Access to Life: Advanced Heart Failure Therapies for Undocumented Immigrants

The U.S. healthcare system systematically excludes undocumented immigrants (UIs) from life-sustaining treatments for advanced heart failure (AHF), creating profound ethical violations and health disparities. This thesis demonstrates how excluding UIs from AHF therapies breaches justice, autonomy, beneficence, and non-maleficence by restricting access to mechanical circulatory support, inotropic therapy, and heart transplants. Analysis of Medicaid restrictions, legal barriers, and a representative patient case study reveals how current policies institutionalize preventable harm. Contrasting these failures with successful state-level expansions for end-stage renal disease (ESRD), the work proposes actionable solutions to redress inequities exacerbated by immigration policies. The findings underscore that structural reform is both ethically imperative and financially viable, with critical implications for public health, equity, and clinician moral distress. This thesis calls for immediate policy changes guided by the ESRD model and further research to address healthcare exclusion.