Photo/Illutration A medical team performs lung transplant surgery on a 1-year-old child at Okayama University Hospital. (Provided by Okayama University Hospital)

Forty-one percent of university-affiliated hospitals had not received a single organ donated by a brain-dead person in the 26 years since the organ transplant law took effect, health ministry statistics showed.

One cause for the dearth in organ donations stems from the difficulty of raising the issue with family members of the brain-dead patients, experts said.

According to guidelines in the law, organs can be donated only at university-affiliated hospitals and medical facilities that can provide specialized emergency and cranial nerve care.

As of the end of March 2023, 895 facilities, including 144 university-affiliated hospitals, were eligible.

However, the difference in the number of donated organs among facilities has long been an issue.

Last autumn, the ministry for the first time calculated the number of organ donations at each of the 144 university-affiliated hospitals since 1997, the year the law went into effect.

A total of 401 organ-donation cases were recorded by the end of September 2023, including 27 at Okayama University Hospital, followed by 21 at Tokyo Medical University Hachioji Medical Center, 19 at Fujita Health University Hospital, and 18 at Hokkaido University Hospital.

The top five facilities were responsible for 100 cases, or a quarter of the total.

At 59 facilities, or 41 percent, the number was zero, including such large institutions as Tokyo Women’s Medical University Hospital and Yamaguchi University Hospital.

Atsunori Nakao, head of the Advanced Critical Care and Emergency Center at Okayama University Hospital, said the gap in organ donations may come down to “timing.”

Although the law stipulates that the wishes of those who want to donate their organs “must be respected,” consent of the family must be obtained.

Family permission is also required for organ donations from brain-dead patients whose will is unknown.

Nakao said more than half of the patients’ families chose organ donation.

But according to Nakao, health care providers in many medical settings are hesitant to present families with the option of organ donation.

In most cases, organ donation is not even discussed unless the family requests it, he said.

“Organ donation is the patient’s right. Since the patient is unable to talk, it is important to find out if he or she has indicated a willingness to donate organs,” Nakao said.

Health care workers may find it difficult to broach the topic with family members during such difficult times. Many families cannot accept the fact that their loved ones, who had basically been healthy right up until the last minute, will not survive.

“Is the family ready to listen to the talk? Have (medical workers) done what they should have done by then? If not, it’s no wonder the family can’t accept (the reality of brain-death),” Nakao said. “So we have to take our time and wait.”

Yuichi Kataoka, a professor who specializes in acute care surgery at Kitasato University Hospital Emergency and Disaster Medical Center, said, “The option of organ donation comes up only when we provide grief counselling to the family.”

One thing that medical facilities with a high volume of organ donation have in common is a focus on palliative care, including support for the patients’ families.

But the medical field also faces administrative challenges concerning organ donations.

The process of organ donation involves communication with outside agencies. Brain death must be confirmed in two studies, which can take two to three days to complete.

During this time, the patient remains in a bed in an emergency room or intensive care unit.

Hospitals have said they are struggling to free up beds in their emergency rooms and ICU units.

“The difficulty of bed coordination may not be apparent on the surface, but it is probably a big part of the background,” said Hiroyuki Yokota, a professor of emergency medicine at Nippon Sport Science University, who has long been involved in the establishment of a domestic organ donation system.

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