Photo/Illutration An Organ Donation Decision Card (Provided by the Japan Organ Transplant Network)

More than a quarter-century has passed since the institutionalization of organ transplants from brain-dead donors, and last year saw a record high of 131 organ donations under the system.

Despite a temporary decline during the COVID-19 pandemic, organ donations are basically trending up in Japan.

Still, the number of available donors is overwhelmingly lower than the number of patients hoping for a transplant. The average waiting period is about one to four years for hearts, lungs and livers, and as long as some 15 years for kidneys, which are in high demand.

Meanwhile, a health ministry survey has revealed that some organs available for donation were not used due to reasons related to the hospitals to which the transplants were proposed.

Of the 831 organs donated by the 131 donors last year, transplants did not take place for 192 organs, more than 20 percent.

The most common reason was medical unsuitability, but hospitals also declined to receive organs in some cases due to their failure to secure necessary doctors, staff or operating rooms.

Decisions concerning organ transplants from brain-dead donors are made based on a number of factors to prioritize medically suitable recipients and ensure fair opportunities.

When a proposed organ transplant does not proceed due to logistical and other complications at the receiving hospital, valuable opportunities for waiting patients are lost. Such cases cannot be overlooked from a fairness perspective.

According to estimates by a study group at the health ministry, more than 4,000 people nationally are declared brain dead in terminal stages each year.

But even if donors increase, there is a risk that the donated organs might not be effectively utilized under the current organ transplant system. A sweeping review of the system is needed.

Currently, only a limited number of medical institutions, mainly university hospitals, have the ability to conduct transplant surgeries.

The ministry and related academic societies should engage in debate from a long-term perspective on issues and challenges involved in responding to the increase in donors and establishing organ transplants as a standard medical practice, including those concerning medical remuneration.

Issues are also becoming apparent concerning the Japan Organ Transplant Network, which exclusively handles everything from explaining and obtaining consent from donor families to selecting recipients.

According to the ministry’s guidelines, the network should "immediately dispatch a coordinator" upon request.

However, there have been cases where delayed hospital arrivals of coordinators due to staff shortages and other issues resulted in missed opportunities for organ donation, affecting the system's credibility.

The ministry is currently considering system restructuring plans to separate the processes and procedures for handling donors and selecting recipients, but discussions from a personnel development perspective are also necessary.

The limited availability of hospitals that can perform brain-death assessments and organ donations, combined with regional disparities in access to such institutions, remains an ongoing issue.

Efforts are needed to promote the sharing of expertise from experienced hospitals and the organization of hospitals' internal systems.

--The Asahi Shimbun, Nov. 1

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