Many hospitals unready for change to law on organ Transplants from brain-Dead children

July 2, 2010

Just 36.8 percent of medical institutions that the Ministry of Health, Labor and Welfare has recognized as able to provide organs donated by brain-dead children will be equipped to handle such donations when they become legal later this month, a Mainichi survey has found.

A revision to the Organ Transplant Law that comes into effect on July 17 will make it legal for organs from brain-dead children under the age of 15 to be donated. However, medical institutions have complained that the field of emergency medicine which handles brain deaths is too busy for them to cope with organ transplants. It has also been pointed out that some doctors are hesitant to receive organs from children. The situation highlights the fact that the medical field in Japan is lagging behind the legal revisions.

At Japanese Red Cross Okayama Hospital in the city of Okayama, doctors and nurses in the hospital's intensive care unit hurriedly make their way around the beds of patients who are attached to tubes and other equipment.

"It's hard enough determining brain death in adult patients, and to respond to children as well is too much of a burden," says Takeshi Mikane, head of the hospital's emergency and critical care center. Even after the law is revised, the hospital reportedly has no plans to handle organ donations from children.

Each year the hospital receives over 40,000 people seeking emergency care, and it is not uncommon for the intensive care unit to be full.

Since the current organ transplant laws were adopted in 1997, the hospital has not provided any organs from brain-dead patients, but it conducts simulations once a year. It takes 45 hours for the donation of organs from a patient who is judged to be brain dead to be completed, and during this time there is no option but to halt the daily activities of the emergency division. In the case of a child under the age of 6, the period between the two decisions that are made in determining brain death is increased to 24 hours or more -- four times the current period -- and so the process takes 18 hours longer.

The wishes of the patient's family also play a part in the process.

"Most families want us to do all we can up until the person's heart stops beating. We put a full effort into treatment, even if we aren't getting enough sleep," Mikane says. "Our mission is to save the lives of patients, and if we can't save them then we are defeated. We want to be understanding of people's wishes for organ transplants, but we can't go ahead with them if it means going as far as to sacrifice day-to-day emergency diagnosis and treatment."

One pediatric hospital in eastern Japan that will be allowed to provide organs from brain-dead children has already decided that it will not be doing so as of July 17. Some pediatricians who have established longstanding relationships with patients and their families reportedly say it is emotionally difficult to confirm the wishes of parents when it comes to organ donations from brain-dead children. Furthermore, children have a strong ability to regain consciousness, and there are cases when their hearts keep beating for years even though they are thought to be brain dead, making the process of judging them to be brain dead difficult, medical workers say.

"As a result of discussions, about half of our doctors thought that we should cooperate in transplants, but everyone is troubled by the issue, so we can't go ahead with it," the director of the hospital said.

Many of the medical institutions designated to handle the transplants are hubs of emergency medical treatment and advanced medicine known to face a doctor shortage and harsh working conditions.

Sadao Suga, the vice director of Tokyo Dental College's Ichikawa General Hospital, says the hospital has provided organs from two brain-dead people. At the hospital there are three full-time neurosurgical doctors who are involved in determining whether a patient is brain-dead, and they have only two or three days off a month.

"All core hospitals in regional areas are worn out," Suga says. "There are also concerns about the medical difficulty of determining brain death in children." For the time being, the hospital does not intend to provide organs from children who are brain-dead.

A major pillar of the revision to the Organ Transplant Law is that it will become possible to supply organs with the consent of the patient's family even if the wishes of the person themselves remain unclear. However both the dental college hospital and Japanese Red Cross Okayama Hospital have no plans to voluntarily provide explanations about organ donations from brain-dead children, and unless they are approached by families, they will continue to respond only to patients aged 15 or over who have expressed their intention to donate organs on a donor card.

Satoshi Teraoka, president of the Japan Society for Transplantation, says that reform of Japan's emergency medical treatment system is a pressing issue.

"In order to further treatment involving transplants, we urgently need to improve the emergency medical treatment system," he said. "We also need to make efforts to provide explanations to each medical institution and enlighten the public."

Copyright © 2010 The Mainichi Newspapers

This article posted November 13, 2010