Photo/Illutration Health minister Keizo Takemi during a news conference in Tokyo’s Kasumigaseki district on Aug. 2 (Kazuhiro Fujitani)

Faced with an inefficient system on saving lives, the health ministry is planning drastic revisions to facilitate organ donations from brain-dead people and create an environment conducive to transplantation.

It is considering establishing multiple mediation organizations and strengthening the sharing of information between medical institutions and mediation organizations about patients “in a condition that could be considered brain death.”

The ministry’s organ transplant committee began discussions at a meeting on Aug. 14.

According to the ministry, Japan has about 900 medical facilities that can donate organs from brain-dead people.

However, only about 300 have actual experience in organ donations, and 110 of them have each dealt with only one case so far.

Regional differences in the availability of organs are significant, and even when there is a possibility that a brain-dead patient can donate an organ, the option is often not adequately presented to the patient’s family.

According to an estimate by the ministry, about 4,400 patients were considered brain dead in fiscal 2022. But in only 1,113 cases, or 25.2 percent, their families were offered the option of donating his or her organs.

As a result, only 105 brain-dead people actually donated organs in fiscal 2022.

If the patient is diagnosed as being in a condition that could be considered brain death, the process of end-of-life care, including organ donation, is initiated.

The family can also ask a mediating organization to dispatch a coordinator to explain about organ donation.

Permission from the health minister is required for the mediation of organs.

Currently, the Japan Organ Transplant Network (JOT) is solely responsible for the mediation of organs, excluding eyes.

However, coordinators are dispatched throughout Japan.

There is also a labor shortage that has led to delays in responding to mediation requests.

The number of brain-dead organ donations rose to a record 131 in 2023, making it necessary to reduce the burden on JOT.

Therefore, the ministry was expected to propose the establishment of multiple mediation organizations for each region and role during the committee meeting on Aug. 14.

Some lawmakers in the ruling Liberal Democratic Party have suggested that information sharing between medical institutions and mediation organizations be made mandatory concerning patients in a condition that could be considered brain death.

If this were made mandatory, the burden on the mediation organizations to receive information would increase.

So the ministry was expected to ask the committee to discuss the structure of the mediation organizations.

In response to the situation where medical institutions that perform transplants refuse to accept organs, the ministry will consider allowing patients in need of an organ transplant to register with more than one medical institution.

The committee will also discuss ways to publicize the number of patients on the waiting list and the number of transplants performed at each medical institution.

There have long been calls to restructure JOT as an organization.

JOT was found to have informed relevant institutions to uniformly refrain from removing organs from people 15 years of age or older with medical care certificates for intellectual disabilities.

Such a discriminatory operation was directed by JOT’s former chairperson, a third-party committee’s investigation report noted.

The report also pointed out that JOT’s governance was not functioning.

Health minister Keizo Takemi said at a news conference on Aug. 2 that he had instructed JOT to report on the status of all cases handled to date.

Based on the results, the ministry “will steadily examine how organ mediation should be handled in the future,” Takemi said. “I don’t believe that we should leave things as they are now.”

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