Kuwait, Israel, and the United Arab Emirates.
"It doesn't feel good to me," Danovitch says. "Ideally, each country should have what we like to call self-sufficiency."
The year Ochsner released Bubba, the hospital performed 14 liver transplants on non-U.S. citizens who came to the U.S. for the sole purpose of receiving a new liver. These transplants were strictly from deceased donors, and those livers need to stay close to their donation location - they have to be transplanted within about 24 hours of recovery.
"There's a sense that, ethically speaking, if you can be a donor you ought to be able to be a recipient," Danovitch tells us. "If you're a recipient, you ought to come from potential donors."
Some medical ethicists agree. A 2016 article in the American Journal of Transplantation said foreigners should be last in line for a transplant. One of the authors wrote, "When you take people from other parts of the world and provide an organ transplant to them rather than someone who's here, there's a real cost, there's a real life that's lost."
"But if your home is somewhere else, a long way away, there's no way that you can be a donor or your family or your friends could be a donor," Danovitch says. "And in some respects, when you then come here to the United States, you are using up a valuable resource that is in great shortage here."
Right now, the waiting list for all U.S. hospitals is around 14,500 . But each year, livers are only available for about 7,000 people.
Dr. Danovitch chaired the international committee for UNOS, the United Network for Organ Sharing, which contracts with the federal government to operate the National Organ Donor Network. UNOS tracks all liver donations and transplants.
"When you give an organ in the United States to a wealthy individual from another country, not only are you undermining the allocation of organs to United States residents," he says. "You are also taking away from the other country the necessity to develop organ donation."
Danovitch says a U.S. citizen can't go to Saudi Arabia to receive a transplant. Still, Ochsner appears to recruit Saudi patients. In 2015, the hospital signed a global strategic partnership agreement with a Saudi company to "facilitate the procedures and mechanisms of medical tourism."
Since 2013, Ochsner has performed 953 liver transplants, 34 of those non-U.S. citizens - foreign nationals who come to the states for the sole purpose of receiving a liver transplant. That's more than any other hospital in the country, more than Memorial Hermann in Houston and the Cleveland Clinic. Foreign transplants are concentrated among a handful of these hospitals.
Many others, such as Tulane, Emory in Atlanta and Mount Sinai in New York, made the decision to perform none.
Ochsner declined our request for an on-camera interview. The hospital did send us a lengthy statement, telling us, "UNOS does not have any restrictions preventing transplant for international patients" - which is true. UNOS does, though, have the authority to question these centers about the number of foreign transplant surgeries, but hasn't done so. UNOS says these are decisions left up to transplant centers.
"We do not address issues that are non-medical in nature," says Joel Newman, a UNOS spokesman. "If we addressed citizenship or residency as a particular reason for whether to accept a patient or not, then that would open up the door to lots of other non-medical criteria: religion, race, political preference."
Congress passed laws governing the transplant program more than 30 years ago, when the country had a liver surplus. This practice is legal as long as these non-U.S. citizens wait their turn, just like U.S. patients.
"Doctors are doctors - they're not priests or rabbis or ministers," says U.S. Senator John Kennedy of Louisiana. "You don't want to set up a system where someone, including but not limited to physicians, can play God."
Kennedy says he's hesitant to change the law but warns, as long as our country has a shortage of livers, tough decisions need to be made.
"And I think, as a general rule, you've got to take care of Americans first as long as you have more demand than supply," he says. "That doesn't mean that there aren't exceptions."
Even many critics of transplants going to non-U.S. citizens credit Ochsner's program. Medically speaking, they say Ochsner makes good use of the livers it receives.
The solution to all of this is for more people to sign up as organ donors. Until that happens, people like Theresa Greenlee-Jeffers will continue to wonder whether rich non-U.S. citizens, ready to pay cash, get an unfair advantage.
"To say that we are going to let someone from a foreign country come in and pay money... I'm just not OK with that," she says. "These are people's lives. And each of these people is the brother, sister, mother, father of somebody. And if we're not going to be taking care of our own people first, then what are we doing? It just is not OK."
Even if non-U.S. citizens were last in line, our country would have a liver shortage.
FOX 8 partnered with our colleagues at ProPublica on this investigation. You can find Charles Ornstein's report for ProPublica at this link.