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Japan’s donor card rule, termed the world’s most restrictive, has been blamed by organ transplant promoters for the delay in establishing the life-saving procedure in Japan. Satoru Todo, a world-renowned liver transplant surgeon, disagrees.From a different angle, the donor card rule is “the most advanced” way to supply organs, said the Hokkaido University professor, who returned to Japan last year after practicing for 13 years at the University of Pittsburgh Hospital in Pennsylvania.In many countries where organ transplants are an established practice, relatives can speak on behalf of brain-dead patients. But when tragedies occur, families sometimes find it difficult to act on the true wishes of their loved ones to donate organs, Todo said.Countries that face a serious donor shortage, including the United States, encourage potential donors to share their wishes with their next of kin, Todo said.Japan has taken a further step to promote expression on the issue, he said. Donors must provide written consent, but this in turn means their declared decision leaves no room for doubt.Then why haven’t there been any donors? “This is an example of how Japan stresses making an outward display without (providing) adequate enforcement,” Todo said. “The public doesn’t have easy access to donor cards. In addition, the public still doesn’t understand the meaning of brain death, and most Japanese think organ transplants have nothing to do with them.”Todo is not merely a detached observer of this situation. He is preparing for the day when his team is added to the list of facilities allowed to conduct organ transplants. This includes liver transplants from blood-related live donors, often from parents to their children. He has sent members of his staff to the University of Pittsburgh for training.”It may take another 10 years for Japan to establish a system of organ transplantation, but I am trying to shorten it by three to five years in Hokkaido,” he said. “I want to make Hokkaido a model region for organ transplantation in Japan.” (S.O.)

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