The concept of brain death was introduced with the Harvard criteria in 1968 . However, brain dead (DBD) donors were not used for organ transplantation in Japan until the enforcement of the Japanese Organ Transplant Law in 1997. Therefore, prior to this, all cadaveric kidney transplantations were performed using DBD donors according to the law regarding DCD for cornea and kidney transplantation. Due to a severe shortage of deceased donors, kidney transplantation is mainly performed using living donors in Japan. Changes in the number of kidney transplantation (Fig. 14.1) showed 212 patients underwent kidney transplantation from deceased donor in 2011, while 1,389 patients underwent living donor kidney transplantation . Even after the enforcement of the Japanese Organ Transplant Law in 1997, the number of DBD donors remained low, such were only several donors per year. Although the number of DBD donors has been increased since the enforcement of the revised Japanese Organ Transplant Law in July 2010, deceased donor kidney transplantation is still mainly performed from DCD donors. Therefore, a history of deceased donor kidney transplantation is almost equal to the history of kidney transplantation using DCD donors. In March 1995, Koostra et al. have introduced the classification of DCD donors into four categories (Table 14.1) . Category III, in which donors were on awaiting cardiac arrest after withdrawal of life-sustaining therapy, is considered to be suitable for organ donation for transplantation because of a short period of warm ischemia. The condition of DCD donors in Japan is, however, different from those in other countries like the United States and Europe. The withdrawal of life-sustaining therapy (respirator) is rarely performed even though the donor is diagnosed to be a brain death except for an approval of donor families for the donation as DBD donors. Therefore, the DCD donors in Japan are difficult to be classified to any Maastricht categories. The condition of procurement is uncontrolled because of no withdrawal of respirator and long-lasting hypotension and oliguria (anuria) are frequently observed until cardiac arrest. In Japan, early kidney transplantation from DCD donors was performed by regional sharing rules. Several transplantation centers in each region, in which the devoted transplant surgeons were working, conducted the registration of the recipients, procurement, organ sharing, and transplantation. Since Japan Organ Transplant Network (JOTNW) was established in 1995, the regulation of registration of the patients, procurement, organ sharing, and transplantation in all organs including the heart, lung, liver, pancreas, small intestine, and kidney have been conducted by JOTNW. In this chapter, we describe the current status of kidney transplantation using DCD donors in Japan.
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