HARRISON — Sal Padovano might be too poor to live.

The retired union carpenter can’t do much without losing his breath and feeling faint. He just sits around his small apartment in Harrison and thinks. He thinks about when he was useful and could make things with his hands, earn a living as a carpenter who helped build stores at the Garden State Mall. He thinks about his bills — he’s behind in the rent and just about everything else. About his three kids and grandson and how he can’t help them. About the unfairness he sees when other people get what he can’t get.

Mostly, he thinks about dying.

"I don’t know how long I’ve got," says Sal, who is 54 and suffers from congestive heart failure. Suffers from it so bad that the doctors over at Newark Beth Israel Medical Center say he needs a new heart. A new heart would fix him up fine, they told him.

Except that he’s too poor. Sal Padovano might be too poor to live.

Too poor to ensure the people who make decisions about heart transplants that he will be able to afford the "after-care," the expensive drugs and post-operative medical treatment that ensure the precious organ keeping him alive — bought at the price of a stranger’s death — lasts long enough to make it all worth it. He can’t pay for it and no insurance company will sell him the supplemental health coverage he would need.

"These are terrible, terrible situations for everybody involved, but not that uncommon," says John V. Jacobi, a Seton Hall Law School professor and expert on health laws. Like others who have been told about Padovano’s dilemma, he’s trying to help but he says the sick man’s options are limited.

Social workers at Beth Israel are trying to help, too. As is the office of U.S. Sen. Robert Menendez (D-N.J.) and employees of the state Banking and Insurance Department. Trouble is this all takes time and, just in the same way Sal Padovano doesn’t have much money, he also doesn’t have much time.

"If I had the money, I could have had the transplant by now, maybe a month ago," says Padovano. "Now, who knows? The doctors tell me my heart is operating at about 20 percent. I could go any minute."

Padovano lives on a small pension of $666 a month and Social Security disability benefits, less than $20,000 a year. Medicare pays 80 percent of his medical bills. His wife, Cecilia, had a job with benefits working for Harrison but, just like what happened to many public employees in New Jersey, she was laid off three years ago. With her benefits went any chance her medical insurance could provide the supplemental insurance to keep her husband of more than 30 years alive.

A heart transplant, according to the United Network for Organ Transplants, a national organization that establishes guidelines for providing the operations, costs $997,000 — and that’s only within the first 180 days post-surgery and it’s only a national average. After that, maintaining the heart could cost $4,000 or more a month.

Padovano can’t afford even 20 percent of that and he doesn’t have insurance to cover the extra costs. So, although he’s been tested and found medically eligible for a heart transplant, he can’t get on the list to receive one because he can’t prove he can afford to keep himself alive.

"It’s a queue for a limited resource," says Jacobi. "A difficult ethical judgment."

And, says Jacobi, not even the new health care law can help.

Who lives? Who dies? Should it be based on income? Is Sal Padovano’s life worth less because he makes so little money? He talks with some desperation about what a good and patriotic person he is. Born in America. A member of the Elks. A Little League coach. A good father and grandfather.

"Where’s the fairness?" he asks.

But here’s what happens: Hospitals have to play God and decide.

Caren Malone, a spokeswoman for Beth Israel’s Heart Failure Treatment and Transplant Program, issued a formal statement saying, "Transplant centers have an obligation to engender long-term success in every transplant they perform."

The UNOS guidelines require that those who receive transplants have "adequate insurance coverage that affords the patient all the life-long medications and treatments necessary to maintain the transplanted organ and avoid financial hardship."

She concludes: "Newark Beth Israel Medical Center has two full-time financial coordinators and two full-time social workers dedicated to facilitating our patients’ access to heart transplant. The Heart Failure Treatment and Transplant Program continues to partner with Mr. Padovano and his family to identify and address insurance coverage gaps and seek funding alternatives. These issues are not uncommon and more often than not, they are resolved."

Cecilia has been on the phone for weeks, calling every insurance company listed. None would take her husband on. So far, nothing.

Five years ago, this column published stories about 12-year-old Billy Williams of East Orange. He was denied a heart transplant because he was developmentally disabled and an evaluation committee from Columbia Presbyterian Hospital decided he might not be able to properly take care of himself and a his new heart. Billy Williams died 18 months later.

Billy Williams wasn’t smart enough to live. Sal Padovano might not be rich enough.