In the current landscape, undocumented patients encounter significant barriers throughout the transplant pathway. These include inconsistent insurance coverage, restrictive state-level policies, and lack of access to pre-transplant diagnostics. Many dialysis programs struggle with unclear processes for referring undocumented patients, especially when coverage for evaluation varies across regions. Language barriers, fear of immigration enforcement, and limited health literacy further reduce engagement in transplant workups. On the provider side, common misconceptions regarding eligibility and financial responsibility hinder consistent advocacy and referral practices. The result is a fragmented system where undocumented patients are often under-evaluated and infrequently listed for transplantation, despite meeting clinical criteria.

A more equitable transplant landscape is attainable through targeted interventions. In the desired future state, dialysis and transplant programs implement standardized policies and workflows that ensure all clinically appropriate patients—regardless of immigration status—are consistently referred for evaluation. Hospitals and dialysis providers partner with community organizations to support navigation, translation, and resource alignment. Providers receive training that corrects misconceptions, strengthens cultural competency, and improves understanding of coverage options for undocumented patients. Clear communication pathways between nephrology, social work, transplant teams, and patient advocates promote timely testing and evaluation. Policy advocacy at local and state levels helps expand medication access and long-term sustainability of transplant care. In this improved state, undocumented patients receive transparent, compassionate, and equitable access to transplant listing aligned with national quality standards.