Lung transplant programs in developing countries: challenges and solutions
Anh Nguyen1,2, Marek Brzezinski3, Joy Chen4, Nhung V. Nguyen1,2, Luong V. Dinh2, Jasleen Kukreja4.
1Department of Tuberculosis and Lung Diseases, Hanoi Medical University, Hanoi, Viet Nam; 2Lung Transplantation Center, National Lung Hospital , Hanoi, Viet Nam; 3Department of Anesthesia, University of California San Francisco, San Francisco, CA, United States; 4Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, CA, United States
Introduction: The overwhelming majority of lung transplants (LT) performed are in developed countries of Europe and North America. In contrast, little is known about the current status of LT in developing nations. The objective is to summarize the unique challenges and present potential solutions for starting a new LT program in a developing country such as, ours in Vietnam. We hope this review will guide healthcare providers in developing countries who are contemplating embarking on such journey.
Materials and Methods: For this review, studies were identified by searching the electronic database PubMed using keyword “lung transplantation” published within the past five years. To be included in this review, articles needed to be original, involving human studies, and published by programs from developing countries. Overall, we identified 25 papers that are included in our review. They are from 10 countries including Argentina, Brazil, Chile, China, Colombia, India, Iran, Korea, Turkey and Vietnam.
Results and Discussion: The key challenges that programs in developing countries encountered included shortage and marginal quality of donated organs, lack of dedicated multi-disciplinary LT team, limited availability of advanced technology such as extracorporeal membrane oxygenation or ex-vivo lung perfusion and high risk of post-transplant infections. Education and collaboration among government, public, and healthcare sectors was seen as fundamental to building and maintaining a successful program. Despite minimal resources and the challenges above, LT survival rates in developing countries improved and were comparable with outcomes reported by the International Society for Heart and Lung Transplantation Registry.
Conclusion: Starting a new LT program is a daunting task that is complex and resource intensive, regardless of geography, and is even more so in developing countries. But it is feasible if all stakeholders allocate appropriate resources to develop dedicated, qualified multi-disciplinary LT healthcare teams, establish a nationwide network of organ sharing, as well as raise public awareness about the importance of organ donation.
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