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Heart transplantation in children in foreign countries with reference to medical, transportation, and financial
1Division of Cardiology, National Children's Hospital, Tokyo, Japan.
Insights
Pediatric heart transplantation faces significant hurdles in Japan due to legal restrictions on pediatric organ donation. Eight children were transferred overseas for heart transplantation, with mixed outcomes and considerable challenges.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Heart transplantation is a growing therapy for end-stage heart failure in adults and children globally.
- Japan's organ transplantation law, enacted in 1998, has specific limitations regarding pediatric donors, particularly for children under 15.
- The absence of clear protocols for brain death in children under six further complicates pediatric organ donation.
Observation:
- Eight pediatric patients requiring heart transplantation were transferred overseas (USA or Germany) due to limitations in Japan.
- Four of the transferred patients successfully received heart transplants.
- Four patients died while awaiting transplantation overseas, highlighting critical issues in the waiting period.
Findings:
- Legal and regulatory frameworks in Japan significantly impede access to pediatric heart transplantation.
- International transfer of pediatric patients for heart transplantation involves substantial medical and logistical challenges.
- Financial burdens associated with overseas medical treatment are a major consideration for families.
Implications:
- There is a critical need to address legal and ethical barriers to pediatric organ donation in Japan.
- Developing national protocols for pediatric brain death and organ donation is essential.
- International collaboration and financial support systems are crucial for facilitating life-saving pediatric transplants when domestic options are unavailable.
Abstract:
Heart transplantation is increasingly becoming accepted worldwide as therapy for end-stage heart failure not only in adult patients but also in pediatric practice. The new law in Japan for organ transplantation from brain-dead patients was established on 16 October 1998, but there is no definite law or protocol for brain death in children under the age of 6 years and children less than 15 years of age cannot become donors. These facts make organ transplantation from the cadavers of neonates, infants and young children almost impossible in Japan, even though there are children who need heart or heart-lung transplantation. The present authors have to date transferred 8 patients to the USA or Germany for heart transplantation: 4 successfully underwent heart transplantation, but 4 died during the waiting period overseas. There are many things to consider; not only the medical problems involved in transportation, but also the financial issues when transferring patients to other countries. This report details the experience with the 8 cases that were transferred overseas for heart transplantation, and highlights the problems that need to be considered.