Clinical Implication of Organ Transplantation from Donation after Circulatory Death: A Japanese Multi-institutional Survey

Abstract

The number of organ donations from brain death has been steadily increasing since the revision of the Organ Transplant Law in 2010; however, the current situation of the waiting list for each organ, which is increasing year by year, indicates that the shortage of donors is an ongoing problem. The first priority is to increase the number of donations after brain death (DBDs), but as an alternative, organ donation from donation after circulatory death (DCD) has been attracting attention and controlled DCD (cDCD), in which withdrawal of life support therapy (WLST) is the mainstay of such donation, has rapidly spread overseas in recent years. In Japan, however, the definition of death is still under debate, and careful consideration is required. In this environment, the AMED study on DCD (Margin Donor for Clinical Application and Heart Transplantation from Cardiac Arrest Donors) was conducted. The introduction of cDCD has been an inevitable and urgent issue, and has been the subject of much discussion. In addition, there is an erroneous understanding among medical professionals, including transplant physicians, that the introduction of cDCD requires revision of related laws, and we believe that one of the important objectives of this proposal is to create guidelines for the correct understanding and realization of donation. Against these backgrounds, we have summarized the issues involved in the introduction of cDCD for heart and lung transplantation and prepared a draft proposal that will serve as a basis for discussion on how to proceed with cDCD in Japan.