Organ Donation Constraints / Japan Lags behind from Lack of Resources; Leading Hospitals in U.S., S. Korea Have Dedicated Staff, Facilities

The Yomiuri Shimbun

6:00 JST, June 15, 2024

As more organs from brain-dead patients become available for transplants, the lack of capacity at medical institutions to accept them has become a serious issue. What can the government, medical institutions and concerned entities do to increase donations further and bolster the medical system to save the lives that can be saved? This series looks at the United States and South Korea, which are among the world leaders in transplants.

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“My disease is getting worse so fast. I wonder if I’ll receive a transplant in time,” a woman suffering from an intractable lung disease whispered from her bed in her apartment in early May.

Her reliance on a nasal tube to provide her with enough oxygen is increasing day by day.

The woman is registered with the Japan Organ Transplant Network and is hoping to undergo a lung transplant at the University of Tokyo Hospital.

What has been haunting her is a series of news reports about transplant facilities declining organs donated by brain-dead patients due to a lack of staff and beds.

A survey by the Japan Society for Transplantation found three university hospitals — including the University of Tokyo Hospital — had declined 62 organ donations in 2023.

Although the order of patients set to receive a donated organ is based on factors such as how long they have been on the waiting list and the severity of their condition, many have missed out on transplants due to circumstances at the hospital.

“I spend my days thinking that I might die tomorrow,” she said.

She is eager to petition the government to improve the situation. But she is not in condition to do so as she suffers chest pains with just a slight shift in bed.

Difference in scale

In Japan, a total of 451 transplant operations — of hearts, lungs, livers, pancreases and kidneys — were performed using organs from brain-dead donors and from donors whose hearts had stopped. This is the lowest level among developed countries. In the United States, the number of transplant surgeries performed is over 80 times higher than in Japan.

Cleveland Clinic, a large hospital located about a 20-minute drive from the center of Cleveland, boasts one of the best organ transplant records in the United States.

Seven surgeons are responsible for liver transplant operations, and 235 were performed last year.

“We can perform three transplant operations at the same time,” one of the surgeons, Masato Fujiki, 48, said. “Compared to Japan, the division of work is way more advanced here.”

The hospital “rarely turns down organ donations” for their own reasons, he said.

Hospitals in the country set up transplant systems in anticipation of huge profits. According to a report of the U.S. consulting firm Milliman Inc., the total amount paid to a medical institution for a single heart transplant, for example, was $1.66 million (¥260 million) in 2020.

Each hospital publishes on its website data such as the number of transplants performed, the waiting period for patients and the survival rate after transplant.

The United Network for Organ Sharing (UNOS), a U.S. organ donor agency, audits each hospital every three years to check that it meets the required standards. Because performance is directly related to a hospital’s reputation, its executives are said to be constantly aware of the data as they formulate their strategies.

Dedicated space, staff

A series of news reports about the circumstances of Japanese hospitals shocked the South Korean transplant circle.

At the Asan Medical Center, which has the best record for transplant surgeries in South Korea, The Yomiuri Shimbun in late May showed five doctors the reports carried in a copy of its English newspaper, The Japan News. Its Organ Transplantation Center Director Shin Hwang and the others all looked puzzled.

“We have learned about transplant systems from the University of Tokyo and Kyoto University and have been utilizing that knowledge,” said Hwang, who also is chair of board at the Korean Society for Transplantation. “It’s just unbelievable that Japan has such advanced technology but couldn’t perform operations because they couldn’t organize resources.”

Asan Medical Center has a dedicated intensive-care unit and doctors on duty for transplant operations on weeknights and weekends. In South Korea, hospitals that perform transplant surgeries are considered prestigious, he said.

“Our hospital as a whole regards transplants as very important and is proud to have a system in place,” Hwang said.

In Japan, even the University of Tokyo Hospital, which is one of the top in the nation for transplants, does not have a dedicated ICU. It is common for the hospital to lose money. Striking a balance between transplants and regular medical care for cancer and emergency patients has forced Japanese hospitals to turn down organ donations.