Facing the Challenges of Heart and Lung Harvesting and Procurement in Resource Limited Settings: Colombia

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posted on 2024-04-25, 16:08 authored by Eric E. Vinck, Jose J. Escobar, Juan C. Rendon

Background

The first heart transplant in Colombia was performed in Medellín on December 1, 1985 and the first successful lung transplant in Colombia was performed on October 28, 1997 at the same center. The principal surgeon of these two milestones was Alberto Villegas Hernández (1, 2). Today, the Cardio VID Clinic at Pontifical Bolivarian University in Medellín, Colombia is still both the lung and heart transplant epicenter of Colombia. Currently, ten centers perform heart transplants in different cities in Colombia. Four of these centers have achieved sustainable lung transplant programs in association with their heart transplant divisions (Table 1–2). In Colombia, cardiac and thoracic surgery are different subspecialties, so heart transplants are performed by cardiac surgeons and lung transplants are performed by general thoracic surgeons. In Medellín, both cardiac and thoracic surgeons perform lung transplants (3–6).

Table 1

Table 2

General Cardiopulmonary Transplant Characteristics

The mean annual number of heart transplants in Colombia is 55±5 and 21±2 for lung transplants (3–6). The average number of patients on the national Colombian transplant waiting list is 21±2 for hearts and 32±2 for lungs, and waiting time is between 1–5 months—1.5 month at the authors’ clinic (3–6). Donor to recipient matching is arranged through a national network database and a multi-institution transport model. Once a heart and/or lung becomes available, a tissue match is determined by the transplant network protocol, including anatomy and HLA type matching. If emergency transplant criteria (INTERMACS II) are met in any city, the heart is procured and air bridged to the recipient’s city and center. If no national emergency transplant criteria are met, the heart or lung stays in the city where it has been harvested and is ground transported to the nearest transplant center (Figure 1). Procured lungs are kept within the same city limits for transplantation, as there is still no intercity lung bridging in Colombia (3–6).

Transplant center location influences outcomes. The four heart transplant centers located in Bogota are the only ones in the world based at 8,660 ft above sea level, with no apparent effect on survival (3). Air transport of the donor hearts to Medellín, Colombia, according to city of origin is as follows: from Bogota (415 kilometers), from Cali (417 kilometers) and from Bucaramanga (387 kilometers), all of which average 50 minutes air bridging time. Other nearby locations have transfers conducted through ground transport. The emerging nature of Colombia has led to many obstacles regarding survival. Suboptimal care of potential recipients, poor adherence to therapy, socioeconomic difficulties during post-transplant care and high numbers of traumatic donor deaths have all been significant factors influencing survival in Colombia (3–6). Many organ recipients also live in rural locations, impeding appropriate postoperative follow up with delayed identification of complications. This challenges prompt intervention. In addition, some health insurance companies have been inefficient in covering and providing immunosuppressive drugs.

Figure 1. Harvest Transplant Team transport van in Medellín, Colombia.