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Ministry of Health: at least 10,000 potentially brain-dead patients by 2023; Number of people declared brain dead in the same year: only 132


Yomiuri Shimbun file photo
The Ministry of Health, Labor and Welfare in Tokyo

According to an estimate by the research team of the Ministry of Health, Labor and Welfare, there were at least 10,000 patients who may have been brain dead in Japan in 2023. It was the first time that the ministry made such an estimate.

The number of people declared brain dead due to organ donation in the same year was only 132.

The team believes that if more families were given the option of organ donation, it could lead to an increase in the number of potential donors.

The study was conducted by a team of physicians, including those from Nippon Medical School Hospital in August 2023, and surveyed 895 university hospitals, emergency hospitals and other facilities that can diagnose brain death.

The survey asked about the number of patients who met the four criteria to be considered brain dead – including unconsciousness and dilated pupils – and who had not improved despite proper treatment within the week of August 3.

A total of 184 patients met the four criteria across the 601 facilities that provided valid responses, or 67% of respondents. Based on these results, the team estimated that there were 9,568 potentially brain dead patients in the facilities that responded to the survey alone.

Determining whether a patient is brain dead is based on the Organ Transplantation Act.

Although organ transplantation requires the consent of the family of a patient declared brain dead, the family is rarely given the opportunity to consent. This is due to the fact that doctors, who are dedicated to saving lives, do not have time for that. Moreover, they feel reluctant to inform families that recovery for the patient is unlikely.

It has also been pointed out that medical institutions are not rewarded for conducting tests prior to legal declaration of brain death, despite such tests being required.

Furthermore, medical criteria must be met before individuals can become brain-dead donors. These criteria include the absence of organ-related problems, cancer and infections.

The age limit for donation varies depending on the organ. For example, donors must be 70 years or younger to donate a lung or kidney.

“Not all estimated potentially brain-dead patients can become donors,” said Prof. Shoji Yokobori of Nippon Medical School, who represents the research team. “However, the study has shown the potential to significantly increase the number of brain-dead donors if various efforts are made, saving more lives.”

The country’s top university hospitals for organ transplants, including the University of Tokyo Hospital, have rejected donations from brain-dead donors due to a lack of staff, hospital beds and other reasons, which is considered a significant challenge.

“It is essential to build a network to avoid strain on the organ transplant system, while implementing measures to alleviate current hurdles in the process of declaring brain death,” Yokobori said.

At least 10,000 patients could become brain dead per year in Japan, according to an estimate by a research team from the Ministry of Health, Labor and Welfare. This figure serves as important baseline data to help formulate strategies for promoting organ transplants.

According to a 2021 Cabinet Office survey, 40% of respondents said they ‘want to donate organs’ or ‘somewhat want to’. To fulfill one’s wish to save another’s life, it is essential to inform a patient’s family of the possibility that they may be brain dead and present the possibility of organ donation. However, currently this is the responsibility of doctors, which imposes heavy mental and physical burdens on them.

Japan has the lowest number of organ donations from brain-dead people per capita among developed countries. In the United States and South Korea, potential donors can be found through a system that requires medical institutions by law to notify an organ transplant coordination organization of patients who may be brain dead. Several support systems for physicians also became available, contributing to the increase in donor numbers. Japan should consider whether to introduce a similar system.

However, if such a system is introduced, medical institutions involved in transplants would face a heavy burden. Currently, some institutions are refusing to accept donated organs, leading to concerns that the situation could become more serious if a similar system is introduced.

Based on the estimate, the government should speed up discussions on supporting the costs necessary for training personnel involved in organ transplants and improving the system for relevant medical institutions.

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