Trainee Awareness of Transplant Barriers for Undocumented Immigrants

Despite being eligible for transplant, undocumented transplant recipients have reported being told they were ineligible for transplantation due to their citizenship status, delaying access to transplant. The objective of this nationally representative survey-based study was to understand nephrology trainees' knowledge of transplant eligibility, transplant benefits, and clinical experience working with undocumented immigrants, utilizing an existing annual survey instrument by the American Society of Nephrology in May 2023. The main outcome was responses to survey items, and logistic regression and Chi-square tests were used to evaluate associations between transplant eligibility knowledge and transplant referral practices. Of 954 nephrology fellows, 450 responded (response rate 47%). A minority correctly identified undocumented individuals were eligible for transplant (39.1% for living donor and 31.7% for deceased donor). 45% of trainees were unsure of the available insurance options for undocumented immigrants. Correctly identifying living and deceased donor transplant eligibility was significantly associated with referring undocumented people to transplant (p<0.001). To our knowledge, this is the first study to examine clinicians' knowledge and experiences regarding transplant eligibility for undocumented individuals. These findings highlight the need for targeted educational interventions to improve trainees' understanding of transplant eligibility and insurance barriers for undocumented immigrants, ultimately fostering more equitable access to kidney transplantation for this vulnerable population.