Organ Transplant Law Research Articles

Effect of revised organ transplant law in Japan on lung transplantation.

To investigate how revision of the organ transplant law in Japan affected lung transplantation in this country. Lung transplant candidates registered between January, 2000 and December, 2009 were designated as the pre-revision group (n = 396) and those registered between January, 2011 and December, 2020, as the post-revision group (n = 1326). Both groups were analyzed retrospectively using data collected by the Japanese Society of Lung and Heart-Lung Transplantation. The number of patients who underwent brain-dead donor lung transplantation (BDLT) increased significantly after the law amendment (32.2 vs. 13.8%, p < 0.01). The median waiting time for BDLT was significantly reduced (708days vs. 1163days, p < 0.01) and the mortality rate while waiting for BDLT improved significantly after the law amendment (33.1 vs. 42.6%, p < 0.01). In the post-revision group, 18 pediatric patients underwent BDLT. The 5-year survival rates after BDLT were comparable between the groups (73.5% in the pre-revision group vs. 73.2% in the post-revision group, p = 0.32). The organ transplant law revision shortened the waiting time for BDLT significantly and decreased the mortality rate while waiting for BDLT. The posttransplant outcomes in Japan remained favorable throughout the study period.

Family-based consent and motivation for familial organ donation in Bangladesh: An empirical exploration.

The government of Bangladesh approved the human organ transplantation law in 1999 and updated it in 2018. This legislation approved both living-related donor and posthumous organ transplantation. The law only allows family members to legally donate organs to their relatives. The main focus of this study was to explore how Bangladeshis make donation decisions on familial organs for transplantation. My ethnographic fieldwork with forty participants (physicians and nurses, a healthcare administrator, organ donors, recipients, and their relatives) disclosed that the organ donation decision was family-based. An assessment of the relationship between religion, culture, and biomedicine leads to the conclusion that deciding on donating organs to relatives is primarily family-based and is perceived to be steeped in Islamic ethical principles and religious cultural tradition. The family-based consent and motivation for donor-recipient pair organ transplantation strengthen an altruistic environment for the family and act as the moral and legal authority that ensures ethical healthcare outcomes for Bangladeshis.

The history of Japanese lung transplantation: the unique pathway to establishing the program and its initial success.

Japan is a unique country in terms of organ transplantation. Despite the impressive progress in transplant medicine achieved during the late 20th century in many Western countries, Japan was unable to implement a program for organ transplants from brain-dead donors due to persistent public distrust regarding the ethical understanding of "brain death as human death". In 1997, the Japanese Organ Transplant Law was enacted, and organ transplantation from brain-dead donors was finally legalized. However, this law was strongly opposed by religious leaders, philosophers, politicians, and even medical personnel who did not accept the idea that brain death is human death, so transplant physicians had to start performing transplants in the face of strong social resistance. The Japanese National Lung Transplant System was established based on the following three philosophies: (I) an institutional certification system based on strict standards; (II) a rigorous central monitoring system for transplant results; and (III) a third-party review system to determine eligibility for patient registration. The purpose of these policies was to avoid ethical issues at lung transplant institutes, and to achieve high-quality transplant results. The actual progress of Japanese lung transplantation has been quite unusual compared to other countries. The number of brain-dead organ donations was extremely limited at first, so more than 60% of lung transplants were performed as living-donor transplants during the first 9 years [1998-2006]. The number of brain-dead donations subsequently increased, particularly after the revision of the Organ Transplant Law in 2010 such that the majority of lung transplants are now performed as brain-dead transplantations. Regarding the results of lung transplants, the most recent national registry report indicated that a total of 668 lung transplants including 447 from brain-dead donors and 221 from living donors, had been performed as of 2018. The 5- and 10-year survival rates for brain-dead donor lung transplantation were 71.9% and 57.8%, respectively, with no significant difference between the living-donor and brain-dead-donor groups. These results are comparable with the outcome of preceding programs in the US and European countries.

Present status of organ transplantation from DCD donors in Japan

As organ donation under DBD donors has reached a plateau in developed transplantation countries in Europe and the United States, organ donation after DCD donors has been actively promoted. This has led to the introduction of extracorporeal membrane oxygenation (ECMO) after cardiac arrest and withdrawal from life support when the patient is incapable of recovery, enabling the removal and transplantation of multiple organs after cardiac arrest. In Japan, these efforts have not been implemented, and only kidneys have been transplanted from DCD donors after spontaneous cardiac arrest. In addition, the revision of the Organ Transplant Law to allow organ donation under brain death with only family approval has drastically reduced the number of DCD donors. In Japan, efforts are underway to introduce ECMO and to wean patients off life support systems so that multi-organ donation after cardiac arrest will be possible as in Europe and the United States.

