In October 1997, the Japanese Organ Transplant Act was issued and we needed to successfully start the first heart transplantation (HTx) in Japan. For this reason, very strict criteria for the donor heart were established by the task force committee for heart transplantation in the Ministry of Health, Labour and Welfare. These criteria were comparable to the so-called standard criteria for the donor heart in the world.
On February 28, 1999, the first HTx was successfully performed in Japan  and 227 HTx were done up to the end of August 2012. Although many efforts to shorten the transportation time of the heart were done, mean transportation and total ischemic time were about 2 and 3 h, respectively. On the other hand, as the Japanese Organ Transplant Act was very strict, brain-dead organ donation was extremely limited in Japan and only 184 brain-dead donors were available for 13 years after the Act was issued. In order to respond to the will of the donor and donor families, we needed to transplant the heart as much as possible. For these reasons, more hearts should be transplanted from the extended criteria donor (ECD) in Japan than other developed countries.
Since brain-dead organ transplantation was started in 1999, every organ procurement team has taken their own skillful physicians to the procurement hospital . They evaluated the condition of donor organs by echocardiography and flexible bronchofiberscopy (BFS) by themselves in the intensive care unit (ICU), before procurement operation .
Since November of 2002, special transplant management doctors (a medical consultant, MC) have been sent to the procurement hospital. They assessed donor organ function and identified which organs were useful for transplantation. They also intensively cared for the donor, stabilized the donor hemodynamics by giving antidiuretic hormone (ADH) and reducing the dose of intravenous catecholamine as much as possible, and improved donor cardiac and lung function by preventing and treating lung infection before procurement teams arrived at the donor hospital.
Out of 184 brain-dead donors, 136 heart, 1 heart–lung, 143 lung, 159 liver, 1,311 pancreas, and 12 small bowel transplants were performed. Organs transplanted per one donor (OTPD) increased to 5.5 organs after these strategies were applied.
Although 83 of 136 heart donors were ECD, no recipient died of primary graft dysfunction (PGD).
Brain Death Left Ventricular Assist Device Donor Heart Cardiac Allograft Vasculopathy Preservation Solution
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