Linda Wong

Dr. Linda Wong does not seek the spot on the business end of a camera but submitted to publicity in pursuit of one result: that people understand what the community will lose if Hawaii Medical Center shuts down. The biggest loss, she said, is the potential shutdown of the Transplant Institute of the Pacific at HMC-East in Liliha, formerly known as St. Francis Medical Center. That’s where Wong performs surgery to give ailing patients donated livers and a new lease on life.

HMC’s latest bout with bankruptcy is on hold while its owners seek to find a buyer. HMC-West, located in the growing Ewa district, may be the easier sell, as the only hospital directly serving Oahu’s burgeoning Second City. The Liliha campus, by contrast, is a stone’s throw away from, and in competition with, other downtown-area hospitals. But it houses Hawaii’s only organ transplant center, and its disappearance, Wong said, would upheave many more lives than people may realize.

"It’s an important story to tell," she added. "It’s important to preserve this transplant center somewhere in the state of Hawaii, because it’s a community resource."

It’s also a family affair. Wong is one of five children of Dr. Livingston Wong and the late Dr. Rose Wong, an internist. Her father founded the center and performed its first kidney transplant. The doctors there handle heart and pancreas procedures, as well as cell transplantation, such as peripheral stem-cell and bone-marrow transplants.

Of her siblings, she’s the only one in medicine. Wong attended Punahou School (she was a classmate of President Barack Obama) before pursuing her medical studies in California.

"I wasn’t sure if I was going to come back, but my dad said it was time to come back, because he wanted very badly to start a liver program," she said.

Her main objective in this interview was to underscore that the story shouldn’t be about her, but the team of other doctors, nurses, social workers, dieticians, financial coordinators and psychologists who help the patients. All work to help their patients "live normal lives.

"Without a transplant center," she added, "that’s not going to happen."

QUESTION: How many transplant cases are handled here?

ANSWER: Every year, we transplant around 15 to 18 livers and do about 50 to 70 kidney transplants, several pancreas and heart transplants.

Q: The bottom line is, what happens if this transplant center were to close?

A: It doesn’t seem like we do many transplants, but there are probably 400 or 500 patients who are waiting on the list. And the patients who are waiting for kidney transplants are on dialysis; they go to dialysis treatments three times a week, every other day, waiting for a new kidney. And liver patients, some of them have worsening liver function, some of them are in and out of the hospital, and without a new liver, they’ll die. So if we can’t get them a liver in a timely fashion, these patients will die. So the impact is not just those 15 to 20 patients that we do for liver every year — but it’s all these patients who are waiting who have some potential to have a transplant.

Q: So these are people who need to be seen and evaluated before they go on the waiting list? And that whole process has to happen first?

A: Exactly. And that’s not going to happen without a transplant center.

Q: I take it it’s not a simple matter of relocating a transplant center in Hawaii, if this one closes.

A: No. You have to understand that we’re a transplant center that’s been here for 42 years for the state of Hawaii. So we have all of these patients who are not only waiting for transplants, but we’re taking care of the ones who have been transplanted beforehand. So it’s impacting a lot of lives. You know, there have been 1,200 kidney transplants here, 190 liver transplant patients. So all the patients who are waiting, and the ones who are having it this year and the ones who had it before, the physicians and the nursing staff, the social workers and our whole big team of transplant health professionals are taking care of these patients. They’re all going to be impacted by us closing the doors.

Q: And the prospects for recreating a transplant center?

A: It’s difficult. It’s not like opening another office. Transplant is something that’s pretty regulated by the government, and you have to apply to be a transplant center. It’s a long application, and all of the physicians have to be certified, credentialed, and all the nursing staff, and the hospital has to be willing to do all that. And it does take a lot of money in order to move it, too. So this is not something like just opening one branch of an office somewhere else. It has to go through a lot of regulatory things, and an application process as well. And the process does take six months, probably.

Q: So if the center were to close, this would necessarily mean that all the people who would want a transplant would have to fly off to the mainland?

