Lung Transplant is Feasible in Developing Countries with Severe Shortage of Organ Donors: Experiences from Vietnam

Purpose One of the most challenging obstacles for lung transplants in developing countries is the severe shortage of organ donors, which can only be improved over a long period of time with significant changes in laws, community awareness and network for organ donation and sharing. However, there is one practical solution to increase the chance of matching a rare donor with a suitable recipient is to have a rich pool of well-prepared lung transplant candidates. We share our initially successful step of developing a lung transplant waiting list in Vietnam. Methods A lung transplant center has been set up at a tertiary lung hospital in Vietnam. We screen our patients with end-stage lung diseases for lung transplant candidacy. The inclusion and exclusion criteria are from the consensus of ISHLT. The patients on our waiting list are managed in accordance with protocols from one of the best lung transplant centers in the US. In addition, we have weekly online consultations with faculties from this center to give optimal care to our lung transplant candidates. We also work closely with the national coordination center for organ donation to frequently update the most recent information of our patients on the national waiting list. Results From June to September 2020, we have screened over 500 patients and recruited 20 ones who are medically eligible and socially suitable for a lung transplant. ILD accounts for 75% of patients’ diagnosis and the rest are diagnosed with COPD (15%) and silicosis (10%). We were notified about 3 potential donors in July, August, and September 2020 but the first two lungs were of poor quality and could not be utilized. The donor's lungs in September were very good and luckily his blood group was matched with four lung transplant candidates on our waiting list. All four candidates were contacted in a timely manner to come back to the hospital to do physical cross-matches. We had the opportunity to choose the best match after the careful review of the multi-disciplinary selection committee. Conclusion Having a rich and updated waiting list connected to the national network of organ donation is crucial to our initial success. Despite the shortage of donors, lung transplant is still feasible with appropriate recruitment and management of lung transplant candidates per international standards with technical support from experienced lung transplant centers.