Current situation of lung transplantation in Japan

Abstract

: The first lung transplantation (LTx) from a neurologically dead donor (NDD) was performed in 2000 in Japan. This was 2 years after the first LTx from living donors. A total of 250 patients underwent bilateral and 276 patients underwent unilateral LTx procedures from NDDs from then to 2019. The number of LTx s has been increasing since revision of the Japanese organ transplantation law in 2010. However, the shortage of donors and the long waiting time (>2 years) remain problematic. Donation after cardiac death is impractical because controlled death is not permitted in Japan. We challenge the donor shortage with the use of a medical consultant system in which medical consultants give suggestions to the intensivists who care for possible donors, aggressive use of marginal donors such as older donors, smokers, suicidal hanging donors, donors who have contralateral pneumonia, and donors with a long intubation time, preoperative extracorporeal membrane oxygenation support, and living-donor LTx. In total, 234 cases of living-donor LTx were performed. Despite the aggressive use of marginal donors, outcomes in Japan are comparable with international outcomes. Careful assessment of marginal donors and meticulous management of possible donors are important key factors in rescuing as many patients as possible in the currently difficult situation of LTx in Japan.