**9. Outcome of heart transplantation**

### **9.1 Outline**

In February 1999, the first heart transplant was performed by the Organ Transplant Act, but the number of organ donations was small, remaining at around 10 per year. In July 2010, the Revised Organ Transplantation Act was enacted, and with the increase in the number of brain-dead organ donations (**Figure 1**), the number of heart transplants increased, reaching 84 in 2019, and decreased to 54 cases in 2020 and 59 cases in 2021 (**Figure 2**). On the other hand, since April 2011, a

#### **Figure 1.**

*Brain-dead organ donation performed in Japan by year (up to December 31, 2021) before and after implementation of the revised organ transplant act.*

**Figure 2.**

*Heart transplantation performed in Japan by year (up to December 31, 2021) before and after implementation of the revised organ transplant act.*

relatively small non-pulsatile implantable VAD that can be treated at home has been reimbursed by insurance as a BTT. Since the increase in the number greatly exceeds the number of transplants, the waiting period for transplantation is increasing. At the end of August 2022, excluding 3 children after the enforcement of the revised Organ Transplantation Act, the cases are limited to Status 1 cases with high medical urgency, regardless of whether they are children or adults. Heart transplant request registration to the JOT began in October 1997, and by the end of June 2022, 2218 cases had been registered, of which 659 had undergone heart transplantation, 71 had undergone overseas transplantation, and 50 had undergone overseas transplantation. 517 cases have died, with cases being deregistered due to worsening conditions.

With the implementation of the revised law, it became possible to donate braindead organs from children under the age of 15, and heart transplants from children under the age of 6 began to be performed in 2012 and Berlin Heart EXCOR was reimbursed in 2015. As pediatric brain death organ donations gradually increased, 17 pediatric heart transplants were performed in 2019 and the number of pediatric cases (under 18 years old) reached 60 in total at the end of 2021 (**Figure 3**). The waiting period for transplantation was also shorter than that for adults.
