H-1B Visa Changes and its Impact on Transplant Workforce

To the Editor: There is a shortage of trainees pursuing transplant fellowships across all solid organs.1 This led to the creation of the American Society of Transplantation Fellows Task Force who endorsed easing visa requirements for graduates that have trained outside the United States to fill in this gap.1 The J-1 and H-1B visas are commonly used by foreign medical graduates to permit their entry into the United States for medical training and continued employment. On September 19, 2025, a Presidential Proclamation was released2 requiring a $100 000 payment (Sec 1(a)) for new H-1B applications for those outside the United States, effective September 21, 2025, with expiration after 12 mo unless extended. Multiple US transplant fellowship programs (in addition to their prerequisite pipeline training programs) match foreign medical graduates requiring H-1B visas. Recent data show that transplant specialty fellowships have unfilled spots every year (e.g., 62% unfilled transplant hepatology spots in 2024)1 with a predicted 35% shortage of adult transplant hepatologists by 2033.1 The significant payment requirement for new H-1B visa applicants will worsen the strain on the workforce across all solid organ transplant fields including transplant surgery. This will likely have a negative impact on the ability to recruit trainees pursuing transplant fellowships across all organs and subsequently compromise patient care, delivery, and outcomes. Sec 1(c) of the proclamation2 does, however, permit an exception to the aforementioned payment if the Secretary of Homeland Security determines that “all aliens working in an industry…” (or on an individual or company basis) “…is in the national interest and does not pose a threat to the security or welfare of the United States.” Individuals who require an H-1B visa represent a critical component of the transplant workforce yet this new proclamation imposes administrative and financial barriers that threaten their ability to contribute to patient care and innovation in the United States. Given the strong bipartisan and bicameral presence of national medical and transplant-focused societies, they are uniquely positioned to lobby and engage with the Executive branch of the federal government to highlight the urgency of reducing visa-related obstacles and attempt to stabilize the transplant physician pipeline. Transplant-specific societies were not included on publicly available letters3 cosigned by other national medical societies sent to the federal government. This demonstrates a unique opportunity for transplant and supporting national medical societies to highlight how international trainees and physicians are critical to augment the work being done by US transplant physicians without replacing their efforts or compromising job availability. Another pathway would be for transplant societies to file an amicus brief as a part of current litigation (e.g., Chamber of Commerce of the United States of America v. United States Department of Homeland Security, 1:25-cv-03675 [D.D.C.]) to support clarity and discuss a targeted exemption for medical fields. Such efforts are essential to safeguard the current and future workforce and to meet the growing demand for high-quality transplant care nationwide. International mentees should also educate prospective fellows about evolving visa regulations and connect them with US programs experienced in visa sponsorship.