뇌사 판정 논의와 장기이식법의 개선방안 연구

The Act on Organ Transplantation makes it possible to judge brain death with the consent of the bereaved family, even if the donor does not express his/her intention to donate in writing before death, as long as the donor does not express his/her intention to the contrary. Legislation on long-term donations is a new area that was created relatively recently and is still developing with the development of medical and life science technology. It can be said that it is meaningful to examine the current state of overseas legal systems and the content of legislation in order to identify and improve the problems of laws related to transplantation of organs and other organs. In particular, Germany had an organ transplant scandal (Organspende-Skandal) based on changes in organ transplantation, followed by institutional changes. On this basis, we examined the long-term harvest requirements and consent of the German organ transplantation law and derived some improvements in our organ transplantation law.&#x0D; First, as with the consent requirements for determining brain death, there is a problem as to whether or not the bereaved family can refuse the donation despite the donor's consent. If the bereaved family has inherent rights to the long-term donation after the donor's death, the bereaved family will naturally have the right to veto the long-term donation. In the Korean method of determining the scope of relatives, which does not allow such relatives to have the right of veto, it would be a problem to neglect the person's right to self-determination.&#x0D; The second is the scope of long-term donors and recipients. Under the Organ Transplantation Law, family members or bereaved families are the subjects of consent or refusal of long-term donation of organs from donors. German long-term transplant law stipulates that close relatives and decision-making authority must only be given to the donor if they have had personal contact within the last two years prior to death. there is That is, close relatives are primarily spouses or registered Lebenspartners, children, parents, siblings and grandparents. In addition, if an arrangement is made among close relatives and there are multiple close relatives in the same position, it is sufficient if one of them satisfies the above circumstances.

Changes of brain death donors for recent 10 years in Korea: based on Organ Transplantation Law

Changes of brain death donors for recent 10 years in Korea: based on Organ Transplantation Law

Organ donation after cardiac death in Japan

In Japan, since the revision of the Organ Transplant Law in July 2010, donation after brain death (DBD) has increased, while donation after cardiac death (DCD), which has been mainly used by kidney transplantation, has decreased. The number of DCD donors decreased from 98 in 2009 to 28 in 2019. There is no clear reason for the decrease in DCD donors. Furthermore, since 2020, there has been a marked decrease in DCD due to the influence of the COVID-19 pandemic. On the other hand, the outcomes after kidney transplantation from DCD donors are improving year by year. The outcomes of kidney transplantation from DCD donors in Japan are comparable to those of kidney transplantation from DBD donors in Western countries. In order to further improve transplantation outcomes from DCD donors, the clinical introduction of continuous machine perfusion preservation technology, for the purpose of reducing ischemic reperfusion injury, is expected in Japan.

P11.10: Changes of Brain Death Donors for Recent 10 Years in Korea (Based on Organ Transplantation Law)

P11.10: Changes of Brain Death Donors for Recent 10 Years in Korea (Based on Organ Transplantation Law)

臓器移植の現状と今後の展望について

臓器移植の現状と今後の展望について

The will to Donate Human Organs in the Human Organ Donation and Transplant Law in the Kurdistan Region - Iraq

The issue of the will of human organs is one of the contemporary jurisprudential issues and the ancient jurisprudential heritage has not been exposed to it, neither from near nor from a far, but a group of contemporary jurisprudential books and research have been written regarding this issue and some of contemporary scholars permit and others prevent. To add, a set of international laws have been issued regulating the issue of the will of human organs, including: Law of Donation and Transplantation of Human Organs in Kurdistan – Iraq, This law dealt with the issue of the will of the human body through a set of legal articles and paragraphs related to this matter. In this research, the researcher tries to evaluate and compare these legal articles and paragraphs with Islamic jurisprudence regarding this subject. The research included two topics, we mentioned in the first topic: the definition of the will and donation in the law and its evaluation in Islamic jurisprudence. In the second topic: we illustrated the position of the law of the Kurdistan Region - Iraq regarding the commandment of the members of the human body and its evaluation in Islamic jurisprudence. In conclusion, the researcher reached a number of results and recommendations.

