Purpose: The number of people on the waiting list for heart transplants in Japan is approximately 850, and increasing organ donation is an urgent issue. In this study, we sought to see the current status of donation after circulatory death (DCD) heart transplantation overseas as well as opinions and situations about DCD in Japan.
Methods: Current situation, including practice pattern and outcomes of DCD heart transplantation in foreign countries were investigated by collecting information through presentations and papers at academic conferences and by interviewing overseas medical professionals. We also conducted a questionnaire survey on organ transplantation from DCD, and explored the awareness of DCD in Japan and the issues that need to be addressed to realize its implementation. The survey was developed by the committee for DCD in The Japan Society for Transplantation to perform multi-institutional survey.
Results: Recent reports showed that the survival rate (99%) was not different compared to brain-dead donors (97%) 1 year after DCD heart transplantation in the United States. In Australia, where DCD heart transplants have been performed since 2014, the 10-year survival rate was 72%, which was similar to that of brain-dead donors. The percentage of DCD among all heart transplants varied by country, but in the United States it increased from 2.9% in 2019 to 21.8% in 2024, and it accounted for 63% of all heart transplants in the Netherlands. With regard to ethical, legal, and social issues, it has been argued that the method of resuscitation by NRP (general perfusion other than head by ECMO) has ethical issues due to the possibility of perfusing the brain. In contrast, DPP (extracorporeal cardiac perfusion) is expensive around 150,000 USD per transplantation, and many hospitals still use NRP with ECMO. For a questionnaire, while 82% of respondents saw DCD organ transplantation as necessary, 34% found it difficult to implement. Only 52% were currently willing to perform it, mainly due to lack of guidelines and hospital resources. However, 68% would be willing if these issues were resolved.
Conclusion: Clinical outcomes of DCD heart transplantation are comparable to those of brain-dead donors, and the use of DCD is increasing in Western countries. In order to realize DCD heart transplantation in Japan, it was considered necessary to create guidelines and protocols for the definition of death and the actual retrieval/perfusion method.