LUNG TRANSPLANTATION AMONG UNDOCUMENTED IMMIGRANTS

Abstract

TOPIC: Transplantation TYPE: Original Investigations PURPOSE: Legal status in the United States is an important social determinant of health. Undocumented immigrants face several obstacles in obtaining equivalent healthcare to United States citizens or resident aliens. Despite these obstacles, undocumented individuals are eligible to be listed for and receive organ transplant for advanced disease. We hypothesize that this population represents healthy workers, and has significantly different social and clinical needs pre-transplantation than the population of listed US Citizens or resident aliens. We sought to describe this population of undocumented patients, listed for lung transplantation, for the first time, to identify potential disparities in care and develop strategies to address the needs of this unique patient population. METHODS: Using the de-identified United Network for Organ Sharing (UNOS) Thoracic dataset we identified 64,585 individuals who had been listed for lung transplant between 1985 and 2020. We identified 232 undocumented individuals; non-resident aliens who did not travel to the US for the purpose of transplant evaluation or have their care paid for by a foreign healthcare system. We evaluated demographic, disease characteristic, and payer differences between documented and undocumented individuals using bivariate tests of difference. We report Cohen’s d statistics, when possible, to characterize the degree of difference between the two populations. RESULTS: The mean age of undocumented individuals listed for transplant was 41.1 years, which was significantly lower than that of documented individuals (p < 0.00001). The proportion of individuals with the listing diagnoses of idiopathic pulmonary fibrosis (IPF), pulmonary arterial hypertension (PAH), and bronchiectasis was significantly higher in the undocumented cohort of patients (p- values of 0.002, < 0.001, and <0.001 respectively). However, the proportion of undocumented individuals with a listing diagnosis of chronic obstructive pulmonary disease (COPD) was significantly lower (p < 0.001). Patients within the undocumented cohort also had a higher initial Lung Allocation Score (LAS) than documented individuals with an average score of 43.1 indicating more severe disease (p = 0.046). Undocumented individuals were less likely to have a history of tobacco use (p < 0.001). The majority of undocumented individuals were self-pay and there were no significant differences in Medicaid users between both cohorts. CONCLUSIONS: Undocumented patients listed for lung transplant represent a younger population of non-smokers who likely have very different medical and social needs than US citizens or resident aliens. Further evaluation of the specific needs of this population is warranted, particularly in areas with high populations of undocumented individuals. CLINICAL IMPLICATIONS: These patients are not more likely than US citizens or resident aliens to rely on public insurance programs (e.g. Medicare and Medicaid) indicating that the current practice of listing these individuals does not place an excessive burden on public health programs. DISCLOSURES: No relevant relationships by Lilia Cervantes, source=Web Response No relevant relationships by Daniel Colon Hidalgo, source=Web Response No relevant relationships by Matthew Griffith, source=Web Response No relevant relationships by Guillermo Jimenez, source=Web Response No relevant relationships by Matthew Rockstrom, source=Web Response