Japanese Strategies for Maximizing Organ Availabilities: Experience from 159 Consecutive Brain Dead Donors

Abstract

As donor shortage is extremely severe in Japan because of very strict Organ Transplantation Law, special strategies for maximizing organ transplant opportunities should be established. The purpose of this study is to review consecutive 159 brain dead donors to evaluate our special strategies to identify and manage organ donors. Method: All of 159 consecutive brain dead donors procured since the Organ Transplanted Act was issued in 1997 were retrospectively reviewed. 91 were male. A mean donor age was 45.1 year. The cause of death was 97 in cerebrovascular disease (SAH 76, stroke 7, bleeding 15), 28 in head trauma, 25 in asphyxia, 8 in post-resuscitation brain damage and 2 in others. 58 donors had a history of cardiac arrest. 58 required high dose of cathecholamine drip infusion. Donor evaluation and management system: Since November in 2002, special transplant management doctors were sent to donor hospitals in order to assess donor's organ function and to identify which organ could be transplanted. They also intensively cared the donor to stabilize hemodynamics and to improve cardiac and lung function by intravenously giving anti-diuretic hormone and pulmonary toileting by broncho-fiberscope. Results: Out of 159 brain-dead donors, 120 heart, 1 heart-lung, 123 lung (70 single and 53 bilateral lung Tx), 136 liver, 121 pancreas and 12 small bowel transplant were performed. Organs transplanted per one donor (OTPD) increased after these strategies were applied. Although brain dead donors 5-fold increased (86 donors at 13 years to 73 at 17 months) by the revision of the Tx Act, OTPD was kept around 5.5 organs. None of 121 heart Tx recipients died of primary graft dysfunction (PGD). Patient survival rate after heart Tx was 95.2 % at 10 years. Only three of 123 lung Tx died of PGD after lung Tx. Patient survival rate at after LTx was 72.7 % at 5 years and 54.0% at 10 year. After inducing frequent pulmonary toileting, procurement rate of lungs and a patient survival rate after LTx were significantly improved. Patient survival rate at after liver Tx was 78.6 % at 5 years and 70.8 % at 10 year. Graft survival rate at after pancreas Tx was 76.0 % at 5 years and 62.6 % at 10 year. Patient survival rate at after small bowel Tx was 83.3 % at 5 year.Figure: [Changes in organs transplanted per one donor]Conclusion: Although the number of Tx was still very small, the availability of organs has been very high and the outcomes of organ Tx were acceptable. These strategies may be useful to maximizing organ transplant opportunities.