2013 - ISODP 2013 Congress

Oral Presentation 6 on Deceased Donor Management

13.4 - Heart donation in Japan before and after revision of Japanese Transplantation Act

Presenter: Norihide, Fukushima, Suita, Japan
Authors: Norihide Fukushima, Minoru Ono, Yoshikatsu Saiki, Takeshi Nakatani, Satoshi Saito, Suguru Kubota, Juntaro Ashikari

Heart donation in Japan before and after revision of Japanese Transplantation Act

Norihide Fukushima1, Minoru Ono2, Yoshikatsu Saiki3, Takeshi Nakatani4, Satoshi Saito5, Suguru Kubota6, Juntaro Ashikari7

1Department of Therapeutics for End-Stage Organ Dysfunction, Osaka University, Suita, Japan, 2Department of Cardiothoracic Surgery, Tokyo University, Tokyo, Japan, 3Department of Cardiovascular Surgery, Tohoku University, Sendai, Japan, 4Department of Transplantation, National Cardiovasuclar Center, Suita, Japan, 5Department of Cardiovascular Surgery, Tokyo Women's Medical College, Tokyo, Japan, 6Department of Cardiovacular Surgery, Hokkaido University, Sapporo, Japan, 7Head Quarter, Japan Organ Transplant Network, Tokyo, Japan

After revision of Organ Transplant Act in July 2010, brain dead organ donation increased from 13 to 45 in a year and heart donation increased. The purpose of this study is to review consecutive 163 brain dead heart donors to evaluate our special strategies to identify and manage organ donors.

Method: Consecutive 163 brain dead heart donors since the Act was issued were reviewed. While 69 heart donations were performed between October 1997 and July 2010 before revision of the Act, 97 heart donations were done for 3 years after revision.

Donor evaluation and management system: Since November in 2002, special transplant management doctors were sent to donor hospitals in order to assess donor’s organ function and to identify which organ could be transplanted. They also intensively cared the donor to stabilize hemodynamics and to improve cardiac function by intravenously giving anti-diuretic hormone and pulmonary toileting by broncho-fiberscope.

Results: A mean donor age of heart donor was increased from 41.0 to 43.9 years. Especially 11 hearts from a donor older than 60 years were transplanted successfully. Before revision, the cause of death was 37 in cerebrovascular disease (SAH 34, stroke 1, bleeding 2), 18 in head trauma, 13 in asphyxia, and 2 in post-resuscitation brain damage. After revision, that was 49 in cerebrovascular disease (SAH 37, stroke 2, bleeding 16 and other 4), 17 in head trauma, 10 in asphyxia, and 11 in post-resuscitation brain damage. 58 donors had a history of cardiac arrest. 58 required high dose of cathecholamine drip infusion. Only one recipients died of primary graft dysfunction (PGD). Patient survival rate after heart Tx at 3 years was not different before and after revision of the Act (95.2 % vs 94.2%).

Conclusion: Although donor age was increased and donor who died of cerebral bleeding or post-resuscitation after the revision of Act, the outcome after heart transplantation was not changed.

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