Objective: The number of organ donors in Japan is extremely low, at 1.18 per million population—approximately one-fortieth that of Spain and one-eighth that of South Korea. Our hospital is the leading facility in Japan in terms of the number of organ donations having achieved 36 cases of organ donation after brain death over the past seven years through proactive engagement and system development. In this presentation, we analyzed the background characteristics of patients identified as having a potential brain-death condition (PBD) and would like to share our experience regarding the patient care.
Methods: A retrospective review was conducted of 85 patients who met criteria for brain death between 2017 and 2025. PBD was defined as a condition that met the criteria of absence of brainstem reflexes, unresponsiveness to endo- or exogenous stimuli, and exclusion of critical conditions confounding the clinical presentation. We evaluated age, sex, underlying disease, decision-making process, implementation of multidisciplinary conferences (MDCs), frequency and participants of MDCs, number of medical explanations provided to families, and length of hospital stay. MDCs were defined as ad-hoc meetings among multiple healthcare professionals to share information regarding end-of-life assessment and family understanding.
Results: Of the 85 patients presented with the option of organ donation, 36 (42%) proceeded with donation. Patient background characteristics are summarized in the Table. There was a tendency for the donor group to be younger than the non-donor group, and patients with external causes of disease were more likely to choose organ donation than those with internal causes. The median duration from ICU admission to PBD identification was 5 days in both the donor and non-donor groups. Length of ICU stay was prolonged, with medians of 16 days in the donor group and 13 days in the non-donor group. In the donor group, decisions were more frequently guided by interpretations of the patient's presumed wishes regarding end-of-life care, including a desire to contribute through organ donation. In contrast, in the non-donor group, decisions tended to reflect the family's preferences for how the patient should spend their final moments. MDCs were held in 92% of cases, typically led by physicians and nurses, with up to nine different professions participating and a mean of two sessions per case. On average, families received six separate medical briefings.
Conclusion: The average ICU stay was 4 days, while patients with PBD remained in the ICU for extended periods, during which family discussions and multidisciplinary support facilitated end-of-life decision-making based on presumed wishes. Organ donation was selected in 42% of cases when options were clearly presented. These findings highlight the importance of building systems that respect and support patients' presumed intentions at the end of life.