Introduction: 

Transplantation is the treatment of choice for children with end-stage liver disease, though transplantation in undocumented immigrants is controversial. Despite recent Medicare expansion, 32% of undocumented immigrant children remain uninsured, limiting access to transplantation. We evaluate national trends in waitlist and transplant activity amongst undocumented immigrant children, with a focus on regional trends.

Methods: 

Pediatric liver transplant and waitlist data were obtained from the Organ Procurement and Transplantation Network (OPTN). Data on region, waitlist additions, procedures, and citizenship status were analyzed from 2012-2022.

Results:

On average, between 2012-2022, 713±47 pediatric liver patients were added to the waitlist and 544±32 transplants were performed annually. Of these, non-citizen US residents comprised 1.5% of both waitlist additions and transplant procedures. These trends remained stable over the study period, with no significant changes in waitlist or transplant activity nationwide (Figure 1A-B). There was significant geographic variation in the percentage of waitlist additions and transplants across United Network for Organ Sharing (UNOS) regions amongst non-citizen US residents, with most pronounced variation in regions 3, 4, and 5 (Figure 1C-D). 

Conclusion: 

This is the first study to evaluate national trends in transplantation activity amongst undocumented immigrant children. Despite state-specific expansions to healthcare coverage for undocumented individuals, transplant activity within this group remains unchanging. There is significant regional variation in transplant and waitlist rates for undocumented children unexplained by population differences. Together, these findings suggest structural barriers to increasing transplant accessibility and underscore the need for targeted interventions to improve the health of all children.