Publication Name	World Journal of Nephrology
Manuscript ID	105768
Country	Italy

Category	Urology & Nephrology
Manuscript Type	Letter to the Editor
Article Title	Complex role of insurance in living donor kidney transplantation: Perspectives from the affordable care act era
Manuscript Source	Invited Manuscript
All Author List	Guido Gembillo, Giuseppe Lanfranchi and Domenico Santoro
Funding Agency and Grant Number
Corresponding Author	Guido Gembillo, Assistant Professor, MD, PhD, Unit of Nephrology and Dialysis, AOU "G. Martino", University of Messina, Via Consolare Valeria n 1, Messina 98125, Sicilia, Italy. ggembillo@gmail.com
Key Words	Living donor kidney transplantation; Renal transplantation; End-stage renal disease; Chronic kidney disease; Pediatric nephropathies
Core Tip	The ACA’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.
Citation	Gembillo G, Lanfranchi G, Santoro D. Complex role of insurance in living donor kidney transplantation: Perspectives from the affordable care act era. World J Nephrol 2025; In press

Received	2025-02-06 03:58
Peer-Review Started	2025-02-06 08:11
To Make the First Decision
Return for Revision	2025-04-08 06:23
Revised	2025-04-16 21:43
Second Decision	2025-06-19 02:43
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-06-20 01:16
Articles in Press	2025-06-20 01:16
Publication Fee Transferred
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2220-6124 (online)
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: http://creativecommons.org/licenses/by-nc/4.0/
Copyright	©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Permissions	For details, please visit: http://www.wjgnet.com/bpg/gerinfo/207
Publisher	Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Website	http://www.wjgnet.com