While transplants from brain dead donors were not available in Japan, kidney transplants, which can be performed after the donor's heart arrests, were conducted.
A person can lead a healthy life as long as at least one of his/her two kidneys is functioning. Therefore, when suffering from renal failure, a patient has the following three options: living kidney transplant using a family member's kidney; cadaver kidney transplant using a donor kidney from a cadaver, or dialysis.
Dialysis is classified into two types: four to five hour dialysis performed at a dialysis facility twice or three times a week and continuous ambulatory peritoneal dialysis (CAPD) in which a patient dialyzes him or herself using dialysate in a portable bag at three to four hour intervals. Although recent advances in dialyzers have resulted in longer lives, restrictions on time and complications caused by dialysis are a large burden on the patient's life.
The number of patients with diabetic renal failure is increasing sharply in Japan, a rapidly aging country. The current number of dialyzed patients is reported to be 300,000. A third of these patients are said to be in search of a kidney transplant. However, only 13,000 patients have actually registered on a waiting list for this radical treatment. Considering the number of cadaver kidney transplants in 2010 was a mere 147, many patients seem to think it is better to stay on dialysis, which provides some level of certainty, rather than hope for the remote possibility that a transplant becomes available.
In Japan, where the number of organ donations is low, it is naturally encouraging to meet patients who have received a kidney transplant from a donor with matching HLA (a type of white cell) and have recovered to a point where they have improved their countenance and appetite, can enjoy sports, traveling and hobbies, and have returned to an active social life. Since the clinical use of an immunosuppressant called cyclosporin in 1986, both the take rate (rate of survival of transplanted organs) and survival rate (the rate of survival of organ recipients) have greatly improved. It is safe to say, therefore, that kidney transplanting has been established as a normal treatment procedure, albeit the number of cases remains small.
As for cost, both dialysis and transplants are covered by health insurance. But the health care cost for dialyzed in-patient and outpatient amounts to 8 million yen and 6 million yen respectively, per year for the rest of the patient's life. In contrast, after paying 6 million yen for the year of the transplant, in subsequent years a patient need only visit a hospital once or twice a month, take simple tests and pay for drugs. This is yet another reason why transplants are necessary.