Faculty Sponsor

Jana Stedman

College

College of Nursing & Health Professions (CONHP)

Department/Program

Physician Assistant

Presentation Type

Poster Presentation

Symposium Date

Summer 7-22-2026

Abstract

Objective: Evaluate the clinical, economic, and ethical implications of emergency-only dialysis under the EMTALA and examine evidence supporting pathways to kidney transplantation for uninsured patients with ESRD. The population included uninsured and undocumented patients with ESRD. The intervention was transplant pathways compared with emergency dialysis, with outcomes including transplant access, clinical outcomes, healthcare utilization, costs, and ethical considerations.

Methods: A structured narrative literature review was conducted using Google Scholar, UpToDate, and Research Rabbit. Searches focused on uninsured and undocumented populations, emergency dialysis, EMTALA, organ transplantation, health equity, ethical considerations, and post-transplant care. English-language publications after 2019 were included, with older datasets incorporated. Eligible studies evaluated emergency dialysis or transplantation among uninsured or undocumented populations and reported clinical outcomes, patient experiences, policy or cost analyses, or transplant pathways. Non-U.S. systems, opinion-only articles, and studies before 2019 were excluded.

Results: Uninsured individuals remain underrepresented among transplant recipients despite contributing to the organ donor pool. Emergency-only dialysis was associated with fragmented care, prolonged hospitalization, increased healthcare utilization and costs. Outpatient dialysis pathways reduced hospital length of stay without increasing mortality or readmissions. Qualitative evidence identified barriers in education, financial support, and care coordination limiting transplant access. Multidisciplinary transplant pathways demonstrated feasibility when financial barriers were addressed.

Conclusion: Transplant pathways may improve kidney transplantation access for uninsured patients while enhancing continuity of care and reducing healthcare utilization and costs. Future research should evaluate outcomes and implementation strategies.

Keywords: ESRD, emergency dialysis; EMTALA; kidney transplantation; uninsured patients; health equity; undocumented immigrants

Biographical Information about Author(s)

Heta Patel has a special interest in Emergency Medicine and plans on working in Illinois following graduation. She will be presenting on “Emergency-Only Dialysis Under EMTALA and Barriers to Kidney Transplantation in Uninsured Patients: Clinical, Economic, and Ethical Considerations” as she developed interest through her experiences in the emergency department, where she observed how patients with limited access to preventative and specialty care often rely on emergent care for life-saving and maintenance treatment.

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