Skip to main content

Advertisement

SpringerLink
Log in

Interim report of the Japanese original donor evaluation and management system: the medical consultant system

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Lung transplantation (LTx) is an established therapy for end-stage lung failure. However, in Japan, the donor organ shortage is extremely severe compared with other developed countries, because of the strict Japanese Organ Transplantation Law. To maximize LTx opportunities in Japan, we have established a special donor evaluation and management system termed the medical consultant (MC) system.

Methods

Data from 171 lung donor candidates registered in Japan from May 1998 to May 2012 were obtained and investigated in a retrospective manner. The candidates were separated into the non-MC-intervened and MC-intervened groups, and then data regarding the PaO2/FiO2 ratio, donation rate and organ survival rate were analyzed and compared between the groups.

Results

The PaO2/FiO2 ratio of the MC-intervened group was ameliorated from the time of first brain death diagnosis to organ harvest. Although the base condition of the MC-intervened group was significantly worse than that of the non-MC-intervened group, the donation rates showed no significant difference (0.64 and 0.66, respectively; p = 0.89). There was a difference in the organ survival rate between the non-MC and MC-intervened groups (5-year survival rates of 67.2 and 88.3 %, respectively; p = 0.16).

Conclusion

The MC system used for organ donor evaluation and management in Japan has achieved acceptable interim results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

LTx:

Lung transplantation

PaO2/FiO2 :

The ratio of arterial oxygen tension to inspired oxygen fraction

MC:

Medical consultant

UNOS:

United Network Organ Sharing

JOTNW:

Japan Organ Transplantation Network

BD:

Brain death

BFS:

Bronchofiberscopy

5YSR:

5-year survival rate

References

  1. Arcasoy SM, Kotloff RM. Lung transplantation. N Engl J Med. 1999;340:1081–91.

    Article  CAS  PubMed  Google Scholar 

  2. Snell GI, Griffiths A, Levvey BJ, Oto T. Availability of lungs for transplantation: exploring the real potential of the donor pool. J Heart Lung Transpl. 2008;27:662–7.

    Article  Google Scholar 

  3. de Perrot M, Snell GI, Babcock WD, Meyers BF, Patterson G, Hodges TN, et al. Strategies to optimize the use of currently available lung donors. J Heart Lung Transpl. 2004;23:1127–34.

    Article  Google Scholar 

  4. Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transpl. 2000;19:1199–204.

    Article  CAS  Google Scholar 

  5. Botha P, Trivedi D, Weir CJ, Searl CP, Corris PA, Dark JH, et al. Extended donor criteria in lung transplantation: impact on organ allocation. J Thorac Cardiovasc Surg. 2006;131:1154–60.

    Article  PubMed  Google Scholar 

  6. http://optn.transplant.hrsa.gov/latestData/rptData.asp.

  7. http://www.eurotransplant.org/cms/index.php?page=yearlystats.

  8. Fukushima N, Ono M, Nakatani T, Minami M, Konaka S, Ashikari J. Strategies for maximizing heart and lung transplantation opportunities in Japan. Transpl Proc. 2009;41:273–6.

    Article  CAS  Google Scholar 

  9. Aita K. New organ transplant policies in Japan, including the family-oriented priority donation clause. Transplantation. 2011;91:489–91.

    Article  PubMed  Google Scholar 

  10. The Japanese Society of Lung and Heart-Lung Transplantation. Registry Report of Japanese Lung Transplantation—2010. Jpn J Transpl. 2010;45:638–40.

    Google Scholar 

  11. Smits JM, Nossent GD, de Vries E, Rahmel A, Meiser B, Strueber M, et al. Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant. J Heart Lung Transpl. 2011;30:22–8.

    Article  Google Scholar 

  12. Arnaoutakis GJ, Allen JG, Merlo CA, Sullivan BE, Baumgartner WA, Conte JV, et al. Impact of the lung allocation score on resource utilization after lung transplantation in the United States. J Heart Lung Transpl. 2011;30:14–21.

    Article  Google Scholar 

  13. Couetil JP, Tolan MJ, Loulmet DF, Guinvarch A, Chevalier PG, Achkar A, et al. Pulmonary bipartitioning and lobar transplantation: a new approach to donor organ shortage. J Thorac Cardiovasc Surg. 1997;113:529–37.

    Article  CAS  PubMed  Google Scholar 

  14. Date H, Aoe M, Nagahiro I, Sano Y, Matsubara H, Goto K, et al. How to predict forced vital capacity after living-donor lobar-lung transplantation. J Heart Lung Transpl. 2004;23:547–51.

    Article  Google Scholar 

  15. Camargo JJ, Irion KL, Marchiori E, Hochhegger B, Porto NS, Moraes BG, et al. Computed tomography measurement of lung volume in preoperative assessment for living donor lung transplantation: volume calculation using 3D surface rendering in the determination of size compatibility. Pediatr Transpl. 2009;13:429–39.

    Article  Google Scholar 

  16. Date H. Update on living-donor lobar lung transplantation. Curr Opin Organ Transpl. 2011;16:453–7.

    Article  Google Scholar 

  17. Cypel M, Keshavjee S. The clinical potential of ex vivo lung perfusion. Expert Rev Respir Med. 2012;6:27–35.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

The authors of this manuscript have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, Osaka, 565-0871, Japan

    Tomoyuki Nakagiri, Masayoshi Inoue, Masato Minami & Meinoshin Okumura

  2. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan

    Yasushi Hoshikawa

  3. Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University, Mibu, Japan

    Masayuki Chida

  4. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan

    Toru Bando

  5. Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan

    Takahiro Oto

  6. Department of Thoracic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan

    Takeshi Shiraishi

  7. Division of Surgical Oncology, Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Naoya Yamasaki

  8. Japan Organ Transplantation Network, Tokyo, Japan

    Juntaro Ashikari

  9. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshiki Sawa

  10. Department of Transplantation Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshiki Sawa

Authors
  1. Tomoyuki Nakagiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masayoshi Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masato Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasushi Hoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masayuki Chida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toru Bando
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahiro Oto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeshi Shiraishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Naoya Yamasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Juntaro Ashikari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshiki Sawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Meinoshin Okumura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomoyuki Nakagiri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakagiri, T., Inoue, M., Minami, M. et al. Interim report of the Japanese original donor evaluation and management system: the medical consultant system. Surg Today 44, 1227–1231 (2014). https://doi.org/10.1007/s00595-013-0731-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0731-1

Keywords

Search

Navigation