Transplant recipients of undocumented immigration status face health insurance barriers
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Key takeaways:
- Patients on emergency hemodialysis had limited kidney replacement therapy education access.
- Quality of life was a facilitator for transplant recipients.
Transplant recipients of undocumented immigration status who once relied on emergency hemodialysis face barriers in care due to a lack of health insurance, according to recently published data.
“Citizenship does not preclude eligibility for transplant in the [United States]. However, lack of affordable insurance coverage is a major structural barrier,” Katherine Rizzolo, MD, of the section of nephrology at the Boston University Chobanian and Avedisian School of Medicine, and Boston Medical Center, wrote with colleagues. Given the obstacles to care, “exploring what factors and resources enable success in transplant for this vulnerable population can help improve care ... with similar access barriers in other states,” they wrote.
It has been previously reported that “undocumented immigrants with kidney failure receive very little kidney replacement therapy and kidney disease education, and experience many barriers to transplant, the most major being lack of federal insurance,” study coauthor Lilia Cervantes, MD, MSCS, of the department of medicine at the University of Colorado, Anschutz, told Healio. “We were interested in understanding how this population was able to overcome these barriers as well as their key drivers and motivations for transplant.”
Researchers conducted a qualitative study of 25 participants, which included 15 transplant recipients and 10 caregivers, who had emergency hemodialysis and transitioned to scheduled dialysis and primary caregivers in Denver. Researchers examined the overall experiences in transplant care of the groups. Investigators conducted semi-structured one-to-one interviews in English or Spanish, and found the following six themes about the transplant care:
- limited kidney replacement therapy education while on emergency hemodialysis, lack of treatment option awareness and discriminatory kidney education;
- the motivating prospect of receiving a transplant through scheduled dialysis, and the potential impact on family and quality of life;
- not enough in-clinic transplant education during dialysis, or peer-to-peer transplant education and peer-to-peer communication on private health insurance availability;
- uncertainty and difficulty navigating the transplant evaluation and wait-listing processes, an unclear timeline and concern for family limiting living donation;
- post-transplant concerns such as the ability to work. Researchers highlighted that autonomy with transplant improved mental health and transplant maintenance; and
- facilitators like self-advocacy, spirituality and optimism, and peer support.
“These issues are important to acknowledge given a key ethical argument against providing transplant for individuals of undocumented immigration status is that they have no fiscal right to health care benefits because they do not pay into the system, despite evidence showing these individuals do pay taxes, which are largely used to subsidize U.S. citizens’ health care,” the researchers wrote in the study. “Improving education regardless of systemic barriers may be an important next step toward patient-centered kidney care for this population.”
The next step, according to Cervantes, would be to increase provider understanding on availability of non-traditional insurance for patients who do not have Medicare, develop culturally and language concordant kidney transplant education to include information on coverage and broaden peer support access for vulnerable patient populations. “Expanding the reach and breadth of kidney transplant education is key to reach vulnerable patient populations who may experience structural barriers and discrimination in traditional education models.”
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