The Process Leading Up to an Organ Transplant

Harvest of organs from brain dead donors can be performed at about 500 facilities including university hospitals, Japan Emergency Medical Guidance Facilities, special neurosurgical training facilities designated "A" by the Fellows of the Japanese Association for Acute Medicine, and affiliated facilities of Japanese Association of Children's Hospital and Related Institutions (JACHRI). Transplant facilities are limited too. The purpose of limiting transplant facilities is to promote the steady development of expertise in transplanting organs through the accumulation of experience and improvement of success rates. A patient in search of a transplant must enter a designated hospital as soon as a donor appears. Presently, the time available from an organ's harvest to its transport to a designated hospital to transplant and finally to reperfusion of blood is: four hours for a heart; 12 hours for a liver; eight hours for a lung; and 48 hours for a kidney. The transplantation process of course, is constantly being reviewed based on the most recent technological developments, so that all transplants can be performed under the best conditions.

Flowchart of organ donations

1. Explanation by a transplant coordinator
   If an individual has expressed his/her wish to donate an organ, or, if the individual's intention is unclear and the family wants to receive an explanation on organ donation, a transplant coordinator is contacted by the primary care doctor, who then visits the hospital, and provides information.
2. The intention to donate is decided by the family
   If you feel that you do not want to hear such explanations, you can always cancel them. After receiving information by the transplant coordinator, all the members of the family discuss the matter thoroughly and decide whether to donate an organ or not.
3. Diagnosis and pronouncement of brain death (only when an organ is to be donated after the donor is brain dead)
   If organ donation has been decided, a diagnosis of brain death will be made. Diagnosis and pronouncement of brain death are a rigorous procedure, conducted in strict compliance with the law. The time at which the second diagnosis of brain death has been completed becomes the time of death. If the family so wishes, the members may watch the diagnosis and pronouncement of brain death being made.
4. Selection of patients who receive a transplant
   People who wishes to receive a transplant have registered their names with the Japan Organ Transplant Network, or JOT. Patients who will receive a transplant, or "recipients", are selected fairly according to medical criteria to make sure that those who are best suited for an organ to be donated are selected.
5. Removal of an organ and its transport
   After a recipient is selected, the organ to be donated is surgically removed. The extracted organ is quickly transported to a medical facility where surgical transplantation will be performed, and transplanted in a patient who awaits the organ.