A 20-year-old patient who had lost all functions in her lungs received a new chance in life after both her parents sacrificed a portion of their lower lung for a successful living lung donation.
The first living lung transplant in the nation has become possible thanks to the combination of the parents’ dire wishes to prolong their child’s life and medical workers’ strong will, opening the way for other patients with damaged lungs waiting for just brain-dead donors, the Asan Medical Center서울아산병원 (AMC) said Wednesday.
The lung consists of three pieces on the right side and two pieces on the left. As healthy life is possible after resecting part of lungs, a biopsy is a safe procedure for both the donor and the recipient, by transplanting a part of the lungs of two donors to the pulmonary insufficiency.
Oh Hwa-jin오화진 began to experience sudden shortness of breath and started to gain weight in 2014. She was diagnosed with idiopathic pulmonary arterial hypertension, in which the pulmonary artery became thicker due to the increased blood pressure of the pulmonary artery for no particular reason, making it difficult to send blood from the heart to the lungs.
In July 2016, Oh was at risk of cardiac arrest but experienced a close shave. She was told that she would only have 20 percent chance of survival had another myocardial infarction occurred. To obtain the lungs from a brain-dead donor, however, Oh had to be at the end-stage of her lung disease and insert an artificial respirator.
According to the Korean Network for Organ Sharing국립장기이식센터(KONOS) last year, the average period of waiting for a donor to donate lung cancer in Korea is 1,456 days. From 2014 to July 2017 in AMC alone, out of the 68 patients who waited for brain-dead donors, 32 died.
Oh’s parents, who couldn’t bear to see their daughter not be able to undergo surgery even when her heart stops again, tried to contact Professor Hiroshi Date of Kyoto University Hospital, which is renowned for lung transplantation in Japan.
The AMC's lung transplant team has been watching the deaths of patients waiting for transplants for the last 10 years and had a sense of mission that live-lung transplantation can save waiting for patients for lung donations for transplant. Since 2008, the team has continued to visit Professor Date and learned the know-how of live-lung transplantation surgery and has been steadily preparing to treat end-stage pulmonary insufficiency patients waiting for donations from brain dead patients.
The AMC lung transplantation team held an emergency meeting to find an alternative for Oh. In August, the hospital’s clinical trial deliberation committee and the medical ethics committee decided to save Oh's life. Although it is not under the current law, the Korean Society for Thoracic and Cardiovascular Surgery대한흉부심장혈관외과학회 and the Korean Society of Transplantation대한이식학회 requested a medical ethical review and received a positive reply.
The committee also reported to related institutions, including the National Assembly and KONOS, to persuade the inevitability of biopsy for Oh.
On Oct. 21, Oh and her parents were on the operating table at Asan Medical Center. In addition to the thoracic surgery professors who directly visited the surgery, about 50 medical workers, including anesthesiologists, respiratory, cardiologists, and infectious medicine professors, nurses, and cardiopulmonary workers, took part to perform their respective roles.
The lungs below the right side from Oh’s father and the lungs below the left side from her mother were transplanted into the right and left lungs of their daughter, respectively.
Oh, who received intensive care, has been recovering rapidly since taking the ventilator off six days after surgery and moved to the general ward on Nov. 6. Her parents, who donated a part of the lungs for her daughter, are also discharged from hospital six days after the operation and are living their everyday life.
"I was able to undergo surgery because of my parents and medical staff's dedicated efforts in a situation where I could not walk even three steps because of my breath,” Oh said. “The day when I regained my consciousness six days after surgery was my birthday, and I feel thrilled and thankful for being born again.”
Doctors also expressed satisfaction with the successful operation. "We are pleased to be the first in Korea to succeed in living lung donation,” said Professor Park Seung-il박승일 of the Department of Thoracic Surgery. "It is a major surgery that offers another treatment for patients who die from aggravated conditions, especially pediatric patients, waiting for a brain-dead lung transplant."