Lung Transplantation in Korea

At a Glance

Overview

Lung transplantation replaces one or both diseased lungs with healthy donor lungs to restore respiratory function in patients with end-stage lung disease. It is among the most technically demanding solid-organ transplants performed in thoracic surgery.

South Korea operates a mature, nationally coordinated lung transplant programme through a small number of high-volume academic medical centres. The programme is governed by the Act on Organ and Human Body Part Donation and Transplantation, administered by the Korea Health Industry Development Institute (KHIDI) in partnership with KONOS.

Three main surgical approaches are used in Korea:

• Single-lung transplant — one diseased lung is replaced; shorter operative time, preferred for older patients or those with idiopathic pulmonary fibrosis (IPF) when the native lung will not compete with the graft
• Bilateral sequential lung transplant — both lungs replaced in a single operation via a clamshell or bilateral thoracotomy incision; standard for younger patients, COPD, bronchiectasis, and cystic fibrosis
• Living-donor lobar lung transplant (LDLLT) — the right lower lobe from one living donor and the left lower lobe from a second living donor are transplanted into the recipient; Korea was among the first countries in Asia to report this technique and amended transplant law in 2018 to formally permit living-lung donation

Idiopathic pulmonary fibrosis (IPF) has historically been the most common indication in Korea, reflecting the country's ageing patient population and the rising incidence of fibrotic lung disease across East Asia.

Am I a Candidate?

Lung transplantation is considered when chronic lung disease has progressed to a stage where medical therapy no longer maintains acceptable quality of life or survival, and life expectancy without transplant is estimated at fewer than two years.

Common diagnoses that may qualify a patient for evaluation include:

• Idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases
• Chronic obstructive pulmonary disease (COPD) or emphysema not responding to medical management
• Bronchiectasis or cystic fibrosis with recurrent infections and declining FEV1
• Pulmonary arterial hypertension refractory to advanced therapies
• Sarcoidosis or lymphangioleiomyomatosis with severe functional impairment

Korean transplant centres conduct a thorough multi-disciplinary evaluation before listing. This typically includes pulmonary function testing, six-minute walk distance, echocardiography, CT imaging of the chest, cardiac catheterisation, and infectious disease screening.

Contraindications that would generally exclude a candidate include active malignancy within the preceding two to five years, severe dysfunction of other major organs (unless combined transplant is planned), active smoking or recent cessation under six months, uncontrolled psychiatric illness, and inability to adhere to a complex lifelong immunosuppression regimen.

For LDLLT, living donors must be healthy adults — typically family members — with compatible blood type and lobe size sufficient to fill the recipient's chest cavity. Both donors undergo independent surgical risk assessment before consent is finalised.

How the Procedure Works

Once a compatible deceased donor lung is identified by KONOS and allocated to a recipient on the waiting list, the transplant team mobilises within a strict cold ischaemia window — typically under six hours for lungs.

The operative sequence for a bilateral sequential lung transplant (the most common approach in younger Korean patients) proceeds as follows:

• The patient is positioned supine or in a lateral decubitus position depending on surgeon preference and incision choice (bilateral anterior thoracotomy with transverse sternotomy, or sequential lateral thoracotomies)
• Cardiopulmonary bypass or veno-venous ECMO (extracorporeal membrane oxygenation) is established if haemodynamic or respiratory stability cannot be maintained during single-lung ventilation
• The first native lung is excised, and the donor lung is implanted with bronchial, pulmonary artery, and pulmonary vein anastomoses
• The second native lung is then excised and the second donor lung implanted in the same fashion
• Haemostasis is secured, chest drains are placed, and ECMO is weaned if it was used intraoperatively

For single-lung transplant, only one side is replaced via a standard posterolateral thoracotomy.

For LDLLT, two separate donor operations (one for each living donor) are coordinated simultaneously with the recipient operation. Each donor's lower lobe is resected via a video-assisted or open thoracotomy, and the two lobes are implanted into the recipient as a functional right and left lung.

All procedures are performed under general anaesthesia with double-lumen endotracheal intubation for independent lung ventilation.

Recovery Timeline

Recovery from lung transplantation is prolonged and structured across several distinct phases.

