Rise in US Immigrants on Kidney Waitlist in Some States

TOPLINE:

Compared with citizens, the number of undocumented immigrants added to the waitlist has doubled in the three US states with policies offering kidney transplant coverage, but rates of kidney transplant from the deceased-donor pool and posttransplant outcomes have not changed.

METHODOLOGY:

• Undocumented immigrants face challenges in accessing kidney transplants due to the lack of standardized coverage, ineligibility for Medicare, and exclusion by the Affordable Care Act, but three states have expanded coverage for kidney transplants to undocumented immigrants through Medicaid, health safety nets, and charities.
• This study aimed to evaluate the impact of state policies on access to deceased-donor kidney transplants and posttransplant outcomes for undocumented immigrants.
• Citizenship was ascertained from center-reported information on the adult kidney transplant candidate registration form for the Organ Procurement and Transplantation Network, with the citizenship categories being citizens, residents, and presumed undocumented immigrants.
• A total of 23,950 waitlisted adults (21,474 citizens, 1900 residents, 576 undocumented immigrants) and 15,230 first-time adult kidney transplant recipients (13,750 citizens, 1138 residents, 342 undocumented immigrants) were included from the states with policy changes between 2013 and 2023 (Illinois in 2014, Minnesota in 2016, and Massachusetts in 2021).
• The researchers used statistical tools to compare the average annual listing rate of presumed undocumented immigrants before and after the policy change, as well as the adjusted hazard ratio of receiving a deceased-donor kidney transplant and posttransplant outcomes compared to citizens. Due to small sample sizes, the data were combined across three states.

TAKEAWAY:

• Overall, of the 576 presumed undocumented immigrants included in the study, 62% of them were listed post-policy, and 38% were listed pre-policy in their respective states.
• The incidence rate of presumed undocumented immigrants listed for kidney transplants post-policy was more than double the pre-policy incidence rate (adjusted incidence rate ratio, 2.21; 95% CI, 1.15-4.27).
• These policy changes did not affect the likelihood of receiving a kidney transplant from a deceased-donor, and posttransplant outcomes continued to remain favorable for presumed undocumented immigrants and residents.

IN PRACTICE:

“Despite barriers to kidney transplant listing, posttransplant outcomes are favorable among undocumented immigrants, emphasizing the need to further increase transplant accessibility for this population,” the authors wrote. “State-led efforts…could inform national policies to ultimately improve transplant equity.”

SOURCE:

This study was led by Gayathri Menon, MHS, New York University Grossman School of Medicine, New York City, and was published online in JAMA Internal Medicine.

LIMITATIONS:

This study’s limitations included the lack of citizenship data for all patients with end-stage kidney disease. Additionally, posttransplant outcomes may have been delayed or missing in undocumented immigrants, as the Death Master File from the Social Security Administration does not capture non-US deaths.

DISCLOSURES:

This study was supported by grants from the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of Allergy and Infectious Diseases. The authors disclosed receiving grants, consulting fees, and honorarium and speaker fees and having other ties with various organizations and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.