Current Status and Challenges of Organ Donation and Deceased Donor Kidney Transplantation

Abstract

Organ donation and deceased donor kidney transplantation in Japan have increased in recent years, with a notable recovery after the COVID-19 pandemic and improved public expression of donation intent. However, the waiting time for transplantation remains prolonged at approximately 15 years, and many candidates are removed from the waiting list due to death or clinical deterioration. The increase in organ donation has highlighted limitations in the transplant infrastructure, including shortages of human resources and strain on immunological testing systems. In particular, the decline in specialized testing centers and the inefficiency of conventional physical crossmatching pose significant challenges. Virtual crossmatching, based on anti-HLA antibody assessment, is expected to reduce testing burden and facilitate timely decision-making. In addition, re-evaluation of recipient selection and organ allocation policies is needed to ensure fairness and efficiency. New approaches, such as pediatric en bloc kidney transplantation and regionally integrated organ procurement systems, are also being explored. This review outlines the current status and key challenges of organ donation and deceased donor kidney transplantation in Japan and discusses future directions toward a sustainable and equitable transplant system.