Hi Maga,
That's a very interesting question. In researching it, I couldn't determine if it's elective in all states or just some. Everything I found indicated it's based very much on the rules of the state you live in. For instance, Arizona appears to have some of the most stringent rules for paying for transplants. Since we're talking about hundreds of thousands of dollars, the reason boils down to a financial one. In most states, Medicare and Medicaid will pay for parts of the procedure, but not all. Private insurance also has strict limitations on what they'll pay for, often leaving the patient with a huge burden of debt.
There are a number of organizations set up to not only match people with donors, but also to provide financial assistance. There's usually a rigorous application process, but if you qualify, it would certainly be worth it.
I'm sorry I didn't have a better answer for you. Perhaps others will chime in with more information. I know it doesn't make sense that something as important as a transplant should be considered elective.
Best,
Lyn (moderator)