A: Yes. They would have to move to the mainland to be evaluated by a second center. … Some of them — especially the liver patients, who are sicker — would have to relocate there until they get the transplant. Some of them may not be able to take commercial planes. If they’re in the hospital, they may need to be air-ambulanced out of here to another center. They all have to go through the entire evaluation process and listing process at another hospital.

Q: How long would that process take?

A: It can take a month or two, a couple months. And in addition, many insurances are not going to pay for all of the expenses required to travel. And these patients have to take a caregiver with them; they can’t go by themselves. So there’s two people who need to fly there, there’s living expenses, people who are working now will have to stop their work to go help the person … and if insurance doesn’t pay for it, a lot of people in Hawaii are not going to have this opportunity. They’ll either die or stay on dialysis for the rest of their lives.

Q: Would the federal government have a way to intervene to preserve a transplant center?

A: I don’t know that the federal government can intervene. All the transplant centers are private. They may belong to a private hospital or university, or maybe even state university. Although they’re regulated by the federal government, they’re not necessarily funded by it. … In terms of opening the transplant center and helping them develop funds in order to open a transplant center, I don’t believe that that’s possible.

Q: I just wondered if Hawaii’s special circumstances made any difference.

A: It’s difficult. We’re really geographically isolated. There are some states in the United States that don’t have transplant centers. States like Idaho and Montana don’t have it. But a lot of the people who live in Idaho and Montana and some of the other states, they can drive to another state. They can wait in their home town and drive over at the time of transplant. But you really can’t do that in Hawaii. We’re 2,500 miles from the next transplant center. Even if you wait in Hawaii, when they call you, you have to fly there quickly in order to get your transplant. And if you’re a liver patient, you’re probably too sick to get on the plane at the moment you need the liver. So that’s why you probably have to relocate and live there.

Q: Because you get progressively sicker as you wait?

A: That’s exactly right.

Q: Any other repercussions?

A: There’s so many ramifications about this. I mean, there are all these people who also donate organs. There’s probably 30 to 40 donors every year, and all the organs that are donated locally would have to fly out to mainland centers, where they would never be used to save a Hawaii patient. … Hawaii won’t have that ohana, trying to take care of each other and trying to give back locally, if there’s no local transplant center. And I think organ donation might go down if people realized they would be donating organs to go away and not stay here in Hawaii.

Q: Also, wouldn’t it be harder to match some of our particular ethnic mixes somewhere else?

A: There are a lot of other factors besides ethnicity, but that may be a factor, too, yes.

Q: How is the survival rate for transplant patients improving?

A: Over the years things have gotten better. Patients do better, they get out of the hospital, we have good medications that can keep them alive a long time without having rejection or other problems. And they go back to normal lives. These are patients that get to go back to work. We had one in the news who got married, she wants to … have kids. They get to do normal stuff. Our survival rates are improving, and they’re no different from any program in the United States. The technology has improved, the medications are better, we better understand how to take care of these patients beforehand.

Q: Did you just naturally follow your parents into medicine, or did you resist that career path at first?

A: No, I didn’t resist it. … They never said one way or the other that I should be a doctor. They just went to work, and I saw that they really liked what they did.

Q: Did you ever contemplate another profession?

A: I wanted to be an architect, I wanted to be a math teacher, a ballerina, a whole bunch of things that all normal kids want to be.

Q: But ultimately you found yourself on the medical path, taking science classes … ?

A: Yes. And my parents didn’t encourage me to go into surgery or into transplants; my father tried to talk me out of it. He said, "You should be an ophthalmologist. That way you could have a more normal lifestyle." And he said, or a pediatrician or a family doctor. My mom was an internist, and she said, "No, don’t do that." I gradually found my way here, on my own, without them saying, "You have to be this."

Q: What is it about transplant surgery that you find satisfying?

A: It’s exciting; it’s life-altering. You get to save lives.

Q: Do you know how many may go under the knife this week?

A: We don’t know. It depends on who dies and is willing to donate. We can’t tell. It changes every day. My life is totally unpredictable, but it’s OK. We get to save lives. It’s worth it.