Current situation of Organ Transplantationand Social Background in Japanand Social Background in Japan

Teleconference at APAN 2011-8-25

Naohiko Fukami, M.D., Jyunichi Yoshida, M.D.,Atsushi Sugitani, M.D., Ph.D.

Department of Urology andDepartment of Urology, andOrgan Transplantation and Regenerative Medicine, Fujita Health Universityj y

Prognosis of the patients on waiting list in Japan by 2006

0 100 200 300 400 500 600

Heart Tx 34 26 85 83 12

0 100 200 300 400 500 600

BDDTx

O THeart Tx OverseaTx

LDTx

Waiting119 892816

Waiting

Death

Withdraw

Lung Tx

32 174 119 17415 37Liver Tx

14227 13 4Pancreas Tx 14227 13 4Pancreas Tx

The number of cadaveric donors in the world

Spain34.635

30

20.220

25

Japan10.8

15

Japan

0 755

10

0.75

0

Organ and Tissue 8(2), 79-82, 2005

Patients on dialysis and of Renal transplantation in JapanPatients on dialysis and of Renal transplantation in Japan

300,000

Dialysis

Dialysis 250,000

200,000NHBDLD

150,000

100 000

NHBD

HBDRecipients

Candidates 100,0001200

1000Candidates10000800

600

400

200

78 79 80 81 82 83 84 85 86 87 88 89

200

90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

ABO incompatible renal transplantationABO incompatible renal transplantation

%5.2%

0.5% 0.8% 1.1% 0.4% 0.0% 0.2% 0.8%100%Unknown

21 1%

13.3%

11.9%15.5% 14.6% 17.7% 20.9% 23.3% 23.3%

80%

ABOi

18.2%21.1%

19.9% 18.6%20.4%

19.7%21.3% 20.2%

60%

Mismatch

60%

63.3% 66.4% 63.8% 65.7%61.5% 59.4% 55.1% 55.8%

40%

M t h

ABOc

20%Match

0%2000年 2001年 2002年 2003年 2004年 2005年 2006年 2007年

Public opinion （1998～ 2008）

YESYES NONO

Donation after Brain death

YESYES NONO

31.6% 37.6%19981998

32.6% 35.4%20002000

32 8%35 4%

31.8%36.0%20022002

32.8%35.4%

27 5%41 6%

20042004

20062006 27.5%41.6%20062006

24 4%43 5%20082008

0 20 40 60 80 100％

24.4%43.5%20082008

Revision of Transplant Law (July 17, 2010)

“Brain death is a whole death under the law”Brain death is a whole death under the law

Consent by donor family without written consent (Opting-out)consent (Opting-out)

Possible donation from a pediatric patient

Allocation priority for the family memberp y y

36 Brain Death Donors after the law revised

From July 17 till February15, 2011

H t 30

34 out of 36 cases were based on Family Consent.

Heart 30

Lung 29Lung 29

Liver 32

Pancreas 28

Small intestine 2

Kidney 36

The current status of organ transplantation and Bioethics in Asia–Proposal of new p

bioethics to advance the transplantation in Eastern AsiaEastern Asia

Delhi India, August 25, 2011

Atsushi Sugitani, M.D., Ph.D.

Department of Organ Transplantation and Regenerative Medicine, Fujita Health University, Aichi, JAPAN

Asia

1. Huge population

2. Difference of medical standards due to diversity of cultures, races, and religionsy g

3. Specific diseases in Asia, such as thalassemia, chicken flu, SARS, etc

4. Little time difference and short distance among countries

10

Beijing Sapporo

Seoul

Tokyo

KJCNKJCNBusan

Nagoya

500 kmShjanghai Fukuoka

1000 km

Taipei

11

p

1500 km

Pancreas Transplantation Teleconference on 18th March 2005

Kyushu University Hospital (Venue) Seoul National UniversityKyushu University Hospital (Venue) Seoul National University

Taipei Veterans General Hospital Tsinghua University

12

Living donor nephrectomyg p y

Haｎd assisted retopertoscopic surgery

Donation from the Non-heart beating donor

②

①

②

③③

Waiting

Super Rapid Techniquep p q

Video Presentation

Kidney procurement from the non-heart beating donor (Cadaver)beating donor (Cadaver)

Simultaneous pancreas kidney transplantationp y p

Questionnaires(September 2008)

Seoul, Korea22 f227 people in medical field including doctors, nurses, medical students, clerks, etc.

Nagoya, Japan182 people in medical field including doctors, nurses, medical students, clerks, etc.

I. When are you dead? (Death and Life Concept)II. Knowledge about Organ TransplantationIII. Idea about Organ DonationIV. Whose is the transplanted organ? (Organ Property)V. If you or your family become a patient?

Let’s discuss What’s common and What’s different!!

1. The current situation of kidney/pancreas transplantation in Asia

2. The history, culture and religion in Asia3. Bioethics in Asia4. Medical insurance and medical finance in Asia5. Legislative problems in Asia5. Legislative problems in Asia

P id b t “Lif d D th”Propose a new idea about Life and Death” which is different from the Western philantorpism

lt i22

or altruism.

The 22nd Annual Meeting of Japan Association for Bioethics

November 20-21, 2010, Fujita Health University

“Transplantation and Bioethics”and Bioethics

Configuration diagram of DVTS （Fujita Health University)

2.3.Speaker

MicrophoneVideo CamcorderDisplay (Receiving image)

Analog RGBA di li Analog RGB(D-Sub15)

7.

4.

Audio line (Mono)

Audio line (Stereo)

5.

Analog-digital 1.Composite/S-video

DVTS PC(Reception)

video converter

IEEE1394Analog RGB

6.

DVTS PC HUB / VPN Router

Analog RGB(D-Sub15)

(Transmit)Display(Sending image)

Items list of DVTS configuration （Fujita Health University)

No Company Product

Analog-digital Anycast Station 1 video converter Sony AWS-G500 1

2 Microphone Panasonic WA-531 1

3 Video camera Sony BRC-300 (NTSC) 1

4 Cable XLR×1 -> XLR×1 5m 1

5 Cable RCA×1->RCA×1 5m 1

6 Cable IEEE1394 4PIN-6PIN 16 Cable IEEE1394 4PIN 6PIN 1

7 Cable RCA×2->RCA×2 5m 1

Conclusion and Proposal

1. Let’s investigate the factors to affect the ideas

p

about life and death in Eastern Asia.

2 Let’s find out the difference compared to the2. Let s find out the difference compared to the Western countries.

3. Let’s educate the people for better life and for mutual understanding.

4. Let’s develop a solidality culture as do in the West.

5. Let’s propose a “New Bioethics for Organ Donation” from Eastern Asia to save many patients.