The growth of the undocumented immigrant population in the United States has been
explosive. The absence of a uniform policy regarding health care for this population
has created a unique problem for nephrologists. How should provision of care for undocumented
immigrants with end-stage renal disease be delivered and compensated? This problem
is exacerbated by the multiple complex laws that govern delivery of and payment for
care, as well as that state regulations vary widely and are not easily understood.
Furthermore, the ethical and moral commitments of providers to ensure adequate and
appropriate care for any patient whose life is at stake, irrespective of his or her
immigration status, place nephrologists in a difficult position. This review focuses
on the scope of this problem, relevant case law and legislation, current care and
payment models, the response of nephrology groups, and ethical dilemmas inherent in
caring for this vulnerable population. Recommendations for further study, including
convening of a consensus conference, are discussed.
Copyright 2009 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights