Related Experiment Video
Updated: May 6, 2026
Study of Experimental Organ Donation Models for Lung Transplantation
Published on: March 15, 2024
Japanese strategies to maximize heart and lung availabilities: experience from 100 consecutive brain-dead donors
1Department of Therapeutics for End-Stage Organ Dysfunction, Osaka University.
Insights
Japan
Area of Science:
- Transplantation medicine
- Organ donation strategies
- Graft survival rates
Background:
- Severe organ donor shortage in Japan due to strict transplantation laws.
- Need for specialized strategies to maximize heart and lung transplantation (HT and LT) opportunities.
- Previous organ procurement rates and outcomes in the context of donor limitations.
Purpose of the Study:
- To evaluate specialized strategies for identifying and managing heart and lung donors in Japan.
- To assess the impact of these strategies on organ availability and transplant outcomes.
- To analyze the characteristics of marginal donors and their impact on graft success.
Main Methods:
- Retrospective review of 100 consecutive brain-dead donors since 1997.
- Implementation of special transplant management doctors to assess and stabilize donors.
- Use of antidiuretic hormone and bronchofibroscopy for hemodynamic and pulmonary management.
- Analysis of donor demographics, causes of death, and organ utilization.
Main Results:
- Increased organs per donor from 4.5 to 6.8.
- Successful performance of 79 heart transplantations (HTs), 1 heart-lung transplantation, and 78 lung transplantations (LTs).
- High graft survival rates: 95.4% at 10 years for HT recipients and 72.2% at 3 years for LT recipients, despite utilizing marginal donors.
- Improved lung procurement and survival rates after implementing pulmonary toilet protocols.
Conclusions:
- Specialized strategies enhance organ availability for heart and lung transplantation in Japan.
- Acceptable patient survival rates achieved even with marginal donors.
- Continuous improvement in lung procurement and patient outcomes through dedicated management.
Objective:
Because the donor shortage is extremely severe in Japan because of a strict organ transplantation law, special strategies have been established to maximize heart and lung transplantations (HTs and LTs, respectively). We reviewed 100 consecutive brain-dead donors to evaluate our strategies to identify and manage heart and lung donors.
Methods:
We retrospectively reviewed all 100 consecutive brain-dead donors procured since the law was issued in 1997. There were 56 mens and the overall mean donor age was 43.5 years. The causes of death were cerebrovascular disease (n = 62), head trauma (n = 20), and asphyxia (n = 16): Since November 2002, special transplant management doctors were sent to donor hospitals to assess cardiac and lung functions, seeking to identify transplant opportunities. They stabilized donor hemodynamics and lung function by administering antidiuretic hormone intravenously and performing bronchofibroscopy for pulmonary toilet.
Results:
Seventy-nine HTs, 1 heart-lung transplantations, and 78 LTs (46 single and 32 bilateral) were performed. By applying these strategies organs per donor were increased from 4.5 to 6.8. Among heart donors, 61/80 were marginal: high inotrope requirement (n = 29), cardiopulmonary resuscitation (n = 28), and/or >55 years old (n = 20). None of the 80 HT recipients died of primary graft failure (PGF). Patient survival rate at 10 years after HT was 95.4%. Among lung donors, 48/65 were marginal: pneumonia (n = 41), chest trauma (n = 4), and >55 years old (n = 9). Only 2/78 LT recipients died of PGF. Patient survival rate at 3 years after LT was 72.2%. After inducing frequent pulmonary toilet, lung procurement and patient survival rates increased significantly after LT.
Conclusions:
Although the number of cases was still small, the availability of organs has been greater and the outcomes of HT/LT acceptable.
