9/30/2016 Disclosures I have nothing to disclose Current Status of Organ Donation in Japan Shigeyoshi Yamanaga, MD Chief of Renal Transplantation Program Department of Surgery, Japanese Red Cross Kumamoto Hospital Japanese Red Cross Kumamoto Hospital From KUMAMOTO To the WORLD International Relief Disaster Rescue 1
9/30/2016 Organ Transplantation Deceased Organ Donation in Japan 2014 2006 Population 324 M Population 127 M Organ Donation Organ Donation 8,126 112 Total 2199 Worldwide ORGAN DONORS 2015 Deceased Organ Donation in Japan PMP : PER MILLION Deceased Living 2010 Revised Organ Transplant Law POPULATION 1997 Organ Transplant Law 2008 Istanbul Declaration (n) 1 ST SPAIN 39.7 1 ST TURKEY 45.4 USA 28.5 USA 18.8 … JAPAN 12.5 JAPAN 0.7 (year) 2
9/30/2016 Medical Consultant Maximizing the donation � Medical consultant Evaluation Especially for heart and lung. Japan Organ Transplant Network started Decides whether it is suitable for donation or not. medical consultant system in 2002 Management � Expanding the criteria for donation Organ Quality. Utilization of marginal organs Common Kidney Donor Expanding the criteria for donation Characteristics in Japan Heart; 77% marginal donor � Bench replacement of donor aortic valve before heart transplantation Saito S et al; J Heart Lung Transplant. 2009 Sep;28(9):981-3. 60 yo, M � Cerebrovascular stroke, no diabetes � Cr 1.3 mg/dl � Ht 170.5cm BW 68.8kg BMI 23.7 � HCV negative � DCD (with 1 week of Agonal phase*) � *Ventilator withdrawal is not allowed in Japan. Pancreas donor � 63% over 40 years old 59% died of cerebrovascular attack KDPI 97%! Over 50% required multiple catecholamine treatments at the agonal phase. Egawa H, et al; AJT 2012; 12: 523-530 3
9/30/2016 HEART TX LIVER TX Organs Transplanted per donor; PMP (brain dead donor) 10Y PS 95% LIVING 10Y PS 70% DECEASED 10Y PS 72% LUNG TX KIDNEY TX KDPI 97% LIVING 10Y PS 76% LIVING 5Y GS 91% DECEASED10Y PS 51% DBD 5Y GS 85% DCD 5Y GS 77% 6.8 3.0 PANCREAS TX Av. DCD Kidney in Japan (5y GS 77%) KDPI 97% kidney in the US LIVING SPK 3Y GS 88% (5y GS 50%) DECEASED SPK 5Y GS 74% Egawa H, et al; AJT 2012; 12: 523-530 Expansion of donor pool Renal replacement therapy using living donors in Japan ABO-/HLA-incompatible transplantation � Number of Dialysis pt 1y 3y 5y GS ≥ 2001 1995-2000 1989-1994 Number of Kidney Transplant Number of pt on waiting list LD DCD DBD ABO incompatible RTx study group 2009 4
9/30/2016 Renal replacement therapy in the world 2009 Average waiting time In order to get kidney <8 years… Rank Country Dialysis % of total Prevalence of HD Need 9 times more donors 15-20 years!! patients dialysis pts (per population) (1,000) 1 USA 452 18% 1,420 2 China 330 13% 245 3 Japan 315 12% 2,505 4 Brazil 116 5% 575 5 Mexico 96 4% 820 USRDS2009, Current status of dialysis therapy in Korea. Korean J Intern Med. 2011 Jun;26(2):123-31. , Fact book 2009 Japan What makes The Wada Heart Transplant Transplant slow in Japan? 1968 The Wada Heart Transplant 1968 � Cultural Issue � Developing Procurment System � Conflict of Interests � First heart transplant in Japan. � Recipient died POD 83. � Brain death diagnosis by transplant surgeon. � Lack of transparency caused distrust of physicians and organ transplant… 5
9/30/2016 Cultural issue Cultural issue “Ritually preparing the body, dressing the dead in white and applying making-up for the trip to the afterlife” Chunichi newspaper 2011 “Departures” Academy award 2009 best foreign language film Developing Procurment Developing Procurment System System DBD DONOR PROCURMENT: Surgeons bring EVERYTHING, book flights, go there, recover organ and transplant afterwards… 4-5 DOCTORS per team! EGUCHI S ET AL, THE CURRENT STATUS AND FUTURE PERSPECTIVES OF ORGAN DONATION IN JAPAN: LEARNING FROM THE SYSTEMS IN OTHER COUNTRIES; SURG TODAY; 46:387-392 6
9/30/2016 Conflict of Interests Willingness to donate (%) Nephrologists own dialysis center… Note their willingness on the card � Very low referral rates to transplant center… � Increase Organ Donation/ Transplantation Subjects in 2016 Suggest Organ Donation to Donor Family Detect Donor Action Support Willingness to Donate for Hospitals Potential Donor Support Donation System Education to the public Show Willingness Talk about Donation With Family Education of Organ Donation/Transplantation 7
9/30/2016 Summary The 2016 th April 21:26 14 14 th April 21:26 Ｍ Ｍ6.5 6.5 14 14 April 21:26 April 21:26 Ｍ Ｍ 6.5 6.5 Kumamoto Earthquake th th th April 1:25 16 16 th April 1:25 Ｍ Ｍ7.3 7.3 16 16 April 1:25 April 1:25 Ｍ Ｍ 7.3 7.3 Low deceased donation rate in Japan. � th th 55 dead 55 dead 55 dead 55 dead Past incident, cultural issue, developing procurment � system and conflict of interests affect the donation rate. Breakthrough is coming… � Thank you. 8
Recommend
More recommend
