Three days into my medical career, my first patient died. She was a 27-year-old who succumbed to an autoimmune liver disease. She had been denied a liver transplant for years because she was uninsured and undocumented. I watched her young children as they cried at her bedside, saying, “Mami no te vayas!” (mama, don’t go!).

Witnessing her death in my first week of residency was heartbreaking. I came into medicine to save lives yet immediately saw our limitations. I quickly learned that in Maryland, uninsured patients are functionally excluded from organ transplants. Ultimately, this excludes patients from life-sustaining care based solely on their immigration status. This injustice weighs on my conscience as a doctor.

There are many reasons why my patient was denied a liver transplant. Per the Organ Procurement and Transplantation Network policy and the National Organ Transplant Act of 1984, citizenship status does not preclude eligibility for transplant. However, prior to 2024, undocumented individuals in Maryland were mostly unable to obtain health insurance. Lack of insurance coverage made the necessary life-long immunosuppressive medications impossible to afford.

Patients were often unable to access the specialists and surgeons who would see them for their transplant care. The Emergency Medical Treatment and Active Labor Act prohibits refusal of emergency services regardless of immigration status, yet the law specifically excludes solid organ transplants. In theory, the transplant list does not use citizenship status to determine eligibility. But in practice, we are preventing undocumented patients from receiving this care.

Some Americans may think we are saving money by reserving organs for legal residents. But being admitted to the intensive care unit or frequently visiting the emergency department due to complications from organ failure comes with a cost. In many states, patients with kidney failure come to the emergency department for routine “emergency” dialysis, or health care institutions absorb the cost of sending them to a dialysis center. One study from 2019 found a total savings of $5,768 per person per month when providing access that transitioned a patient from emergency dialysis to routine outpatient dialysis.

Most of the arguments against organ transplants for undocumented individuals stem from practical objections. Some opponents believe that undocumented patients will not be able to adhere to treatments as well as citizens. However, studies have found no difference in the rate of kidney graft failure between undocumented and documented individuals. Many of the existing challenges stem from providing care in patients’ native language, which is a problem for citizens and non-citizens alike.

Other people have moral objections to providing organ transplants to undocumented individuals. There are a limited number of organs available, the argument goes, and so they should be prioritized for American citizens. Yet despite not being able to receive organs, undocumented individuals account for approximately 3.3% of the deceased organ donor pool. Most importantly, an immigrant is a human being with just as much right to receive lifesaving care.

There has recently been some progress on this issue. The Access to Care Act in Maryland was passed in 2024 and will allow undocumented residents to enroll in commercial health insurance plans starting in 2026. However, it’s important to note that plans can be expensive, and many of these patients live below the poverty line. Some states have versions of a program known as PRUCOL (Permanently Residing Under the Color of the Law), which allows patients to announce their presence in the United States via an immigration lawyer. This grants them the ability to obtain certain services, including Medicaid, thus providing eligibility for transplant. This process is legally complex, and patients cite fear of deportation through the process. However, it should be considered in Maryland.

Donald Trump’s presidency comes with many concerning policy changes in the immigration space, including the elimination of DACA, ending birthright citizenship, halting asylum proceedings and mass deportations. The future is uncertain for these patients, and I can imagine my early career as a physician will see the downstream effects of these policies impacting my most vulnerable patient populations.

I fear the day that I will once again watch a patient die from lack of access to a new organ. Many of my patients come to the United States to escape danger, provide a better life for their children and reimagine their future. Discriminatory policies, however, cut this new life short for too many of them.

Christine Lopez is a resident physician in Internal Medicine-Pediatrics at Johns Hopkins.