In many respects, Japan’s health system is world-class, with universal insurance, skilled doctors and a culture of social responsibility. Yet there’s one area where the country has lagged far behind other industrialized nations: organ transplants. While an average of 68 transplants are performed in the US every day, until last year Japan was clocking up just 10—every year.
One reason was the restrictive terms of the 1997 Organ Transplant Law, which only allowed donation in the case of brain death and with prior written consent, as well as the consent of the donor’s family. Moreover, children under 15 couldn’t give consent, making pediatric heart transplants essentially impossible. Last July, however, revisions came into effect that significantly relaxed the law, dropping the age restriction and the written consent requirement.
According to Misa Ganse, public relations and education director of the Japan Organ Transplant Network, the number of brain-dead donors has increased about six-fold. “Since the changes to the law went into effect about six months ago, there have been 31 cases of organ donation from brain-dead donors,” she says.
The addition of donor consent forms to medical insurance cards and driver’s licenses has also been a huge help, providing a high-profile alternative to the voluntary consent cards that were previously the only option. As Ganse says, the change “has increased the recognition of organizations dealing with organ donation and the credibility of individual consent.”
However, even with these improvements, the demand for transplant organs still far outstrips the supply. “There has been a decrease in the number of kidneys donated after cardiac arrest,” says Ganse. “And, although it’s now possible under the law, we haven’t yet had a case of a brain-dead donor under 15.”
It turns out that the relaxation of the law was only the first step in a much longer process, beginning with more effective outreach. In countries where organ donation is well established, the public hears about it in school, through the media, and from an extensive network of public health and advocacy groups.
“[In Japan] a lot of people first learn about organ donation when they look at their insurance card or driver’s license,” says Ganse. “So it’s important to raise awareness, to make sure people have the correct information when they are filling out the forms, and to make sure their families are aware of and in agreement with their wishes.”
There is also work to be done within the medical field. A recent study by the Ministry of Health, Labor and Welfare found that Japanese medical facilities may not be ready for a surge in transplants. Of the 492 institutions ostensibly capable of performing transplants after brain death, only about 300 reported that they were properly prepared, and fewer than 60 said they would be able to perform transplants on people under 18.
There’s also still no consensus regarding the sensitive issue of when and how families should be approached if there is no prior written consent. Japan has only a handful of donor coordinators, who have special training in supporting grieving families while counseling them on the possibility of organ donation. Most of the time, individual institutions have to set up their own policy and training.
Still, Ganse is confident that things are now on the right track. “We hope that all of Japan will come to see that organ transplants are a socially necessary part of medical care and be able to give us their support,” she says.
To find out more about Japan Organ Transplant Network, see www.jotnw.or.jp.
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