Current situation of Organ Transplantation and Social Background in Japan and Social Background in Japan Teleconference at APAN 2011-8-25 Naohiko Fukami, M.D., Jyunichi Yoshida, M.D., Atsushi Sugitani, M.D., Ph.D. Department of Urology and Department of Urology, and Organ Transplantation and Regenerative Medicine, Fujita Health University j y
Prognosis of the patients on waiting list in Japan by 2006 0 0 100 100 200 200 300 300 400 400 500 500 600 600 BDDTx 34 26 85 83 12 Heart Tx Heart Tx OverseaTx O T LDTx Waiting Waiting Lung Tx 2816 119 89 Death Withdraw 32 15 174 119 174 37 Liver Tx 13 4 13 4 142 142 27 27 Pancreas Tx Pancreas Tx
The number of cadaveric donors in the world 34.6 Spain 35 30 25 20.2 20 15 10.8 Japan Japan 10 5 0 75 0.75 0 Organ and Tissue 8(2), 79-82, 2005
Patients on dialysis and of Renal transplantation in Japan Patients on dialysis and of Renal transplantation in Japan Dialysis 300,000 250,000 Dialysis LD 200,000 NHBD NHBD HBD 150,000 Recipients 100 000 100,000 Candidates 1200 1000 Candidates 800 10000 600 400 200 200 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
ABO incompatible renal transplantation ABO incompatible renal transplantation Unknown 0.0% 0.2% 0.5% 0.4% 100% 0.8% 1.1% 0.8% 5.2% 11.9% % 14.6% 15.5% 17.7% ABOi 20.9% 13.3% 23.3% 23.3% 80% 21 1% 21.1% 18.6% 19.9% 18.2% 20.4% 19.7% Mismatch 21.3% 20.2% 60% 60% ABOc 40% 66.4% 65.7% 63.8% 63.3% 61.5% 59.4% 55.8% 55.1% Match M t h 20% 0% 2000 年 2001 年 2002 年 2003 年 2004 年 2005 年 2006 年 2007 年
Public opinion （1998～ 2008） Donation after Brain death YES YES YES YES NO NO NO NO 31.6% 37.6% 1998 1998 35.4% 2000 2000 32.6% 31.8% 36.0% 2002 2002 35.4% 35 4% 32 8% 32.8% 2004 2004 41 6% 41.6% 27 5% 27.5% 2006 2006 2006 2006 43 5% 43.5% 24.4% 24 4% 2008 2008 2008 2008 0 20 40 60 80 100 ％
Revision of Transplant Law (July 17, 2010) � “Brain death is a whole death under the law” � Brain death is a whole death under the law � Consent by donor family without written consent (Opting-out) consent (Opting-out) � Possible donation from a pediatric patient � Allocation priority for the family member p y y
36 Brain Death Donors after the law revised From July 17 till February15, 2011 34 out of 36 cases were based on Family Consent. H Heart t 30 30 Lung Lung 29 29 Liver 32 Pancreas 28 Small intestine 2 Kidney 36
The current status of organ transplantation and Bioethics in Asia–Proposal of new p bioethics to advance the transplantation in Eastern Asia Eastern Asia Delhi India, August 25, 2011 Atsushi Sugitani, M.D., Ph.D. Department of Organ Transplantation and Regenerative Medicine, Fujita Health University, Aichi, JAPAN
Asia 1. Huge population 2. Difference of medical standards due to diversity of cultures, races, and religions y g 3. Specific diseases in Asia, such as thalassemia, chicken flu, SARS, etc 4. Little time difference and short distance among countries 10
Sapporo Beijing Seoul Tokyo KJCN KJCN Busan Nagoya Shjanghai Fukuoka 500 km 1000 km Taipei p 1500 km 11
Pancreas Transplantation Teleconference on 18 th March 2005 Kyushu University Hospital (Venue) Kyushu University Hospital (Venue) Seoul National University Seoul National University Tsinghua University Taipei Veterans General Hospital 12
Living donor nephrectomy g p y
Haｎd assisted retopertoscopic surgery
Donation from the Non- heart beating donor
② ② ① ③
Waiting
Super Rapid Technique p p q Video Presentation Kidney procurement from the non-heart beating donor (Cadaver) beating donor (Cadaver)
Simultaneous pancreas kidney transplantation p y p
Questionnaires (September 2008) Seoul, Korea 22 227 people in medical field including doctors, nurses, f medical students, clerks, etc. Nagoya, Japan 182 people in medical field including doctors, nurses, medical students, clerks, etc. I. When are you dead? (Death and Life Concept) II. Knowledge about Organ Transplantation III. Idea about Organ Donation IV. Whose is the transplanted organ? (Organ Property) V. If you or your family become a patient?
Let’s discuss What’s common and What’s different!! 1. 1. The current situation of The current situation of kidney/pancreas kidney/pancreas transplantation in transplantation in Asia Asia 2. 2. The history The history, culture and religion in culture and religion in Asia Asia 3. 3. Bioethics in Bioethics in Asia Asia 4. 4. Medical insurance and medical finance in Medical insurance and medical finance in Asia Asia 5. 5. Legislative 5. 5. Legislative Legislative problems Legislative problems problems in roblems in Asia in Asia Asia sia Propose a new idea about Life and Death” P id b t “Lif d D th” which is different from the Western philantorpism or altruism. lt i 22
The 22nd Annual Meeting of Japan Association for Bioethics November 20-21, 2010, Fujita Health University “Transplantation and Bioethics” and Bioethics
Configuration diagram of DVTS （Fujita Health University) Speaker 3. 2. Display (Receiving image) Video Camcorder Microphone Analog RGB Analog RGB Audio line A di li 4. (Stereo) (D-Sub15) 5. 7. Audio line (Mono) Composite/S-video 1. Analog-digital DVTS PC video converter (Reception) IEEE1394 6. Analog RGB Analog RGB (D-Sub15) HUB / VPN Router DVTS PC Display (Transmit) (Sending image)
Items list of DVTS configuration （Fujita Health University) No Company Product Analog-digital Anycast Station 1 video converter Sony AWS-G500 1 2 Microphone Panasonic WA-531 1 3 Video camera Sony BRC-300 (NTSC) 1 XLR × 1 -> XLR × 1 5m 4 Cable 1 RCA × 1->RCA × 1 5m 5 Cable 1 6 6 Cable Cable IEEE1394 4PIN 6PIN IEEE1394 4PIN-6PIN 1 1 RCA × 2->RCA × 2 5m 7 Cable 1
Conclusion and Proposal p 1. Let’s investigate the factors to affect the ideas about life and death in Eastern Asia. 2 Let’s find out the difference compared to the 2. Let s find out the difference compared to the Western countries. 3. Let’s educate the people for better life and for mutual understanding. 4. Let’s develop a solidality culture as do in the West. 5. Let’s propose a “New Bioethics for Organ Donation” from Eastern Asia to save many patients.
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