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Wednesday, June 27, 2012

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A start: Juntaro Ashikari of the Japan Organ Transplant Network faces reporters at the health ministry June 14 to explain the imminent organ transplants from a boy under age 6 who was declared brain dead earlier in the day. KYODO

Child-donor transplants still testing the water


Nearly two years have passed since the revised Organ Transplant Law took effect. The 2010 revision abolished the minimum age requirement for donors and has enabled surgeons to harvest organs from children declared brain dead. Previously, children aged under 15 were excluded from the donor pool.

On June 14, statutory brain death was declared on a boy under age 6 at Toyama University Hospital to pave the way for transplanting his organs. A stricter set of brain death criteria is imposed on donors under that age because their brains are more resilient and capable of recovering from injuries.

The Japan Organ Transplant Network and Toyama University Hospital said they made thorough preparations for anticipated transplant opportunities, including how to speak to the boy's family when he was in critical condition and working out a manual for checking whether a donor had been a victim of abuse.

Medical experts point out that there are not many hospitals sufficiently prepared to handle child donors and there is also the problem of how to interpret the wishes of children who may become donors.

On June 14, Juntaro Ashikari, an official of the transplant network, expressed hope for increased transplant opportunities from children after the announcement of the young donor's case. Speaking at a news conference, Ashikari said that "it will offer a ray of hope for those people who have registered their small children (on the waiting list)."

For the latest child donor, the network said it was contacted by Toyama University Hospital on June 12 and sent two veteran transplant coordinators, who met the family and other relatives to confirm their wishes along with local coordinators.

Best efforts were made to prepare for the transplants. The brain death pronouncement was made by Dr. Ikuya Ueta, an expert on emergency child care enlisted from Shizuoka Children's Hospital, with Masato Okada, a doctor from Seirei Mikatahara General Hospital, serving as adviser.

Toyama University set up a committee last year to examine ways to exclude child abuse victims from potential donors. The committee produced a manual to prepare for transplants, according to university officials.

The original Organ Transplant Law came into force in October 1997, raising hopes that many potential recipients could have operations in Japan instead of having to explore highly costly transplants abroad. Transplant officials in Japan have also worked hard since then to raise public interest in their endeavors.

But the law erected high barriers. It restricted donors to those aged 15 or older. Donors must also express their wish to provide organs in writing before death. In the roughly 13 years until the law was revised and the new law took effect, there were only 86 donors.

Based on its surveys, the transplant network lamented an apparent lack of interest in transplants, saying a high proportion of the population appears ready to be donors but only a few know they must give written consent.

After the revised law took effect in July 2010, the situation changed drastically. It removed written consent as a condition along with the minimum age limit. Only consent by family is now necessary to perform operations to extract organs from a brain-dead donor.

In August 2010, one month after the law took effect, there was the first case of a donor whose wishes about organ transplant possibilities had not been known. Starting with this case, donors have increased. In less than two years up until June 14, donors numbered more than 90.

It remains to be seen if the latest case will give rise to an increase in child donors. An official at the transplant network was optimistic, however, saying, "The (donor's) family issued a message and the name of the institution handling the donor was announced. Through these, public recognition (about organ transplants) will probably grow."

Tateo Sugimoto, a pediatric neurologist, warned about a possible increase without careful consideration. With the latest example, he said, "Momentum may occur, leading quickly to a second or third example. But I doubt that it should be like this."

Other problems must also be overcome. Hospitals handling child donors will bear heavy responsibility and burdens such as the need to check if a donor was not a victim of child abuse. Staff at these institutions will also have to be trained fully to see if a donor meets brain death criteria. Not all hospitals are ready for such tasks.

As of last September, more than 500 hospitals were listed by the health ministry as potential institutions for handling donors. But more than half of them still say they are not ready.

If a donor is too young, it may not be possible to fully ascertain if he or she is against becoming a donor. Takakuni Tanizawa, a professor at Hyogo College of Medicine, said, "We can educate children to some extent about death. Using that as a springboard, we should consider ways for them to make a decision on their own."

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