[Revised act on organ transplantation from neurosurgeon's viewpoint]

The revised act on organ transplantation was passed in July 2009; it will be implemented in July 2010. This law allows organ donation from a brain-dead person with or without an Organ Donation Decision Card, if the family members permit this donation and the brain-dead person had not decided against it when conscious. In Japan, the legal definition of human death has not changed after the revision of the act on organ transplantation; therefore, brain death is considered human death for the purpose of organ transplantation. Certain minor revisions are required in the medical and legal criteria for diagnosis of brain death, especially for children under 6 years. Ancillary tests, including radioisotope measurement of cerebral blood flow and auditory brainstem evoked potentials, should be considered for younger children or in cases where comprehensive neurological examination was not possible because of injuries to the face, eyes, or ears. An increase in the number of organ donations from brain-dead persons because of the revised act will greatly increase the responsibility of and burden on hospitals and neurosurgeons that treat many emergency cases of severe brain injury and stroke. Adequate socioeconomic and systemic medical support should be provided to hospitals where organ donation is carried out.