Organ donation after brain death is made possible through the contribution and collaboration of many professionals. The high rate of 5.3 organs transplanted per donor is achieved due to Japan’s characteristic system, where the recovery team directly examines the donor by performing echocardiograms, bronchoscopies, and abdominal echoes. Additionally, a recovery team meeting is held prior to the organ recovery surgery, where the incision location of blood vessels between organs is mutually confirmed to maximize the number of transplanted organs. This paper aims to describe the procedures and key aspects of the organ recovery team from the perspective of the transplant network, with the goal of maintaining excellent coordination and cooperation.

This article describes the heart procurement procedure from brain dead donors in Japan. Thoracic and abdominal surgeons operate together in donor surgery, and it is important to consult with each other in advance. Confirmation of the left atrial incision with the lung team and the inferior vena cava incision with the liver team is especially important.

The key to cadaveric donor lung procurement is close collaboration with the other procurement teams, especially the donor heart procurement team which shares the surgical field throughout the entire process, local anesthesiologists, and the Japan Organ Transplant Network coordinators, reliable assessment of the donor lungs, and skillful and consistent surgical technique to complete the harvest without error within a limited time frame. In order to standardize these procurement procedures and present them to all lung procurement teams in Japan, a manual on cadaveric donor lung procurement has been published on the website of the Japan Society for Transplantation. The original version of this manual was prepared through a questionnaire survey conducted from March to May 2011 among seven lung transplant centers at that time to confirm surgical techniques and collect tips and pitfalls, followed by careful e-mail discussion and consensus building. From April to June 2021, another questionnaire was sent to 10 lung transplant centers, and after careful e-mail discussion, a revised version was created. In this process, the technique was reconfirmed and standardized among 10 centers. This article outlines the preparation, preoperative meeting, and procedure for donor lung procurement in the case of heart procurement, in accordance with the Lung Procurement Manual (revised edition 2021) of the Japan Society for Transplantation.

To achieve good outcomes in organ transplantation, it is extremely important that organ recovery procedures be performed accurately and safely. Transplant surgeons should acquire standard techniques and knowledge of the entire process. This paper describes the standard procedures according to the liver procurement manual by the Japanese Society for Transplantation. In addition, this paper discusses the prospects for organ recovery surgery in Japan and the importance of establishing an educational system.

Despite the high number of marginal donors, the results of pancreas transplantation in Japan are excellent. The results of kidney transplantation from cadaver donors are also good. The pancreas and kidneys are often procured en bloc from brain-dead donors. Kidneys are procured not only from brain-dead donors but also from donors after circulatory death. For pancreas and kidney procurement from a brain-dead donor, the aorta and inferior vena cava are cannulated, cross-clamped, and perfused in situ with UW solution. The pancreas and kidneys are procured en bloc after the small intestine and liver are procured. On the back table, the pancreas and the two kidneys are separated. Thereafter, the kidneys are separated from each other. Regarding kidney procurement from donors after circulatory death, there are cases where a double-balloon catheter is placed before cardiac arrest and in situ perfusion is started immediately after cardiac arrest, and there are cases where cannulation is performed after laparotomy in the operating room. Both kidneys are collected together (en bloc) and separated on the back table.

【Objective】 The aim of the present study was to evaluate actual state of quality of life and validate the support needed during adolescence among pediatric liver transplant recipients.

【Methods】 During the study period, 99 liver transplant recipients in the National Center for Child Health and Development were enrolled and participated in a questionnaire survey, including research into school and work status, interaction among recipients, surgical wounds, and adherence to medication.

【Results】 Responses from 73 among the 99 recipients and their parents were obtained. In school life in junior high school and above, the effects of tardiness, early leaving, and absence from school due to hospital visits and hospitalization, and communication issues with the school were indicated. Sixty percent of the junior and senior high school students were concerned about "surgical wounds" and "physical condition," suggesting the need for consideration of surgical wounds and presentation of treatment options regardless of gender. The results also suggested that there was an association between non adherence to medication, and worsening liver function. Regarding the support needed before and after transplantation and future concerns of pediatric liver transplant recipients as adolescents, "physical condition" accounted for the largest proportion, followed by "love, marriage, and childbirth" and "employment".

【Conclusion】 Medication adherence in adolescents after pediatric liver transplantation was indicated by changes in life background in adulthood, understanding of the importance of medication management, and the burden of medical costs. It is an important issue for the future to enhance mental support that takes into consideration the characteristics of adolescents and young adults, in addition to support that accompanies anxiety and daily concerns before surgery.

In recent years, donation after circulatory death (DCD) donors have increased and the "super-rapid" technique is widely used for DCD organ procurement to minimize the duration of organ warm ischemia. However, this technique is associated with increased risk of surgical injury due to the haste in procuring the organs. This study demonstrated the detailed technique used in DCD organ procurement and the strategies to prevent surgical injury during the procurement. Before a donor operation, procurement teams should discuss the surgical steps and set up the surgical equipment. During DCD organ procurement, the liver is first procured followed by the pancreas and the kidneys. A standardized approach of DCD organ procurement will be crucial to optimize DCD transplant outcomes and minimize the risks of surgical injury.

In order to attract and sustain the public’s interest in transplant medicine, it is important that topics related to the subject are continually communicated by the media. The aim of this study was to explore the determinants of the media’s behaviour of ’continually writing about transplantation’. In addition, to develop an environment conducive to this behaviour, the themes of the media workshop and information that should be provided by the Japan Society for Transplantation (JST) were identified.

A questionnaire based on behavioural science was conducted at the end of a media workshop, and responses were received from nine participants. The results showed that the majority of respondents wrote 1-3 articles per year. The behavioural barriers for the media to ’continually write articles’ were the difficulty in approaching the parties involved, such as donors and recipients, the lack of access to real-time data, and their own lack of knowledge. On the other hand, informing the public about the current situation, raising interest in transplant medicine and increasing the number of donors were often mentioned as behavioural values. Listening to the people involved and listening to various discussions at transplant societies were also mentioned as motives for behaviour by the media.

These findings suggest that JST needs to consider regularly providing information to the media, particularly by putting them in contact with the parties and explaining academic conference content in laymen’s terms in real time.