[How to Consider the Heart Transplantation from the Donor after Circulatory Death in Japan]

Area of Science:

• Cardiology
• Transplantation Medicine
• Public Health Policy

Background:

• Heart transplantation (HTx) in Japan has seen an increase post-2010 law revision, exceeding 500 total procedures.
• Despite this, a critical donor shortage persists, with fewer than 100 annual donors and significant waiting list deaths.
• The current donor pool relies heavily on donation after brain death (DBD).

Purpose of the Study:

• To review the status of heart transplantation (HTx) using donation after controlled circulatory death (cDCD) internationally.
• To evaluate the potential of cDCD as a strategy to expand the donor pool in Japan.
• To identify domestic challenges and necessary actions for implementing cDCD HTx in Japan.

Main Methods:

• Review of international literature and transplant data on cDCD heart transplantation.
• Analysis of current organ donation and transplantation laws and practices in Japan.
• Discussion of ethical and logistical considerations for cDCD implementation.

Main Results:

• Heart transplantation (HTx) using cDCD has shown promising outcomes in countries like the UK and Australia.
• cDCD offers a viable strategy to increase the number of available organs for transplantation.
• Nation-wide, cross-sectoral collaboration is essential for successful cDCD program implementation.

Conclusions:

• Donation after controlled circulatory death (cDCD) is a crucial option for addressing the donor shortage in Japan.
• Expanding the donor pool through cDCD can significantly increase heart transplantation (HTx) rates.
• Coordinated national efforts are required to overcome domestic barriers and integrate cDCD into the Japanese transplantation system.