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Organ transplantation is a medical process in which an organ donated by another person is transplanted into a patient with a condition whose organ function has deteriorated and cannot be treated with other methods. This is based on the understanding and support of well-intentioned organ donors and society as a whole. In this second article about organ transplants, we will introduce organ transplant applicants, the situation overseas, and future challenges.

As of the end of November 2023, the number of organ transplant applicants in Japan Organ Transplant Network (JOT) is 14,275 for kidney, 867 for heart, 569 for lung, 372 for liver, 157 for pancreas, There were 9 cases of small intestine. Registration with JOT does not mean that a transplant will be performed immediately; while waiting for a transplant, transplant candidates must wait for a suitable organ donor to appear. The waiting period varies depending on the organ, with the average waiting period being approximately 3 years for the heart, approximately 2 and a half years for the lungs, approximately 1 year for the liver, approximately 3 and a half years for the pancreas, and approximately 1 year for the small intestine. Masu. The waiting period for a kidney is approximately 15 years, so many people die during the waiting period, and the reality is that the number of deaths, especially for lungs, livers, and kidneys, exceeds the number of people who receive transplants. The number of organ donations after death (including brain death and after cardiac arrest) in Japan is around 100 per year, and the number of organ transplants is around 300 to 400.

Looking at the international comparison of organ donors per million people in IRODaT (International Registry on Organ Donation and Transplantation), an international organ donation and transplant database, it is found that Spain has the highest number of donors with 46.03 people, followed by the United States with 44.50 people. This is followed by France with 24.70 people, the UK with 21.08 people, and neighboring South Korea with 7.88 people, while Japan has 0.88 people. In the United States, approximately 14,000 people annually donate their organs after death, out of a population of 332 million, and the number of organ transplants is approximately 40,000. It can be said that Japan has a much lower number of organ donations compared to countries such as the United States and European countries. Contributing factors include awareness of brain death, the number of organ donation facilities, and differences in organ transplantation systems from country to country. In the United States, Germany, and South Korea, there is a system called ``OPTING IN,'' in which organs are donated if the person has expressed his or her intention to donate during his or her lifetime, or if his or her family has consented to organ donation. On the other hand, countries such as the United Kingdom, France, and Spain have a system called ``OPTING OUT,'' in which organs are considered to be donated unless the person expresses an objection to organ donation during his or her lifetime. Even in countries with small populations, countries that adopt the "OPTING OUT" system tend to provide a large number of services.

Currently, when a patient appears with the possibility of brain death, it is up to the doctors at the scene to decide whether to present organ donation to the family as an option. However, it is said that there are currently many cases in which these options are not presented due to the lack of a well-established medical institution system and the psychological burden placed on doctors. For this reason, in order to raise awareness of organ donation on the medical institution side and to ensure smooth cooperation with JOT, we have created an "early information sharing system for donor candidates" to quickly share information on patients who may be brain dead. There is a need to strengthen the system, such as increasing the number of organ transplant coordinators dispatched from JOT to medical institutions during organ donation, and to improve donor hospitals, and discussions are also underway at the Organ Transplant Committee of the Ministry of Health, Labor and Welfare. . In addition, it is important to express your intention to donate organs using an organ donation card, driver's license, My Number card, etc., and to discuss your thoughts on organ transplants with your family members on a daily basis. Activities are also necessary.