Colombia is a mountainous country in South America with a population of 52 million people. It is the fifth largest country in South America and, according to the World Health Organization, has the best healthcare in Latin America. Despite this, there is no official lung transplant program for surgical residents in Colombia, and only three centers actively performing lung transplants.
With limited cardiothoracic surgical infrastructure, undertaking a lung transplant procedure comes with some unique challenges. Mountain ranges block direct access to transplant centers, gunshot wounds render donor organs unusable, and critical technology is not available. Eric Vinck, the first Colombian surgical resident taking part in lung transplantation to a significant extent, is taking the extra step to improve access to care and bolster the lung transplant facilities in his country.
In this interview conducted by CTSNet Global Senior Editor Emily Farkas at the 2023 Annual Meeting of the American Association of Thoracic Surgeons, Dr. Vinck speaks on the socioeconomic, structural, and geographic challenges of lung transplantation in Colombia.
Dr. Vinck is originally from Willemstad, Curaçao but has Colombian heritage and moved to Colombia to study medicine. He stayed for his residency in general and cardiothoracic surgery and developed a special interest in transplantation. He has assisted in twenty-eight lung transplants over two years.
Lung transplantation is a relatively new procedure for Colombian hospitals and surgeons. Dr. Vinck noted that “because it’s a new procedure, there is a lot of training involved—the entire team getting acquainted to the pathology, dealing with rejection, dealing with graft dysfunction, and applying new technologies like ECMO. It’s not a challenge with regard to resources but getting used to dealing with this pathology.”
He also emphasized the importance of centralizing transplant surgery. Ideally, as many transplants as possible would be performed in one center to maximize specialized teams and resources. The lack of a national system for lung transplants only adds to this challenge, making it difficult to procure donor lungs in the same city as the patient.
Dr. Vinck elaborated on this challenge: “When you want to establish a lung transplant program, the best idea would be to establish it in a place that is already used to other transplants, like heart transplants and kidney transplants. But there are few centers performing heart transplants in Colombia … These would be the ideal centers to introduce lung transplants.”
Colombia’s mountainous landscape creates another unique challenge for the high-volume transplant centers Dr. Vinck hopes to grow. While the actual distance between cities isn’t extreme, traversing across the mountains takes anywhere from six to eight hours, rendering donor organs inviable for transplant. Dr. Vinck went on to note that if a donor organ does arrive unharmed, there is still a chance it may have debris, as gunshot wounds are the most common cause of donor availability in Colombia.
Finally, Dr. Vinck explained that the lack of critical tools like transesophageal echocardiogram equipment, bronchoscopy equipment, and ex-vivo organ preservation force surgeons to create innovative solutions for keeping donor lungs viable.
Despite the challenges of performing complex procedures in Colombia, Dr. Vinck and his colleagues have brought innovation and technical skill to a rapidly growing surgical field.
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