Background: Organ donation in Japan from deceased donor is at the lowest among developed countries despite legal revisions regarding brain death made effective in 2010. Recent data suggests it remains around 0.8 per million population (pmp). Development of tissue donation activity, however, has not been described in detail in English literature. We here in present our experience at the University of Tokyo Tissue Bank (UTTB), the core facility based in Eastern Japan.
UTTB is the information hub for East Japan Tissue Transplantation Network (EJTTN) covering all tissue categories in Eastern Japan region (including districts covered by Regional Bureau Health and Welfare of Hokkaido, Tohoku, and Kanto area. Total population 57.5 million, 45% of national population). UTTB is also itself a tissue bank specializing in recovery and processing of heart valve and vessel grafts. To date, UTTB remains as one of the only two of its kind in Japan, the other being a tissue bank in National Cardio-Vascular Center covering Western Japan.
Method: Retrospective analysis of donor information reported to EJTTN during the period of 2018-2022 was performed.
Results: Total number of potential tissue donor information reported to EJTTN between 2018 and 2022 was 219 cases, of which 151 were considered medically adequate for recovery. Of the 151, tissue actual recovery was made in 57 donors (11 per year), 40 under cardiac death and 17 under brain death. UTTB recovered heart-valves and vessels from 27 donors in this period (5 per year), resulting in 46 heart-valve grafts (9 per year), and 252 vessel grafts (includes both arterial and venous grafts) (50 per year).
Adjusted by population, total recovery in Eastern Japan region was 0.20 donor pmp-year. Heart-valve and vessel graft recovery was available in 0.09 donor pmp-year.
Discussion: Revision of the Organ Donation Act enacted in 2010 intended in part to enlighten donation in a wider aspect has shown some positive social effect to date in Japan. However, change has been gradual and organ donation remains as low as 2% of the US when adjusted by population. Even more striking is the struggle of tissue donation and recovery, which unlike organ donation, lacks legal supportive framework. Our study suggests that available tissue donor in Eastern Japan (average 11 donor-year, 0.2 pmp) is approximately 0.1% of the US (average 58000 donor-year, 172.4 pmp).
Conclusion: Struggle of tissue donation in Japan behind the suffering of organ donation must be acknowledged. Future donor action initiatives should aim at enhancing both tissue and organ donation.