CHICAGO — For the past year, three days a week for four hours, Alfredo Pacheco, 37, has been undergoing dialysis. Most days, even if he feels ill, he pushes himself to work after the procedure, thinking of his three young children who wait to see him again one day back in Venezuela.

As time passes, however, he feels weaker and a bit more tired every day, he said.

Pacheco was diagnosed with end-stage renal disease not long after arriving in Chicago seeking asylum. It was then that doctors told him that he needed a kidney transplant, “or else I would die,” he said. Medical records also show the acute illness that has drastically changed his life.

His older brother, Jose Gregorio González, 43, who was denied entry to the country at the southern border, tried to enter once again hoping to donate a kidney to save his brother’s life. He managed to cross and stay in the United States under immigration supervision.

After a long and complicated process to get approved for the transplant under public insurance, the brothers had an appointment in a Chicago hospital in April to go forward with more tests for the organ exchange. But on March 3, González was arrested by immigration authorities and now awaits deportation at Clay County Detention Center in Indiana, leaving Pacheco, once again, desperate and fighting for his life.

The two are pleading with immigration authorities to release González on humanitarian parole to donate the kidney. “After that, I will return to Venezuela,” González said from a call in the detention center.

The video player is currently playing an ad.“Los dos lloramos cuando se lo llevaron, él sabe que él es mi vida,” Pacheco said, or in English, “We both cried when they arrested him because we both know he is my lifeline.”

The two Venezuelan brothers, affected by both immigration policies and healthcare policies at the federal and state level, showcase the turmoil and uncertainty immigrant families are facing in the country, advocates and attorneys said. As the Trump administration continues to double down on efforts to deport unauthorized immigrants — now having reached an agreement with Venezuela to resume repatriation flights — and the threat from the state to dismantle the Medicaid coverage for noncitizens adults, “immigrants are under attack,” said Cook County Commissioner Alma Anaya, who also serves as the vice-chair of the Health and Hospitals Committee.

“[Their story] highlights the complexities of some of the policies. Big decisions are being made statewide and federally that are ultimately deciding whether a person lives or dies,” Anaya said.

In Pacheco’s case, the decision is in the hands of González’s immigration agent, said their attorney Peter Meinecke, who is also the managing attorney at The Resurrection Project legal team. The request for humanitarian parole is a request made directly to the ICE officer in charge of the detainee’s case, in which the agent can authorize their release for a set period at their discretion.

“It is ultimately an opportunity to leave detention for the sole purpose of undergoing the kidney donation to save his brother’s life, and then ICE will be able to detain him again and eventually remove him from the country,” Meinecke said, who added that Gonzalez does not have a criminal background.

In most cases, the maximum amount of time immigrants are released under humanitarian parole is one year. Most are released under supervision or with ankle monitors, said Meinecke.

From the detention center, through a phone call, Gonzalez said his biggest concern is that he will be deported before immigration agents can consider his case. For him, staying in the United States is no longer about finding a better job or stability, but rather to save his brother’s life.

When he made his way north in late 2023, Gonzalez wanted to join Pacheco like thousands of other migrants in Chicago with dreams to work and craft a better future for their children and families in their native Venezuela. He first tried to enter the country but failed the credible fear screening, after learning that his brother was diagnosed with end-stage renal failure, he tried again under the CPB One app, which allowed migrants to make appointments to enter the country.

It was then that Gonzalez was put in removal proceedings and detained for a few months, but since there were no deportation flights to Venezuela, he was released to join Pacheco in Chicago under immigration supervision in March 2024. Due to the previous order of removal, unlike Pacheco, Gonzalez cannot apply for asylum or any other kind of immigration relief.

The oldest of 6 and having lost 2 younger siblings to accidents over the last years in Venezuela, Gonzalez felt it was a blessing to be by Pacheco’s side even if it was only for a few months to donate his kidney.

At the detention center, Gonzalez said, he prays from time to time and writes to his brother, still hopeful that he will be released even for a few months to donate his kidney for his brother so that he can stay in the country and reach the goals that he couldn’t.

It is a promise that the two say they have made to each other despite the uncertainty the two face. They rely on each other and the thought of their family back in Venezuela for strength.

Pacheco’s children, a girl, 17, and a boy twins, 9, still don’t know that their father has a terminal illness. He refuses to tell them because he hopes to get the transplant that could eventually get him back on track with his plans when he first migrated to the United States.

He got to Chicago in July 2022 and applied for asylum shortly after. He said he fled from violence and political turmoil since he was a part of the armed forces in Venezuela. He wanted to find a job here and eventually bring his wife and children.

But in January 2024, he ended up in the emergency room, experiencing strong stomach pain and nonstop vomiting. Though he had lost almost 15 pounds in less than a month, he was afraid to go to the doctor.

“My world completely fell apart,” Pacheco said.

Because Pacheco has a pending asylum case, he is covered under the Illinois “Medical Benefits for Asylum Applicants and Torture Victims” (AATV) program, an extension of the Medicaid program. Under state-sponsored insurance, however, certain treatments, such as kidney transplants, are typically harder to process for those who have an irregular immigration status, often taking a long process that could affect the patient’s life expectancy, according to healthcare experts. Most times, case managers help patients with irregular immigration status or those who are undocumented to navigate the process.

In Illinois, undocumented immigrants with kidney failure can access kidney transplants, thanks to a 2014 law and the Illinois Transplant Fund (ITF) which provides financial support for health insurance premiums, enabling them to qualify for transplants.

Pacheco managed to get on the waitlist for a kidney transplant at the University of Illinois Hospital, a spokesperson for the institution confirmed. Even if Gonzalez is not compatible with Pacheco, if he has a kidney, it could buy Pacheco time and a faster appointment for a transplant.

“Every day that passes without Jose Gregorio Gonzalez being released from detention to donate his kidney puts his brother Alfredo at a greater risk of losing his life,” said state Democratic Party Chair Elizabeth “Lisa” Hernandez, who supports the expansion of medical coverage for undocumented adults or those with an irregular immigration status in Illinois, including HBIA. “The situation we are in is unfortunately unsurprising given the current administration’s haphazard crackdown on hardworking, law-abiding immigrants and their families. Jose deserves the chance to save his brother’s life. The Department of Homeland Security and the Trump Administration on humanitarian grounds should afford him and every immigrant that very opportunity.”

For now, Pacheco only works delivering packages for Amazon from time to time, on days when dialysis does not get the best of him, he said. Last month he couldn’t pay rent of his basement apartment in Cicero, but his landlord’s daughters helped him pay. They’re also helping to collect signatures to support his case and submit it to the ICE agent, begging for mercy.

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