[ISPHLT-CP] Struggle to save children with end-stage heart failure
After the Bailey's first xeno HTx in 1984, the hundreds of neonates and small infants with end-stage heart failure are living today because of primary or secondary HTx in the world. The number of pediatric HTx has been increasing and their survival has been acceptable in every recipient age. However, pediatric brain-dead organ donation in had not been accepted until 2010 in Japan. In 1988, the Japan Medical Association professed that it would accept brain death as human death. In 1990, the Provisional Commission for the Study on Brain Death and Organ Transplantation was set up in 1990. The draft of the Organ Transplantation Act was proposed in 1994. Finally, on October 16, 1997, the Organ Transplant Act took effect, which enabled brain dead organ donation only if the person expressed in writing prior to death his or her intent to agree donate his/her organs. In addition, the Act states that "only persons 15 years and above can express to donate". Then, heart transplants to small children become impossible. So, we started to send children with end-stage heart failure to Dr Bailey as other pediatricians did and continued to perform xeno HTx experiments. But we finished experiments due to FDA and WHO recommendation against pediatric xenotransplantation. Since 2003, the author and members of Japanese Associations of Transplant patients made many efforts to revise the Act and finally the Act was revised in 2010. After then, the number of pediatric HTx has increasing in Japan and finally exceeded that of HTx abroad.