Immediate post-operative period (Days 1–7)

• Patient remains in the intensive care unit on mechanical ventilation, typically weaned to extubation within two to five days if primary graft function is satisfactory
• ECMO may be continued post-operatively if primary graft dysfunction (PGD) is detected
• Chest drains are managed, and fluid balance is closely monitored
• Immunosuppression (typically a calcineurin inhibitor such as tacrolimus, an antimetabolite, and corticosteroids) is initiated immediately

Early hospital phase (Weeks 1–6)

• Stepdown from ICU to a specialised thoracic transplant ward
• Bronchoscopy performed regularly to assess anastomosis and sample airways for infection surveillance
• Pulmonary physiotherapy begins as soon as the patient is haemodynamically stable
• Total inpatient stay is commonly four to eight weeks for uncomplicated recipients

Post-discharge recovery in Korea (Months 1–3)

• Outpatient clinic visits two to three times weekly for blood-level monitoring of immunosuppressants and lung function spirometry
• Korean transplant centres expect international patients to remain in Korea for a minimum of three months post-discharge
• Prophylactic antifungal, antiviral (CMV), and antibacterial regimens continue during this high-risk window

Longer-term rehabilitation (Months 3–12+)

• Supervised pulmonary rehabilitation programme; most patients return to independent daily activities by six months
• Annual surveillance bronchoscopy and PFTs to monitor for chronic lung allograft dysfunction (CLAD)
• Lifelong immunosuppression and regular follow-up are mandatory — coordination with a transplant-experienced pulmonologist in the patient's home country is arranged before discharge from Korea

Cost Breakdown

Lung transplantation involves multiple cost layers that international patients must plan for well in advance.

Evaluation and listing phase covers pulmonary function testing, CT scanning, cardiac investigations, infectious-disease panels, and multi-disciplinary team consultations. This phase typically runs $3,000–$8,000 USD and is required before any patient can be placed on the KONOS waiting list.

Surgical and ICU fees form the largest single component. The transplant operation itself — theatre time, perfusionist fees, ECMO if required, and surgical team costs — combined with four to eight weeks of ICU and step-down ward care typically accounts for the majority of the total bill.

Immunosuppression and pharmacy costs during the inpatient stay are substantial. Tacrolimus, mycophenolate mofetil, prednisolone, and antiviral/antifungal prophylactics are all included in most hospital packages but should be confirmed in writing.

Post-discharge monitoring for the three to six months recommended in Korea adds accommodation, outpatient clinic fees, and drug costs. Patients should budget an additional $8,000–$20,000 USD for this phase.

For LDLLT, two separate donor surgeries add cost but may shorten waiting time significantly. Donor surgical fees, anaesthesia, and short inpatient recovery for each donor are typically itemised separately.

All figures are approximate and depend on the specific procedure type, length of ECMO support, complications, and the centre chosen. International patients should request a detailed written estimate before confirming admission.

Why Korea

South Korea's lung transplant programme is distinguished by several structural and clinical advantages that are difficult to replicate in other medical tourism destinations.

Centralised organ allocation via KONOS

The Korean Network for Organ Sharing allocates all deceased-donor lungs through a transparent, urgency-weighted scoring system modelled on international best practice. This national coordination — rather than fragmented hospital-by-hospital allocation — maximises the utilisation of each donated lung and reduces waiting-list inequity.

Living-donor lobar lung transplantation leadership

Korea is among a very small number of countries with documented experience in LDLLT.

The 2018 amendment to Korea's organ donation law formally legalised living-lung donation, allowing high-volume academic centres to develop this technique for patients — particularly children and young adults — who cannot safely wait for a deceased donor.

KOTRY and outcomes tracking

The Korean Organ Transplantation Registry (KOTRY) provides systematic long-term outcome data across all transplant types, enabling Korean centres to benchmark their results, identify complications early, and continuously refine protocols.

KHIDI international patient infrastructure

The Korea Health Industry Development Institute and the Medical Korea portal (medicalkorea.or.kr) provide government-backed coordination services for international patients, including hospital referrals, interpreter services, and coordination with home-country healthcare providers after discharge.

MFDS regulatory oversight

The Ministry of Food and Drug Safety (MFDS) oversees pharmaceutical and immunosuppression standards used in Korean transplant centres, ensuring that drug quality and protocols meet rigorous regulatory standards comparable to those of the US FDA or European EMA.

Cost efficiency without compromise on complexity

Korean academic medical centres offer lung transplantation at a fraction of the cost of equivalent programmes in the United States or Western Europe, while operating within a universal healthcare infrastructure and a culture of high-volume, protocol-driven surgical practice.

Related Topics

Sources

• The First Living-Donor Lobar Lung Transplantation in Korea — PMC
• Current Status and Future of Lung Donation in Korea — PMC
• Allocation of Donor Lungs in Korea — PMC
• Medical Korea — Transplantation (KHIDI official portal)

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