It is widely known that the PMP of deceased organ donors in Japan is positioned at the lowest in the world (~1.0). I am now a retired emergency neurosurgeon with experience of 10 DCD patients in my career and noticed many issues causing the donor shortage. Therefore, from the viewpoint of a neurosurgeon, I have been working to develop organ donation by educating medical students and enlightening the general public and emergency and transplantation societies through nearly 300 lectures. Amongst the low PMP countries in the world, including Japan, there must be common or unique factors that hamper the augment of donations. In the ISODP 2025 in Kyoto, I want to elucidate and share the negative features in Japan, especially in the DCD and opt-in policies, and discuss them with international attendees. Also, I want to discuss how to educate the medical staff and students to nurture professionalism about organ donation.