Abstract
Heart transplantation is now an established thearpeutic modality for end-stage heart failure abroad. The world registry indicates that the annual number of patients who receive heart transplantation is now over 3, 500 per year, with survival rates of 82.0% at 1 year and 74.2% at 3 years. The main indications are idiopathic (45.6%) and ischemic (45.6%) cardiomyopathy. Quality of life is well maintained after transplantation, with 90% of patients free of symptoms and fully enjoying ordinary life. The main problems currently facing us are; keeping the safe ischemic time at transplantation at 4 hours, the need for lifetime immunosuppression, development of coronary artery obstruction with chronic rejection that accounts for 20% of late mortality, and severe donor shortage leading to a long waiting period. In Japan, after a decade of national attempts to establish a legal background for organ donation under brain death, the first registration was established in 1997 and the first heart and liver transplantation were achieved this year. Social acknowledgment and support have increased, but the social and legal requirements are still very strict and organ donation has been very limited. The discussions on revision of the current registration have particularly focused the very strict regulation for donation which requires a written living will and the issue of transplantation for children which is currently in practical terms illegal. The current practical procedures and surgical methods of heart procurement and transplantation are described.
