Kidney transplantation in undocumented immigrants with ESRD: a policy whose time has come?
BACKGROUND
In most US states, taxpayers are paying, either directly or indirectly, for years of dialysis therapy for undocumented immigrants with end-stage renal disease who lack resources to pay for care themselves. Living donor transplant is a less expensive long-term alternative, but it is unknown what percentage of these patients have potential living donors.


METHODS
We conducted a cross-sectional survey of undocumented immigrant patients receiving dialysis at our outpatient center between March and May 2010. Forty-five patients completed the survey. The survey focused on the availability of potential living donors, perceived health status of those donors, and potential recipients' outlook on remaining on dialysis therapy versus receiving a kidney transplant. We gathered demographic and health status data for the survey participants and the 82 documented resident patients receiving care in the same dialysis unit.


RESULTS
The average age of our undocumented immigrant patients was 44 years. The undocumented patients were healthier than their legal resident counterparts, with a lower incidence of coronary artery disease (7% vs 33%; P < 0.005) and diabetes mellitus (40% vs 68%; P < 0.005). Approximately half the undocumented immigrants were working when they were surveyed. Of the half who had stopped working, 82% said they would seek work if they had a kidney transplant. 60% had at least one potential kidney donor. Most donors were reported to reside in the United States or Canada.


CONCLUSIONS
Undocumented immigrants treated with dialysis in the United States are relatively young and healthy, and many have at least one potential living kidney donor. Given the societal cost-savings associated with transplant, we suggest that policy makers should consider extending coverage to pay for living donor transplant for undocumented immigrants with end-stage renal disease.
Division of Nephrology, Elmhurst Hospital Center, Elmhurst, NY 11373, USA.
Ellena A
EA
Linden
Jeannette
J
Cano
George N
GN
Coritsidis
D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011050:Policy Making; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists