Transplants from brain-dead top 200

Number small when compared with the West, problems remain in determining child donors

Kyodo

Japanese hospitals have performed more than 200 organ transplants involving brain-dead donors since such procedures became legal in 1997.

The law initially applied only to donors who gave consent to use their own tissue, but a revision in July 2010 allowed next of kin to authorize organ removal even when the wishes of the donor are unknown, rapidly increasing organ availability.

The 200-case milestone was reached Nov. 14 when a man in his 20s suffering from encephalopathy was declared brain dead at a hospital in the Kinki region. His organs were extracted and transplanted the same day.

“I feel a world apart when I think about the initial period,” said Setsuko Konaka, an official of the Japan Organ Transplant Network. She helped coordinate the first transplant of an organ from a brain-dead donor.

When she was notified of the first potential donor on Feb. 25, 1999, 16 months after the transplant law took effect, Konaka wanted the family to have enough privacy to say their good-byes quietly, but the media and public scrutiny was intense.

In the ensuing years, however, interest in donors and their relatives appears to have subsided.

“If people lose interest, that might be a problem. But I think they are no longer seen as special medical operations,” Konaka said, expressing confidence that transplants involving brain-dead donors are gaining acceptance.

Transplants, however, are still coming up short when it comes to meeting demand for organs in Japan. Some are still opting to have their operations abroad.

According to the Japan Society for Transplantation, despite the legal revision, there are proportionately fewer organ donors in Japan than in Europe, North America, South Korea and Taiwan.

As a percentage of population, 10 to 50 times more donors are available in those countries than in Japan.

As of Oct. 31, 2,950 people had registered with the Japan transplant network seeking hearts, lungs and livers since it got off the ground in October 1997. Of them, 463 succeeded in receiving organs, but 1,080 died waiting.

In the meantime, organ transplants involving underage donors have been performed just twice despite the abolishment of the minimum age requirement, which was 15.

Parents in grief often find it difficult to let go of their children and hospital staff face the additional task of confirming whether the child donor was the subject of parental abuse.

Dr. Ikuya Ueta, head of the pediatric intensive care treatment center at Shizuoka Children’s Hospital, said the paltry transplant figure also reflects the inadequate emergency care facilities provided for children.

Ueda said children can only be declared brain dead when a hospital has a full range of experts available to determine whether the donor was abused.

“The small number of transplants from brain-dead donors reflects the fact that many children are transported to facilities where they cannot get adequate treatment,” he said.