Paik Hyo-chae
Professor in Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
Paik Hyo-chae is one of the first and best Korean lung transplant surgeons. After pioneering the field in 1996, in June 2019 he became the country’s first surgeon to perform more than 300 cases of lung transplantation.
Intolerable pain comes with every breath they take. Some lose more than half of their body weight in a few months because of their disease,” Professor Paik Hyo-chae at Yonsei University’s Severance Hospital said in an interview. “They tell me that taking a deep, painless breath is their one last wish.” Just 20 years ago in Korea, patients with serious lung disease had no option but to wait for death at the end of their excruciating struggle. But this is not the case anymore. “Today, they can have a second chance at life after receiving a lung transplant,” Paik, 58, said. “It is amazing and rewarding to see patients become healthy again as if they were never sick. Before surgery, some of them could barely walk a few steps.” Paik is the best and most prolific lung transplant surgeon in Korea. After pioneering the field with his professor Lee Doo-yun in 1996, he has performed surgery on 155 patients. In 2015 alone, he conducted 41 out of 64 lung transplants cases in the country. Over the past few years, the performance of his medical team has improved greatly as they took on an increasing number of cases. The one-year survival rate of his lung transplant patients since 2012 is 78 percent, excluding patients in extremely serious cases who could not survive without the aid of a ventilator before surgery, Paik said. “Over time, people started to recognize what we were capable of. More patients came in, and we became more experienced and skilled as a team,” he said. Lung transplantation is a surgery to replace a person’s damaged lungs with healthy ones from a donor.
In Korea, lungs only from brain-dead people can be used. Paik noted that lung transplantation is considered a last resort for those who have no other medical options. “Mostly, end-stage lung patients who are otherwise expected to die within a few years want it,” he said. The demand for transplantation is rising, but there are never enough lungs from donors. Besides, the lungs are much more fragile than other organs. As a result, only a few patients get the opportunity for a new life. According to the state-run Korean Network for Organ Sharing, only 55 lung transplants were done in 2014, compared with kidneys (1,808), liver (1,265) and heart (118) transplants. To be on the waiting list, patients have to be screened to make sure that they are a suitable candidate for lung transplantation. The donor lungs also have to be healthy; otherwise, they can be declined by the medical team. Paik believes the candidate selection process is one of the key areas that his hospital can — and should — improve to save more lives of patients in the long run. “When it comes to surgery itself, Yonsei University’s Severance Hospital is already world class,” he said. “However, the hospital needs to establish stricter systems to determine who should get donor lungs based on their survival prospects rather than their preferences.” Unlike Severance Hospital, which accepts “almost everyone,” he said, most hospitals in developed countries refuse to perform lung transplantation on those whose conditions are deemed too serious or advanced to treat.
Managing risks of lung transplantation
Patients face two main risks before and after lung transplantation. Placed on a ventilator, some patients have to wait several months for surgery, which increases the risks of problems such as bleeding and infection. To reduce such risks, Severance Hospital recently adopted extracorporeal membrane oxygenation (ECMO), the first hospital to do so in Korea. ECMO works by removing the carbon dioxide from the blood and oxygenating the red blood cells. This intervention has mostly been used on children but is now also used on an increasing number of adults with respiratory failure around the world. Unlike most other organs inside the body, the lungs are exposed to air from the outside, which increases the risk of infection for patients who have received a lung transplant. The ECMO machine is helpful for them, Paik said. Another major risk for those who got a lung transplant is rejection of the lungs by the body, which happens because the immune system attacks foreign substances in the body. To allow the transplanted organ to survive in the body, patients must take drugs to trick the immune system. However, complications after lung transplantation are inevitable. The immune system’s rejection of the new lungs can only be slowed but not completely stopped. Also, immunosuppressive medications could cause side effects, such as diabetes and kidney damage. This is why the long-term survival rate after a lung transplant is not so promising, compared with other organ transplants, Paik noted. “It would be great to have a more effective medication with fewer side effects. We need it,” he said. “Nevertheless, the long-term survival rate is improving. Some of my patients who are nearly in their 70s have been in a good shape without any lung issues.”
Unfulfilled promise
Paik and 29 of his patients and their families hiked at Mount Nakga on May 1 in 2015. “It takes healthy lungs to climb a mountain. For transplant patients, this is a symbolic test of their recovery,” he said. “That was our first mountain climbing activity, and we plan to do it every year. At the time, we only needed one bus to take them all there, but we will probably need more buses starting this year.” The activity is also about honoring one of his patients, who died after receiving lung transplantation five years ago. While counseling his patient, Paik told him, “If the surgery is successful, you can even climb a mountain.” “I don’t know why those words came out of mouth that day, but he heard them and he decided to have surgery immediately after our talks. He seemed so full of hope. I still can’t forget his beaming face,” Paik said. But the patient’s dreams never came true. Seven days after surgery, he died from postoperative complications. “I felt like I lied to him. Although it was nobody’s fault, I could not stop blaming myself for what happened. I regretted having mentioned ‘mountain climbing,’ which led him to decide to have surgery. It was a very difficult time for me,” he said. However, a month after his death, his wife called the doctor and thanked him for giving the patient hope and joy in his last days. She also donated 100 million won ($90,000) for other patients with similar conditions. “It moved my heart and made me think about how to fulfill his dream,” Paik said. “That’s why I planned the event with my other patients.”