As his condition worsened, it became clear he would need a heart transplant. In some states and the District of Columbia, the transplant would have been covered by Medicaid — but not in Nevada, where the program covers heart transplants only up to age 20.  Ben Kieckhefer, a spokesman for the Nevada Department of Health and Human Services, defended that policy. “All insurance plans decide what things they are going to cover and what things they are not going to cover,” he said. “Everyone in the state Medicaid program recognized the difficult situation the family was in, but we can’t just start covering something for one individual case.”  This spring, Mr. De La Cruz’s sister, Veronica De La Cruz, a former anchor for CNN, began a two-pronged effort to save her brother. Her first hope was to win disability benefits so he could qualify for Medicare, which would cover a heart transplant. A hearing had been scheduled for spring 2010, far too late to save him. She appealed to state legislators to pressure a federal panel to expedite the disability hearing.  “How can a sick person navigate the system?” she said in an interview. “I am healthy and can barely do it on my own. The system is designed for people to get frustrated and give up.”  Ms. De La Cruz also began contacting heart transplant centers to determine whether she could pay for the operation with donated money. Because Nevada has no heart transplant center, she contacted several medical centers in California and was told that without insurance, her brother would need to post a deposit of at least $150,000 to be evaluated and placed on a waiting list. The total cost for the transplant and subsequent hospital care, as well as antirejection drugs, would be nearly $1 million, payable in advance.  To exert public pressure and raise money, Ms. De La Cruz began sending out messages on Twitter, with daily tweets about her brother’s health, his dog, Chance, and the red tape she was trying to cut. She gained a following of more than 6,300 people, whom she began calling Eric’s Twitter Army.  The troops included Trent Reznor of the band Nine Inch Nails, which said it would award donors backstage passes and time with the band; the famed Tony Hawk auctioned autographed skateboards. Supporters bombarded Nevada legislators with calls, faxes and e-mail. The Medicare hearing was rescheduled, and by June, Mr. De La Cruz had won his long-awaited coverage, opening the door to a heart transplant center.  Elated, Ms. De La Cruz contacted U.C.L.A. Medical Center’s heart transplant program, but now the hospital insisted that her brother get a secondary insurance policy — even though Mr. Reznor told me the band raised nearly $1 million in less than two weeks. A hospital spokeswoman declined to comment on the case, citing patient privacy, but said the hospital “had been working with” the family.  Eventually, Ms. De La Cruz arranged for her brother to be seen by doctors at the University of Southern California Medical Center. There, he spent a week on the “high-priority transplant” list.  But his condition had deteriorated so much that he soon became too sick for the procedure. On July 4, Eric De La Cruz died, at age 31.  Ms. De La Cruz says a surgeon told her he could have helped her brother, but he arrived “two years too late.” If not for all the delays and denials, she says, her brother would be alive today.  She is still crusading, sharing the story with lawmakers in Washington and at rallies, including one in Times Square this past weekend. At the very least, she says, insurance companies should not be allowed to turn down patients with pre-existing conditions.  “If my brother had been able to buy health insurance, he would never have been in this situation,” she said. “No one should ever have to go through what we’ve been through. Eric should still be alive.”  Join the discussion at nytimes.com/well.  A version of this article appears in print on , on Page D5 of the New York edition with the headline: A New Heart, Tangled in Red Tape. Order Reprints| Today's Paper|Subscribe
One man’s battle for a heart transplant is a striking example of the best and the worst that the American health care system has to offer.