title: Heart donation in Japan before and after the revision of the Japanese Transplantation Act.
abstract: BACKGROUND
  After the revision of the Organ Transplant Act in July 2010, brain dead organ donation increased from 13 to 45 per year, and heart donation increased. The purpose of this study was to review 166 consecutive brain dead heart donors to evaluate our strategies to identify and manage organ donors.
  
  
  METHODS
  This study reviewed 166 consecutive brain dead heart donors since the Act was issued. Whereas 69 heart donations were performed between October 1997 and July 2010 before the revision of the Act, 97 heart donations were performed for the 3 years after the revision. Since November 2002, special transplant management doctors were sent to donor hospitals to assess donor organ function and to identify which organs could be transplanted. They also intensively cared for the donors to stabilize hemodynamics and to improve cardiac function by giving intravenous antidiuretic hormones and by pulmonary toileting via bronchofiberscope.
  
  
  RESULTS
  The mean heart donor age increased from 41.0 to 43.9 years after the revision. Notably, 11 hearts from donors more than 60 years old were transplanted successfully after the revision. Before the revision, the cause of death was 37 cerebrovascular disease (SAH 34, stroke 1, bleeding 2), 18 head trauma, 13 asphyxia, and 2 postresuscitation brain damage. After the revision, there were 49 cerebrovascular disease (SAH 37, stroke 2, bleeding 16, and other 4), 17 head trauma, 10 asphyxia, and 11 postresuscitation brain damage. A total of 58 donors had a history of cardiac arrest, 58 required a high dose of catecholamine drip infusion, and only 1 recipient died of primary graft dysfunction. Patient survival rate at 3 years after heart transplantation was not different before and after the revision of the Act (98.6% vs 92.2%).
  
  
  CONCLUSIONS
  Although donor age was increased and donors who died of cerebral bleeding or postresuscitation after the revision of the Act increased, the outcome after heart transplantation was not changed.
authors.affiliation: Department of Therapeutics for End-Stage Organ Dysfunction, Osaka University, Osaka, Japan. Electronic address: nori@surg1.med.osaka-u.ac.jp.
authors.forename: N
authors.initials: N
authors.lastname: Fukushima
authors.affiliation: Department of Cardiothoracic Surgery, Tokyo University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ono
authors.affiliation: Heart Institute Japan, Tokyo Women's Medical College, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Surgery, Tohoku University, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Saiki
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kubota
authors.affiliation: Department of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tanoue
authors.affiliation: Department of Therapeutics for End-Stage Organ Dysfunction, Osaka University, Osaka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Konaka
authors.affiliation: Medical Headquarters, Japan Organ Transplant Network, Tokyo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Ashikari
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death / Q000331:legislation & jurisprudence*; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*