title: Donor evaluation and management system (medical consultant system) in Japan: experience from 200 consecutive brain-dead organ donation.
abstract: OBJECTIVE
  As the donor shortage is extremely severe in Japan because of a strict Organ Transplantation Act, special strategies must be established to maximize organ transplant opportunities. The purpose of this study was to evaluate our strategies to identify and manage 200 consecutive brain-dead organ donors.
  
  
  METHODS
  We retrospectively reviewed the 200 donors procured since the Organ Transplantation Act was issued in 1997, including 118 males, a mean overall age of 45.1 years and cause of death being cerebrovascular disease (n = 119), head trauma (n = 37), and asphyxia (n = 44). DONOR EVALUATION AND MANAGEMENT SYSTEM: Since November in 2002, special transplant management doctors ("medical consultants") were sent to donor hospitals to assess organ function and identify transplantable organs. They also provided intensive care to stabilize hemodynamics and improve cardiac and lung functions by administering antidiuretic hormone intravenously and providing bronchofiberscopic pulmonary toilet.
  
  
  RESULTS
  We obtained 146 heart, 1 heart-lung, and 154 lung (87 single and 67 bilateral), 175 liver (28 splitted liver), 142 pancreas (114 pancreas-kidney), 253 kidney and 12 small bowel grafts. Organs procured from 1 donor increased from 4.5 to 6.8 after applying these strategies.
  
  
  CONCLUSIONS
  Although the number of cases was still small, the availability of organs and outcomes of transplantation have been acceptable.
authors.affiliation: Department of Therapeutics for End Stage Organ Dysfunction, Osaka University, Suita, Japan. nori@tesod.med.osaka-u.ac.jp
authors.forename: N
authors.initials: N
authors.lastname: Fukushima
authors.forename: M
authors.initials: M
authors.lastname: Ono
authors.forename: Y
authors.initials: Y
authors.lastname: Saiki
authors.forename: M
authors.initials: M
authors.lastname: Minami
authors.forename: S
authors.initials: S
authors.lastname: Konaka
authors.forename: J
authors.initials: J
authors.lastname: Ashikari
mesh_terms: D001926:Brain Death; D003253:Consultants; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D016377:Organ Transplantation; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors