A child under 15 was declared brain dead on April 12 for the first time in Japan since the revised Organ Transplant Law took effect in July 2010, allowing organs from the young donor to be transplanted to recipients.
While it was a move long hoped for by families of children requiring heart transplants, who previously had to look overseas for donations, the harvesting of organs from children will likely continue to face a number of challenges, including the emotional aversion of grieving parents, as well as inadequate procedures to confirm whether potential donors were victims of child abuse.
A news conference on the morning of April 12 at the Health, Labor and Welfare Ministry drew a crowd of reporters for the announcement of the groundbreaking case.
Juntaro Ashikari, chief of the Japan Organ Transplant Network, chose his words carefully, emphasizing that transplant coordinators met the parents and another relative of the brain-dead boy to explain the possibility of organ transplantation.
He also detailed the procedures of the ethics panel at the hospital where the boy, who was only identified as aged between 10 to 14 and having suffered serious head injuries in a traffic accident, was being treated.
The atmosphere of the conference room became somber when Ashikari read a statement from the donor’s family saying, “He would have wanted his organs offered to other people if it meant they could live.
“If we can believe that even part of his body remains alive somewhere, we will feel somewhat healed from the pain and sorrow of having lost him,” the statement said.
Ashikari declared that “a new step has been taken.”
The original organ transplant law, which took effect in 1997, did not allow brain-dead patients younger than 15 to become organ donors, making it impossible for small children to have heart transplants in Japan.
The law was revised in July 2009 to remove the age limit of the donor and enable organs to be harvested with the consent of the family, unless the potential donor had specifically objected. It took effect last July.
According to the Japan Society for Transplantation, 102 Japanese received heart transplants in the United States and other countries between 1997, when the original law came into force, and October 2009. Of the total, 63 were under 18.
In 2009, 45 children under 18 were diagnosed as requiring heart transplants, with nine of them dying while waiting for organs to become available, according to the Japanese Society of Pediatric Cardiology and Cardiac Surgery.
Since the law was revised, there has been growing hope that children in similar circumstances will be saved.
Last October, the health ministry revised the criteria for heart transplants, giving priority to recipients under 18. The move was prompted by U.S. data showing young recipients have better chances of survival when they receive hearts from young donors. It was also aimed at promoting heart transplants in Japan, where it had been impossible for small children previously.
In the latest case, the boy’s heart was given to a boy in his late teens at a hospital in Suita, Osaka Prefecture.
The health ministry’s criteria for recipients were worked out by a group led by Soichiro Kitamura, former president of the National Cerebral and Cardiovascular Center. The latest heart transplant case is “the first achievement of the working group’s efforts. It opened a new page in transplants for children,” he said.
Nonetheless, it remains to be seen if the first case will lead to a number of others.
The revised law and criteria for recipients both stipulate that no organs will be harvested from children under 18 if it is suspected that they suffered abuse, regardless of whether the death was caused by the abuse.
Concern expressed during the course of deliberations for the legal revision was that abusive parents could offer their children for organ transplants, which could make it difficult to prove mistreatment.
Against this backdrop, medical institutions need to secure manpower and facilities not only for pronouncing brain death and harvesting organs but also examining whether potential donors suffered abuse.
Some involved in the process have said the additional burden is hindering their work, while others are calling for establishment of third-party panels to support the process of determining whether abuse has occurred.
Yasuo Ono, head of the cardiovascular division at Shizuoka Children’s Hospital, said: “A judgment on abuse is necessary and its necessity is not limited to pronouncements of brain death. We need to improve coordination with child consultation centers, police and other relevant organizations.”
Masataka Kenmoku, secretary general of the liaison council of patients in need of organ transplants, said: “Transplants are only possible when there are donors. What’s important is the family of the donor should not be left with a feeling of regret. It’s important to respect the wishes of the family.”