The nation breathed an almost audible collective sigh of relief this week, thankful that a successful precedent has now been set for organ transplants. Apart from the media hullabaloo and a short-lived controversy over the diagnosis a couple of days before the verdict of legal brain-death was pronounced, the series of transplant operations of multiple organs from a brain-dead donor went as smoothly as could be expected.
On Sunday, hours after the donor-patient at Kochi Red Cross Hospital was pronounced legally dead, her heart started beating again in the body of a 47-year-old cardiac patient in Osaka. On the same day, her liver went to another recipient in Nagano. By Monday morning, kidney transplants were completed in Sendai, Miyagi Prefecture, and Omura, Nagasaki Prefecture, while the corneas found their way to two patients in separate locations in Kochi Prefecture. All the transplants were pronounced successful. No matter what the ultimate outcome of the operations, all the recipients have a better chance of a healthier life, thanks to the generosity of a single person.
Because of the extreme and questionable secrecy surrounding the first heart transplant attempt in Japan 31 years ago, the nation has been wary of brain-death-related organ transplants. A recent survey by the Prime Minister’s Office found that only 32 percent of the public would donate their organs for transplants if they were pronounced brain-dead; a full 38 percent said they would not.
Kochi Red Cross Hospital was therefore prudent to conduct everything openly, providing timely information to the Ministry of Health and Welfare, as well as to the press. It also made a point of following the Organ Transplant Law scrupulously, calling in two doctors licensed to issue brain-death verdicts to conduct the required tests after the initial brain-death diagnosis by the patient’s own doctor. Furthermore, the hospital did an excellent job of coordinating efforts with the medical community nationwide and worked smoothly with the Japan Organ Transplant Network in selecting recipients and delivering the organs.
Less visible, but no less significant, was the way the various regional medical communities cooperated with one another. The Kochi organ-harvesting team was assisted by surgeons from Osaka University, who in turn were joined by experts from the National Cardiovascular Disease Center during the heart transplant operation. At Nagano, medical professors from Kyoto University and Hokkaido University assisted the Shinshu University team. This kind of nationwide cooperation and exchange of expertise no doubt played an important part in making the transplants successful.
This week’s events represent a good start, but only a start. Everything went so smoothly because the Kochi donor-patient was the nation’s first brain-dead transplant case. Future transplants can hardly expect police motorcades to smooth the way every time organs earmarked for donation are shipped to a recipient hospital. Since over 300 sites nationwide have been designated as facilities for harvesting organs, no time should be lost in working out a reliable delivery network.
Then there are the issues of cost and privacy. The Organ Transplant Law requires that five legally established criteria — coma, dilated pupils, absence of brain waves, loss of brain stem reflexes and inability to breathe without the assistance of an artificial respirator — be met before organ transplants can be considered. It also requires the results of brain-death tests performed by doctors licensed to pronounce brain death. Such tests are time-consuming and costly. In the Kochi case, the donor family reportedly shouldered the expense.
The biggest uncertainty during the whole saga was caused by the media frenzy, as TV cameras, photographers and reporters converged on the Kochi hospital. Some released details concerning the donor-patient before the brain-death diagnosis had been made. The family protested, and at one point there was real worry that the organ transplants would be called off altogether. To their credit and everyone’s relief, the family decided to go ahead as planned.
Brain-dead transplants constitute a very important issue for the thousands of patients for whom organ transplant is the only hope of staying alive. Up till now, only those with above-average financial means could afford to travel abroad and await an opportunity for a transplant, often after a lengthy stay. Hopefully, the Kochi multiple-organ donation has paved the way for many more to come. In the meantime, it is important that the media learn to balance the need for the public to know with the wishes and needs of the donors and their families in their hour of sorrow.
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