Originally, JKTNW was established to create a nationwide transplant network dealing with a variety of organs, including the kidney, liver, heart, lung, and pancreas. But delayed enactment of necessary laws regarding organ transplants from brain dead donors forced the organization to limit its function to cadaver kidney transplanting.
In 1988, the Japan Medical Association professed that it would accept brain death as human death. In 1990, the Provisional Commission for the Study on Brain Death and Organ Transplantation was set up in 1990. The draft of the Organ Transplantation Law was proposed in 1994. In reality, however, no substantive deliberations had taken place and the matter was repeatedly suspended for "further review." Finally, on October 16, 1997, the Organ Transplant Law took effect, containing the most stringent of regulations, especially in light of the fact that transplants from brain dead donors were widely accepted around the world. That day, JKTNW was reorganized into the Japan Organ Transplant Network (JOTNW), to deal with heart and liver transplants in addition to kidneys.
The enactment of the Organ Transplant Law was greatly anticipated by patients with no other means for survival than obtaining a transplant as well as those involved in the transplanting process. This new law was expected to have a major impact on transplanting in Japan, but its regulations turned out to be extremely stringent. The donations of organs by a brain dead donor is permitted only if "...the donor expressed in writing prior to death his/her intent to agree to donate his/her organs and agree to be submitted to an authorized brain death declarations, and his/her family members (spouse, parents, children, grandparents, grandchildren, and live-in family members) did not object to the donation." In addition, the law states that "only persons 15 years and above can express an intent to donate." This stipulation has greatly reduced the possibility of transplants to small children; heart transplants to small children have become impossible.
There were countless numbers of cases where the parents of young patients raised huge sums of money, and traveled to the U.S. and Germany so that their children could receive a heart transplant. In view of these situations, The transplantation Society (TTS) released the Istanbul Declaration in 2008. In 2010, the WHO adopted a new guideline on organ transplants, calling on each country to strengthen their structures to save, within the country, lives that can be saved through transplantation. In response to these principles, in 2009, the issue was discussed in the Diet of Japan, and bill for revised Organ Transplant Act was passed and promulgated in July. The following year, on January 17, 2010, some clauses (priority donation to family) were put into effect, and, on July 17, the law was fully enforced.
Rules regarding organ donation after brain death have been eased, and, even if an individual's intention is unclear, donation of his/her organs has become possible, under family consent. As a result, donation of organs after brain death by children under the age of 15 has also become possible. Moreover, together with the expression of intention to donate organs, it has now become possible to express your will to give priority to your family as a recipient. If the requirements are met, donations can be made to family on a priority basis. After the revision of the law, the number of organ donations after brain death has undoubtedly increased.
To make priority donations to your family, you must meet all three requirements below.
- In line with the intention of the individual (age over 15) to donate organs, he/she has declared, in writing, his/her intention to prioritize the offering of organs to family.
- In the event of organ donations, members of the donor's family (spouse*1, child*2, parents*2) have already completed their registration as a recipient applicant.
- Medical conditions (compatibility requirements) have been met.
- *1:This refers to official spouses who have submitted their marriage notifications, and does not include those in de facto marriage relationships.
- *2:Besides actual parents and children, this includes foster/adopted children and parents in special adoptive relationship.
Things to remember regarding priority organ donations to family
- If there are no family members who are eligible for transplant due to medical or other reasons, the organ will be transplanted to individuals other than the family.
- If you designated (wrote) the name of family to whom an organ will be donated on a priority basis, this will be regarded as your intention of priority donation targeting all family, including said recipient.
- If you declared your intention to restrict donation to specified recipient, such as "I want to donate my organs only to XX", no organs will be donated to other people including your family.
- To prevent suicides aimed at donating organs to family, it is determined that no priority donation of organs to the deceased's family will be carried out in suicide cases.