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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Sep 25, 2025; 14(3): 105768
Published online Sep 25, 2025. doi: 10.5527/wjn.v14.i3.105768
Published online Sep 25, 2025. doi: 10.5527/wjn.v14.i3.105768
Complex role of insurance in living donor kidney transplantation: Perspectives from the affordable care act era
Guido Gembillo, Domenico Santoro, Unit of Nephrology and Dialysis, AOU "G. Martino", University of Messina, Messina 98125, Sicilia, Italy
Giuseppe Lanfranchi, Department of Mathematics, Computer Science, Physics and Earth Science, University of Messina, Messina 98121, Sicilia, Italy
Author contributions: Gembillo G, Lanfranchi G, and Santoro D contributed equally to the design and implementation of the paper and to the writing of the manuscript; All the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guido Gembillo, MD, PhD, Assistant Professor, Unit of Nephrology and Dialysis, AOU "G. Martino", University of Messina, Via Consolare Valeria n 1, Messina 98125, Sicilia, Italy. ggembillo@gmail.com
Received: February 6, 2025
Revised: April 16, 2025
Accepted: June 20, 2025
Published online: September 25, 2025
Processing time: 223 Days and 12.6 Hours
Revised: April 16, 2025
Accepted: June 20, 2025
Published online: September 25, 2025
Processing time: 223 Days and 12.6 Hours
Core Tip
Core Tip: The affordable care act’s dependent coverage provision for young adults under 26 offers more than insurance, it offers a lifeline during critical educational and clinical transitions. In nephrology, where delays can mean irreversible harm, continuity matters. Yet this reform reveals a tension: access has widened, but not equitably. Provider deserts, bureaucratic inertia, and systemic stratification still fracture care. This article contends that without structural redistribution, policy is performance. The promise of reform is undermined by persistent exclusions leaving those most at risk stranded between legal entitlement and real-world abandonment.