Kidney transplant access increased for non-citizens in three states after policy change
Key takeaways:
- Non-citizens made up a larger portion of adults on the waitlist after policy changes vs. before these changes.
- The proportion of these patients nearly doubled after policy changes from 1.87% to 2.72%.
Access to kidney transplants increased for undocumented immigrants in Illinois, Minnesota and Massachusetts following state policy changes from 2013 to 2023, data show.
“U.S. citizens are eligible to receive health care coverage for kidney transplantation through Medicare; undocumented immigrants are not,” Gayathri Menon, MHS, a data analyst at the New York University Grossman School of Medicine Department of Surgery, wrote with colleagues. “Coverage is not standardized for undocumented immigrants.”
However, certain states expanded kidney transplant coverage for undocumented immigrants through Medicaid, health safety net and charities during the study period according to the researchers.
Researchers analyzed data from 23,950 adults on the transplant waitlist and 15,230 first-time kidney transplant recipients from the three target states. The aim was to evaluate the impact of health policy, deceased-donor kidney transplant access and post-transplant outcomes.
Researchers used center-reported information from the Organ Procurement and Transplantation Network (OPTN) adult kidney transplant candidate registration, as well as various medical record reviews, to determine citizenship status. Status was categorized into three groups: citizens, residents and presumed undocumented immigrants.
During a median 1.1-year follow-up, presumed undocumented immigrants made up a larger proportion of patients listed after the policy changed compared with before, according to the findings. Specifically, these patients comprised 2.72% of the waitlist vs. 1.87% before policy changes, with an increase in the incidence rate ratio (IRR = 2.21; 95% CI, 1.15-4.27).
“Despite barriers to kidney transplant listing, [certain] post-transplant outcomes are favorable among undocumented immigrants, emphasizing the need to further increase transplant accessibility for this population,” Menon and colleagues wrote.
Still, “while non-citizenship does not preclude transplant eligibility per the National Organ Transplant Act of 1984 and OPTN policy, undocumented immigrants face challenges before and after listing for a kidney transplant,” the researchers added.
Relative to citizens, there were no differences among presumed undocumented immigrants in the likelihood of receiving a deceased-donor kidney or post-transplant outcomes.
In addition, “without insurance, undocumented immigrants often rely on emergency dialysis, which imposes significant morbidity and mortality, higher health care costs and lower quality of life,” the researchers wrote. “State-led efforts to expand kidney transplantation for undocumented immigrants (expanding Medicaid eligibility, covering kidney replacement therapy under Emergency Medicaid and providing undocumented immigrants with private health insurance options off the market exchange) could inform national policies to ultimately improve transplant equity.”
Editor’s note: This article was updated Feb. 7, 2025, to correct the size of change before and after policy implementation. Healio regrets the error.
Collapse