*Heart Transplantation and Mechanical Circulatory Support in Japan – Past, Current and Future… DOI: http://dx.doi.org/10.5772/intechopen.113730*

important social stage, the Liberal Democratic Party's Policy Research Committee launched the "Research Committee on Brain Death, Bioethics, and Organ Transplant Issues," based on the belief that it was important for the legislature to deliberate comprehensively and carefully. In 1990, the Ad Hoc Brain Death and Organ Transplant Research Committee was established within the Prime Minister's Office. In January 1992, a report entitled "Important Matters Concerning Brain Death and Organ Transplantation" was submitted, stating that brain death should be medically, socially, and legally defined as human death. Said, "It is not something that cannot be implemented without a law, but it is desirable to develop legislation such as the Organ Transplant Act (provisional name)." It has been submitted. When this law was enacted, the House of Councilors made amendments such as "Brain death is considered human death only in the case of organ donation," and "It is necessary for the person to indicate in writing their intention to accept the determination of brain death." In June 1997, the Organ Transplantation Act was passed.

During this period, the Joint Committee of Transplantation-Related Academic Societies was established to certify transplant facilities and to consider recipients, donor eligibility criteria, and recipient selection criteria. Furthermore, it is necessary to conduct a two-stage review because it is necessary to strictly select recipients, and in addition to the hospital review of transplant applicants, a committee has been set up in the Japanese Circulation Society to review indications for heart transplantation, and it is essential to determine the indications there. The Joint Committee of Transplantation-Related Academic Societies approved the Osaka University-National Cerebral and Cardiovascular Center joint team and Tokyo Women's Medical University as initial heart transplant facilities.

The Organ Transplant Act was enforced on October 16, 2009. At the same time, the Japan Kidney Transplantation Network was reorganized as the Japan Organ Transplantation Network, and registration of applicants for heart, liver, and lung transplants began. Under this organ transplantation law, the donor needed to express his/her intention to donate in writing. In addition, according to civil law, the age at which a will can be made is valid for people aged 15 and over, and people under the age of 15 cannot donate, and heart transplants for younger children cannot be performed.

The first heart transplantation [3] based on the Organ Transplant Act was performed at Osaka University on February 28, 1999, and the second [4] was performed at the National Cerebral and Cardiovascular Center on May 12, 1999. Since then, the number of cases has gradually increased from a few to more than 10 per year, but in 2003, not a single heart transplant was performed. On the other hand, the number of people who wanted a transplant was increasing, and the waiting period had been getting longer. Many adults as well as children went abroad and had a heart transplant in the U.S.A and Germany.

At that time, a movement to revise the law began to be seen in the Diet in 2003, led by Diet member Taro Kono, who had donated his liver to his father. On February 25, 2004, the Bioethics and Organ Transplantation Committee approved that "if the patient's intention is unknown, brain-dead organ donation is possible with the consent of the family." On the other hand, in addition to the Japan Society for Transplantation, various academic societies that are responsible for patients with severe organ failure established the Council of Organ Transplantation-Related Academic Societies as a community in November 2003, and patient groups are also actively involved in organ transplantation. Activities for revision have been

started. As a member of the Future Planning Committee of the Japanese Society for Transplantation, the author of this chapter was going to make petitions to Diet members one by one with members of patients' organizations related to transplantation. We created pamphlets and videos for petitions and distributed them to councilors of transplant-related academic societies.

In March 2005, the investigative committee stated three items as the skeleton of the revised Organ Transplantation Act, such as (1) organ donation is possible with the consent of family members regardless of age if the individual did not express a refusal to donate before death, and (2) if a donation will be expressed in writing before death, he/she can preferentially donate organs to his/her spouse or relatives within the second degree of kinship, and (3) an organ donation column on driver's licenses and insurance cards will be set up. It was decided that the discussion would be entrusted to the "Organ Transplant Study Group" consisting of volunteers from the Liberal Democratic Party and New Komeito. From March to April of the same year, hearings were held with experts from various fields. At that time, there was an opinion that the chairman of the Japan Pediatric Society Yoshikatsu Eto, and the Japanese Nursing Association had not agreed to regard brain death as human death. On April 28 of the same year, "if he/she has not indicated a refusal to donate, he/she can donate organs with the consent of his/her family regardless of age." was added (commonly known as Plan A) [5].

Although the details after that were omitted in the chapter, every country in the world has a shortage of organ donors, and the pros and cons of traveling overseas for transplantation have become a problem. In May 2010, the World Health Organization issued a new guideline on organ transplantation, putting pressure on legislation. However, what moved the members of the Diet the most was the fact that the parents of three boys who died while preparing to receive heart transplants abroad or after they had traveled abroad went to the Diet, saying, "Parents who lose their beloved children no more." I do not want you to make it."

As a result, the Revised Organ Transplant ACT was enacted in July 2009 and enforced in July 2010. With this revision, it is now possible to donate organs with the family's consent if the person's intention is unknown, and it is now possible to donate organs from children under the age of 15 who have been determined to be brain dead. In addition, as a criterion for selecting recipients, if an organ donation is received from a person under the age of 18, priority will be given to applicants who have registered under the age of 18 for heart transplantation. In February 2014, the recommended age for heart transplantation was raised from under 60 to under 65.
