In Vietnam, dialysis is only provided in hospitals—there are no outpatient dialysis centers. The biggest challenge for patients needing dialysis is getting access to a machine. Thống Nhất Hospital, a large public hospital based in HCMC, has 45 dialysis machines that service about 200 regular patients and operate 20 hours per day, with four hours for maintenance. This contrasts to American dialysis machines that typically operate 12-16 hours per day. Five machines at Thống Nhất Hospital are dedicated to emergency dialysis.⁶

“Many patients who receive dialysis here come for an emergency dialysis session since they are unable to go in for regular sessions,” according to Long Nguyen, MD, a physician in the emergency department of Cho Ray Hospital, HCMC’s largest public hospital. He said, “the dialysis machines run 24 hours [at Cho Ray Hospital] and many patients are on the waitlist for a dialysis chair.” According to local doctors, unlike in the United States, there is no “compassionate” dialysis. If patients are unable to pay prior to a dialysis session, their spot is given to the next patient who can pay. This lack of available dialysis machines inevitably leads to worsened conditions for patients.

The rate of kidney transplants in Vietnam is one percent of ESRD patients compared with 32 percent in the United States. Approximately 46 percent of U.S. individuals with ESRD receive a kidney after being on the transplant waitlist for five years.^7,8 Although there are skilled surgeons able to perform transplants in Vietnam, the issue is in the shortage of available organ donors. There have been recent public health efforts in Vietnam to encourage more individuals to register as organ donors to increase this rate.

Furthermore, there is a drastic difference in the cost of a kidney transplant. Estimated costs for kidney transplants including pre-op and post-op care is approximately $415,000 in the U.S. compared with $8,600 to $13,000 in Vietnam. Again, patient responsibility in both countries is about 20 percent of that cost.^7,9

Overall, if I have a failing kidney and had to pick whether to receive treatment in the U.S. or Vietnam, I would pick the U.S. despite the significantly greater cost. Given that I have a stable income and can afford the higher monthly out-of-pocket costs for dialysis and ESRD-related treatments of about $625 compared with the $65 in Vietnam, I won’t have to fight as hard for a dialysis chair to receive my necessary treatments. I also have access to more reliable medications and greater availability of specialty care.