Organ Donation Constraints / Japan’s National Mediator Struggles with Low Staff, Rising Workload; Psychological Support for Coordinators Essential

The Yomiuri Shimbun

6:00 JST, June 16, 2024

This is the second installment in a series which compares the organ transplant system in Japan with the United States and South Korea, which are among world leaders in the field. This installment discusses the challenges facing coordinators of organ donations in Japan.

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“I slept in the office three days a week sometimes. It was a rewarding job, but …” a man said in late May about his extremely busy days working as a coordinator at the Japan Organ Transplant Network (JOT), which serves as the national mediator of organ donations.

Coordinators at JOT visit medical institutions where potential brain-dead organ donors are hospitalized, explain donation to their families and confirm their wishes. They also decide which facility each organ is sent to.

Once a donor has been selected, coordinators work three to seven days straight, including at night and during holidays.

“About the same number of coordinators that were hired quit because of the hard work,” said the man, who has also left his workplace.

A record 132 brain-dead organ donations were performed in Japan in 2023. A growing number of organ donations has left coordinators hard-pressed.

JOT is licensed by the health, labor and welfare minister as a transplant mediator and is subsidized by the government. JOT employed 34 coordinators as of the end of January, which is much fewer than the 54 coordinators JOT estimates are needed to handle 125 organ donations a year, let alone the 72 needed for 200 donations.

JOT President Hiroyuki Yokota underlined the necessity of securing additional manpower, saying, “We have been sending four to five coordinators per case to a medical institution, but when multiple organs are donated at the same time, it becomes difficult to keep dispatching the same number.”

In South Korea, 483 organs were donated in 2023, and 58 coordinators from the country’s mediating agency Korea Organ Donation Agency (KODA) handled them.

KODA can take the initiative in confirming the wishes of family members and in taking care of all procedures from brain-death diagnosis to organ removal.

“Coordinators have a large workload, but we provide an environment where each of them can work with self-respect,” KODA President Samuel Lee said.

KODA gives them a day off each time they finish their assignment and provides counseling by a psychological specialist.

Meditating agencies for organ donations in the United States, the world’s leading country for transplants, operate on a different scale.

Richard Hasz, president of the Philadelphia-based nonprofit Gift of Life Donor Program, said, “Overall, Gift of Life has coordinated more than 59,000 organs since its founding [in 1974].”

Gift of Life is responsible for organ procurement if a donor is found among about 11 million people living in three states, including Pennsylvania.

The program has about 270 staff members. It provides dedicated beds at transplant facilities it partners with and prepares accommodation for patients awaiting transplants and their families.

“In the United States, a large amount is paid for mediating services,” said Senri Kinran University President Norihide Fukushima, who had visited Gift of Life and has made efforts to train coordinators in Japan. “I hope Japan will examine ways to fund JOT to help increase the number of coordinators and provide them with better psychological care.”