Current situation of lung transplantation in Japan

: 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.

Improving self-sufficiency in organ transplantation in Korea.

After attaining a qualified medical capacity in organ transplantation, Korea has been struggling to increase the number of deceased organ transplants to reach self-sufficiency. As one of these efforts, Korea revised the organ transplantation law in 2010 by adding three articles the mandatory reporting based on the recommendation of the 3rd Global Consultation on Organ Transplantation of Madrid in 2010. Along with the new constitution, considerable efforts have been initiated to upgrade the deceased organ transplantation system while maintaining the virtues of fairness, justice, and transparency. The Korean Society of Transplantation played a critical role in revising the law as well as in establishing organizations such as the Korean Organ Donation Agency (KODA; 2009), the Vitallink (2009), and the Korean Organ Transplantation Registry (KOTRY; 2010). By the activities of these professional organizations, Korea could implement fundamental programs such as mandatory reporting and could develop various education programs for organ donation for students and the general population. As a result, the number of deceased donors increased from 1.08 p.m.p. (2000) to 9.23 p.m.p.(2020). Further efforts are needed to increase the number of organ donor cardholders and family consent rates by well-designed, target-specific education programs to overcome traditional negative cultural barriers toward organ donation. The community atmosphere of honoring and thanking donors and their families should be nurtured by national and regional activities of life-sharing weeks linked with organ donor memorial parks.

Efficacy and Safety of Machine Perfusion for Brain Death Marginal Donor Kidney Transplantation: A Report of 2 Cases

After the revised organ transplant law came into effect in Japan, donations of organs under brain death have been increasing; however, because of the expansion of donor indications, donations from expanded criteria donors and cardiac arrest donors (donation after cardiac death) have also increased. In kidney transplantation, ischemia-reperfusion injury results in a high rate of delayed graft function, which adversely affects patients' long-term prognoses. Hypothermic machine perfusion preservation results in superior postoperative function and survival rates compared with cold storage preservation. We used an organ preservation device for kidneys and performed a graft viability evaluation before to kidney transplantation. We used the CMP-X08 perfusion device (Chuo-Seiko Co, Ltd, Asahikawa, Hokkaido, Japan) and Belzer MPS solution to preserve the donated organ. The perfusion pressure and temperature were monitored during cold storage with continuous perfusion. Standard renal transplantation protocols were followed. A renal biopsy was performed 1 hour after transplantation and the renal function was evaluated. This study followed the principles of the Declaration of Helsinki. The first presented case is of a 63-year-old woman who received a kidney from a middle-aged man with brain death due to hypoxic encephalopathy. The creatinine at the time of admission was 0.9 mg/dL and at the time of excision was 2.86 mg/dL. The total perfusion time was 120 minutes. The total ischemia time was 7 hours and 15 minutes. The recipient urinated 115 minutes postoperatively, and no dialysis was required. The second presented case is of a 47-year-old man with a 15-year history of dialysis who received a kidney from a middle-aged woman with brain death due to subarachnoid hemorrhage. The creatinine at the time of admission was 0.8 mg/dL and at the time of excision was 0.77 mg/dL. The total perfusion time was 240 minutes. The total ischemia time was 13 hours and 14 minutes. The recipient urinated 38 minutes postoperatively, and no dialysis was required. Mechanical perfusion storage performed for 2 to 4 hours resulted in a viable organ that was successfully transplanted in both cases.

Is Post-Mortem Organ Donation a Duty Towards Society and Can It Be Justified by Public Interest? Recent Bills to Amend the German Transplantation Law

The issue of organ donation from deceased donors remains unsatisfactorily resolved in Germany. The number of donors has remained very low in recent years. Consequently, the German Bundestag was holding a debate on two MP bills aimed at amending the organ transplantation law. Two main bills were presented by different groups of MPs. The more controversial of them, supported by the Minister of Health, tried to introduce the opt-out model into Germany’s organ transplantation system. The second one aimed to improve the existing opt-in model. During the final voting, the Bundestag decided against the opt-out model and in favour of the improved opt-in one. In some experts’ eyes, an opt-out model imposes an obligation on the citizens to donate an organ after brain death. Can such a duty to the society be justified by public interest or other principles? The goal of this article is to offer an answer to this question by analysing the provisions of the German constitution.

Organ Transplantation in Ecuador.

Organ Transplantation in Ecuador.

Join the Lone Kidney Club: incentivising live organ donation

Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option,...

