Child organ transplants
(From The Japan Times April 18 issue)

子どもの臓器移植

For the first time in Japan's medical history, organs from a person under 15 were transplanted to other people April 13-14. Such transplants became possible after the revised Organ Transplant Law went into force in July 2010.

Under the original law, which went into effect in 1997, only people aged 15 or older who have expressed their desire to donate organs in writing could become donors on the condition that their families consent. The revised law allows harvesting of organs from anyone at any age if the person has not explicitly expressed his or her refusal to be a donor and if his or her family consents.

If a donor is younger than 18, it must be confirmed that he or she has not been physically abused. The April 13-14 transplants could lead to more organ transplants from children to children.

The donor was a boy between 10 and 15 whose brain was damaged in a traffic accident. His heart was given to a man in his late teens. His lungs, kidneys, pancreas and liver were given to four other older patients.

Until this case, under the revised law, transplants had been made from 38 brain, dead people. But they were all adults. When children are declared brain dead, doctors and transplant coordinators should never induce their families to consent to having the children become donors.

Since children's brains have a strong chance of recovery, priority should be given to saving their lives. This is important since, in Japan, before organs may be harvested from a person, two strict tests are carried out, during each of which the respirator is temporarily removed — a process to legally declare the patient brain dead (as distinguished from a declaration by a doctor treating the person that he or she is brain dead).

The boy's family made a difficult decision. The hospital that treated him should make public what kind of treatment it gave him and why it judged that he had no chance of recovery. It also should be made public what kind of information was given to his family, and how and why they made the decision.

改正臓器移植法にもとづいて日本の医療史上初めて、15歳未満の患者から臓器が移植された。

同法は、本人が提供拒否の意思を示していない限り、年齢にかかわらず家族の判断での臓器提供を可能にした。

法改正後、大人の脳死からの臓器提供は家族の承諾によるものが38例あった。子どもの脳死が判定されたとき、医師と移植コーディネーターは家族に提供の承諾をし向けてはいけない。子どもの脳は回復力が強いため、その命を守ることが優先されるべきだ。

少年の家族は困難な決断を下した。入院先だった病院は治療内容を開示し、回復不能と決断した理由を説明すべきだ。また、家族に伝えられた情報や、承諾の状況も公開されるべきだ。