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Heart surgeries face dangerous legal limbo as Korea's new nursing law threatens to kick vital technicians from operating room

Published: 13 May. 2025, 14:32

Oh Ji-young, a clinical perfusionist, operates a heart-lung machine during cardiac surgery. Perfusionists manage more than 10 devices during procedures, including a heart-lung machine, autotransfusion system and temperature regulator, while monitoring over six screens. [CHAE HYE-SEON]

As Korea prepares to enforce a new Nursing Act, veteran perfusionists who help stop and restart hearts during surgery face legal uncertainty, putting the future of critical cardiac operations and patient safety at risk.

On the morning of April 30, Professor Jung Ui-seok of Kangbuk Samsung Hospital prepared for open-heart surgery on a patient in their 50s.

“I’m taking the heart,” Jung declared after inserting two 1-centimeter-wide tubes into the patient’s aorta and vena cava.

Perfusionist Oh Ji-young injected cardioplegic solution, and the heart, which had been beating 70 to 80 times per minute, gradually stopped.

The patient had collapsed during a meal and was revived with CPR. Tests revealed a heart valve disorder that required immediate surgical intervention.

Stopping the heart during surgery is only possible thanks to a heart-lung machine, which takes over cardiac and pulmonary functions. Perfusionists operate this and over ten other essential machines, including temperature regulators and autotransfusion devices.

Clinical perfusionist Oh Ji-young monitors the patient’s condition during surgery. Behind the heart-lung machine, Professor Jung Ui-seok and his team perform the operation. Cardiac surgeries typically require two perfusionists working together. [CHAE HYE-SEON]

Oh monitored six screens throughout the three-hour procedure, tracking blood flow and volume.

“Increasing flow,” she said at one point. “Volume’s dropped,” she noted later, relaying real-time updates to Jung.

Though Oh focused on the monitors and Jung on the heart, their coordination was seamless.

But now, thoracic surgery teams like Jung and Oh’s face an uncertain future as Korea prepares to implement a new Nursing Act on June 21. The law does not explicitly recognize perfusionists, who play a pivotal role in life-saving heart operations. This raises serious questions about their legal status and rings alarm bells among thoracic surgeons and health care workers.

Pictured is an extracorporeal membrane oxygenation (ECMO) machine, which supports heart or lung function by removing blood from the body, oxygenating it and eliminating carbon dioxide before returning it. Operating ECMO is also part of a clinical perfusionist’s responsibilities. [CHAE HYE-SEON]

Perfusionists are highly specialized professionals trained by the Korean Society for Thoracic and Cardiovascular Surgery (KTCVS).

They must hold a nursing or medical technologist license, complete 28 hours of theoretical training and participate in at least 150 surgeries at a minimum of 1,200 hours before taking a certification exam administered by the society — a process that takes four to five years.

They handle sophisticated medical equipment like extracorporeal membrane oxygenation (ECMO), which oxygenates blood outside the body when the heart or lungs fail.

In countries like the United States and Japan, perfusionists are licensed professionals. In Korea, they operate in a legal gray area.

The new Nursing Act could offer legal clarity. However, the Korean Nurses Association complicated matters in April by classifying perfusion as the responsibility of “thoracic surgery-specialized nurses.”

The problem is that 22.3 percent of Korea’s 264 certified perfusionists are not nurses but licensed medical technologists. That could effectively bar them from participating in surgery.

“If this stands, perfusionists who aren’t nurses will have no legal basis to participate in heart surgery,” said Lee Ok-suk, president of the Korean Association of Clinical Perfusionists.

Many of the most experienced perfusionists in Korea come from medical technology backgrounds, having been among the first to be trained in the field. Thoracic surgeons fear that excluding these experienced professionals could jeopardize half of all cardiac surgeries.

“If medical technologists are pushed out, 40 to 50 percent of heart surgeries could come to a halt,” said Professor Jung.

Adding to the confusion is the ambiguous division of responsibilities between nurses and technologists. Perfusionists often draw blood during surgery to monitor coagulation, but this task is currently defined as a medical technologist's work.

“The boundary between nursing and medical technology in perfusion is anything but clear,” said Oh.

Clinical perfusionist Oh Ji-young operates the heart-lung machine during surgery, while Professor Jung Ui-seok performs the procedure. [CHAE HYE-SEON]

The Ministry of Health and Welfare plans to release new enforcement rules clarifying the scope of duties for physician assistants.

The KTCVS has urged the ministry to recognize perfusion as a specialized support activity and include transition measures for existing workers.

“Without this, perfusionists and surgeons will be forced to choose between breaking the law and saving lives,” the society warned.

The Korean Nurses Association acknowledged the issue, stating, “This needs to be clarified, and we are currently in discussions.”

The Korean Medical Association, meanwhile, has called for a separate license for perfusionists.

A Health Ministry official said the agency was “gathering feedback from all related organizations.”

Translated from the JoongAng Ilbo using generative AI and edited by Korea JoongAng Daily staff.
BY CHAE HYE-SEON [[email protected]]