[Revised act on organ transplantation: a pediatrician's viewpoint]

In Japan, from July 2010, an infant or a child with brain death will be legally regarded as a candidate of donor for organ transplantation under the consent of his or her family members. Official diagnostic criteria of brain death in children are currently under compilation. The causes and incidence of brain death remarkably differ among individuals belonging to different age groups. Secondary brain damages resulting from asphyxia, drowning, hypoxemia, and cardiopulmonary arrest more commonly occur in childhood than in adulthood. Child abuse or neglect is suspected to be involved in many of the cases of brain death. The current Japanese diagnostic criteria hitherto used for adults require several modifications before these can be applied to infants and children. According to the requirements of the new act, abused or neglected infants and children must be excluded from the category of donor candidates. Neonates and young infants below 12 weeks of corrected age will also be excluded, because neurological diagnosis of brain death is difficult in these individuals.