Organ transplants from brain-dead donors are becoming more frequent in Japan. Following the enforcement of the Organ Transplant Law in October 1997, the first transplant took place in February 1999; three more transplants had been carried out as of June. This increasing frequency of transplants is due in large part to the dissemination of donor cards, which indicate a person's willingness to donate his or her organs in the case of brain death. The number of people possessing donor cards has increased more than threefold over the last year, suggesting a rapidly deepening understanding of the issues among the people of Japan.

Increasing Frequency of Organ Transplants
The Organ Transplant Law, which defines brain death as actual death for purposes of organ donation, went into effect in October 1997. According to medical experts, brain death accounts for less than 1% of all deaths, or somewhere between 3,000 and 8,000 cases a year in Japan. The pool of potential donors is also limited by a number of conditions. The organs of brain-dead persons can be donated only if the hospital where treatment was received is one of the 353 designated organ-donation facilities in Japan; the brain-dead person possesses a donor card; the consent of the patient's family is obtained; and the donor does not have any infectious diseases. For this reason, organ transplants from brain-dead donors were expected to take place perhaps once a month at the most.

No transplants took place for nearly a year and a half after the enforcement of the law, however, and there was growing concern that the procedure would not take root in Japan. It was not until February 1999 that the first transplants were carried out, with the heart, liver, kidneys, and corneas of a brain-dead woman in her forties being successfully transplanted to a total of six patients. The national mood began to change, and further transplants were carried out once in May and twice in June. According to an official at the Ministry of Health and Welfare, "If organ transplants looked like they would end after just the first case, we would have had to conclude that the public was not receptive to the idea. But their continuation shows that the nation as a whole is showing understanding, and the idea is becoming established."

The spread of donor cards has been an important factor contributing to growing awareness of transplant-related issues. The cards, about the size of an ordinary business card and easily carried around, indicate whether the holder is willing to donate his or her organs in the case of brain death. As a condition for the removal of organs, the Organ Transplant Law stipulates that the person must have written confirmation of his or her willingness to donate, so the Health Ministry and others have been making efforts to distribute the cards widely.

The holder of a donor card indicates on the card whether he or she (1) agrees to donate organs after brain death, (2) agrees to donate organs after the heart ceases to function, or (3) does wish not to donate organs. In the case of either (1) or (2), the holder also circles the organs that he or she agrees to donate. Once the carrier signs the card, it becomes valid as written evidence under the law.

Since the enforcement of the law, the Japan Organ Transplant Network, which undertakes the registration and selection of patients to receive donated organs, and the Health Ministry have been distributing the cards in municipal government offices, public health offices, and other facilities around the country. About 45 million cards had been distributed by the end of May 1999. Since January the cards have also become available in convenience stores, and there are donor seals that can be attached to a driver's license. English-language cards and explanations have also been made for foreigners living in Japan.

According to surveys by several leading newspapers in May, donor card holders now account for 7% of the total population, a more than threefold increase in one year. Moreover, some 23% of respondents said they would like to possess a donor card, so it is likely that the cards will become still more common as public awareness of transplants and related issues grows.

Edited by Japan Echo Inc. based on domestic Japanese news sources. Articles presented here are offered for reference purposes and do not necessarily represent the policy or views of the Japanese Government.

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