Knowledge and practice of organ donation among police personnel in Tamil Nadu: A cross-sectional study

Context: Police officers are one of the key stakeholders involved in the process of deceased organ donation. In India, as road traffic accidents account for the majority of brain deaths, the police play an important role to ensure legal and ethical practices of organ donation. In many instances, the undue delays in the inquest and postmortem lead to difficulties in completing the donation and also cause distress among the family members who have said yes to organ donation despite their grief. Aim: This study aims to assess the police officers' knowledge of the organ donation process and their practice toward it. Design and Subjects and Methods: This cross-sectional survey was conducted among 627 police officers in the state of Tamil Nadu in India within a period of 18 months. A structured questionnaire with multiple choice questions was used. Microsoft Excel and SPSS version 21 were used to compile and statistically analyze the data collected. The knowledge level and willingness of the officers to follow certain practices were analyzed. Results: It was found that 95.5% of the participants were aware of organ donation. Further analysis revealed that 86.6% of the police personnel were aware of brain death, but only 35.6% were aware of the transplant law, 12.1% knew about the green corridor, and 20.7% about the donor card. Very few participants (9.6%) had experience in processing brain deaths and organ donation cases. Knowledge about postmortem formalities and inquest protocols was unsatisfactory. A significant association between work experience and the knowledge and awareness about organ donation was noted. Conclusions: Including modules on organ donation awareness, transplant law, and hospital protocols in the training syllabus for the recruited personnel, followed by regular refresher courses on the subject, would be the key to enhance the knowledge and work practices of this important group to help ease pain points in the medicolegal cases where organ donation consent is provided by the relatives. A change in the attitude of police officers while handling organ donation cases would have an overall positive impact on the program.

Brain Death and Life Ethics from the Perspectives of Religions

After brain death criteria was first established at Harvard University in 1968, Korea included brain death in the guidelines for the determination of death, through the organ transplant law in February 1999. Since then, various legal, medical, ethical, and social issues regarding the determination of death related to brain death have surfaced, but no research has been conducted from the perspectives of comparative religion regarding the position towards the brain death, The author will examine the life ethics related to the brain death from the perspectives of the Catholicism, Protestantism, Judaism, Buddhism, Hinduism, Islam and Confucianism. Three arguments will be unfolded through this paper at large. Firstly, internal and external perspectives on the brain death will be briefed, and secondly, issues related to brain death will be examined from the perspectives of various religions, and thirdly, a few proposals will be made from the perspective of the life ethics. Through this paper’s various religion’s organic perspectives on the entire human life overcoming biological or reductionist perspectives regarding the brain, the author expects the understanding of the human life to deepen in relation to the brain death.

Ten years of Israel\u2019s organ transplant law: is it on the right track?

The Israeli organ donor law was established in 2008. In the ensuing 10 years there have been some improvements in deceased donation and living donor rates and a reduction in the unethical practice of transplant tourism. There is, however, controversy regarding increased access to transplant for those who have been living donors, who are family members of deceased donors, or who have registered their intent to donate. The issue of routine retrieval versus obtaining consent for organ donation has also been raised. This commentary will address these issue, and propose some steps for improvement of the current Israeli organ donation system.

Similar Outcomes of Kidney Transplantations Using Organs From Donors After Cardiac Death and Donors After Brain Death

BackgroundTo increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively use organs from all donors. Since the revision of the Organ Transplant Law, the number of organ donors after cardiac death (DCD) has decreased but the number of organ donors after brain death (DBD) has increased; however, the number of donor organs and awareness of cadaveric transplantation have increased. MethodsAt our institution, 28 patients underwent cadaveric kidney transplantation from January 2001 to December 2016. These patients were classified into 2 groups according to DBD or DCD. Furthermore, 10 patients received transplants from expanded criteria donors (ECD) and 18 received them from standard criteria donors (SCD). ResultsKidney graft survival and engraftment were observed for all patients. There were no significant differences in renal function at 6 months for DBD and DCD transplant recipients. Renal function at 1, 3, and 5 years and serum creatinine levels were better for the ECD group. Renal function at 5 years after transplantation was significantly better for the SCD group than for the ECD group; however, there was no difference in delayed graft function between the SCD and ECD groups. Comparisons of the 3 groups showed good renal function for transplants from DBDs, but there was no significant difference in survival rates. ConclusionsResults were good for all patients. There were no significant differences in outcomes of our patients who received transplants from ECD or SCD.