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Tuesday, July 14, 2009
Acceptance of donating will still take time
The passage of revised organ transplant legislation Monday may be a big step forward in saving sick children in need of organs, but experts say it will still take time for the ranks of domestic donors to increase.
One big reason is that doctors are either reluctant to harvest organs or lack the knowledge on how to tell families of donor candidates about the options, said Shunichi Yoshikai, a neurosurgeon at Shin Kokura Hospital in Fukuoka Prefecture.
"Many doctors in Japan are reluctant to even learn about organ donations," Yoshikai said. "One of the young doctors even said he thought organs can be donated only when a patient is brain dead."
The organ transplant law until now allowed patients, including children, whose hearts have failed, and people aged 15 and over pronounced brain dead, to be a donor.
Yoshikai pointed out that lack of education is the main reason many Japanese doctors are reluctant to harvest organs.
There are not many lectures in medical colleges on organ donation or transplants, and doctors do not know how to communicate with relatives of candidate donors, he said.
"Nobody told me how to talk with the patient's family about organ donations," said Yoshiaki, who has harvested organs from patients whose hearts had stopped.
When a patient he judges cannot be revived and is a registered donor, he tries to appeal to relatives to get their consent to harvest the person's organs, telling them about the numerous people awaiting organs in Japan.
Although there are donor coordinators in Japan, they have differing approaches. Some explain everything to a patient's family, while others want doctors present when they talk about donating organs. Still others let doctors provide the organ donation option.
Yoshikai said donor coordinators quit after a few years because they are not paid for the hard work they perform.
"In Spain, there are many organ donors partly because the government invests in donor coordinators," he said.
Another reason donors are few is the media tend to go after doctors when misfortune befalls either organ donors or recipients, Yoshikai said.
"When we see doctors apologizing on TV, we feel like we might be next because we're always engaged in a risky job."
Due to such conditions, donors have not increased in Japan, reaching only 109 in 2008. Of the patients waiting for an organ, 94 percent are in need of kidneys that can be donated from people whose heart stopped, as well as from brain-dead patients.
In the U.S., where brain death is recognized as death, there were 7,985 cases of organ donations from the deceased last year.
"The U.S. government has been promoting organ transplants," said Dr. Atsushi Sugitani, who has performed transplants in Pittsburg.
Sugitani, who now teaches at Fujita Health University in Aichi Prefecture, said medical students in the U.S. learn about brain death, organ donations and transplants at universities, and emergency doctors, brain surgeons and paramedics, including nurses, are trained about organ donations through programs offered by United Network for Organ Sharing.
Unlike Japan, donor coordinators in the U.S. provide detailed explanations to a patient's family. When the patient does not have a donor card, doctors give options on whether to stop medical treatment, continue until the heart stops even if the patient is brain dead, or agree to donate organs, Sugitani said.
Because doctors in the U.S. suggest these three options when a patient is brain dead, there is no misunderstanding. But in Japan, families of patients are still skeptical that doctors may end treatment for the sake of an organ donation even though there may be a way to save the patient.
"It is sad that there is such a misunderstanding in Japan."
Now that the law has changed, expectations are rising that patients waiting for organs will not have to travel overseas for transplants.
However, the number of transplants will not increase in a flash, Yoshikai said.