[ISPHLT-SY2-2] Pediatric organ donation and transplantation in Japan: achievements in the past decade and goals in the next
The Revised Organ Transplant Act enacted in 2010 enabled donation after brain death with consent from the donor's family when the donor did not have a document regarding organ donation such as a donor card, whereas prior to the revision both the donor documentation and the family consent was mandatory. The organ donation documentation is considered legally binding as a will, which in Japan is valid from age 15, therefore before the revision, pediatric patients would not be able to donate their organs after brain death. When the revision of the Act was discussed between the politicians, there was strong resistance claiming that the family may be trying to hide child abuse by donating their organs, so the revised Act included the mandatory exclusion of child abuse cases from organ donation, requiring the donor hospitals to have a manual and a committee for child abuse. The donor hospitals prepared for pediatric organ donation were 293 among the 914 emergency medical hospitals (32.0％) as of 2019. At the Japan Organ Transplant Network have been providing training workshop programs for pediatric donor hospitals offline and recently online, and also offering support programs to help pediatric donor hospitals develop their own organ donation manual and hold organ donor training simulations within their own facility. The recipient selection criteria, which is determined by the Ministry of Health, Labor and Welfare, prioritized pediatric hearts to be transplanted to pediatric patients since 2010, but kidneys, liver, pancreas and lungs were similarly prioritized recently between 2018 and 2020. In 2019, there were 18 pediatric donors (18.5％) within the 97 donations after brain death, adding up to a total of 52 from the enactment of the revised Act to 2020. From the 52 pediatric donors, 134 pediatric recipients have been transplanted, including 42 heart and 16 lung recipients. Recently we have started a donor hospital inter-cooperation program where pediatric hospitals with knowledge and past experience of pediatric organ donation share and exchange their expertise with other pediatric hospitals, cultivating a positive culture in pediatric organ donation and transplantation for the next decade.