Brain death baffles 40% of child hospitals

The Yomiuri Shimbun

Twelve medical institutions designated as facilities permitted to remove organs from child donors for transplants are unable to determine when brain death occurs or handle donors' bodies to ensure the viability of the organs, according to a Yomiuri Shimbun survey.

The 12 institutions account for about 40 percent of 29 hospitals specializing in pediatrics that have been newly designated as medical facilities to provide organs from donors under the age of 15, in accordance with the revised Organ Transplant Law that came into force Saturday.

The survey also showed that other hospitals could judge that a patient was brain dead but would have trouble handling the bodies of brain-dead children.

This may result in a delay in conducting organ transplants from child donors, the survey indicated.

The survey was conducted last month on 29 hospitals belonging to the Japanese Association of Children's Hospitals and Related Institutions that were newly designated by the Health, Labor and Welfare Ministry as facilities capable of advanced medical treatments for children and removing organs from child donors for transplants. All 29 hospitals responded.

In the survey, 12 of the hospitals, or 41 percent, said they were able to judge when brain death occurred and handle bodies of brain-dead patients.

But only five, or 17 percent, said they were prepared to carry out transplants immediately after the revised law went into effect.

Of the remaining 17 hospitals, 12 said it would be difficult for them to judge the point of brain death and handle bodies to preserve the organs.

They gave such reasons as "a consensus has not been reached with the hospital," and "our hospital does not have the capability, and assistance from outside is unlikely."

Three of the hospitals said they were able to judge when brain death occurs but were still considering whether they could handle the bodies properly after that point.

One hospital said it was still considering whether either of these would be possible, and another did not respond.

The revised law prohibits the transplant of organs from child abuse victims. Therefore, hospitals have to check whether potential child organ donors are child abuse victims.

Of the 12 hospitals that said they were capable of handling bodies of brain-dead children, 10 said they were also capable of determining whether the children were victims of abuse.

Medical experts fear that people might have second thoughts about whether to donate the organs of their children.

Counseling essential

Though psychological counseling is essential for parents who have lost a child to persuade them to donate their child's organs, only four of the 12 hospitals able to handle bodies to preserve the organs said they could provide such care.

A major controversy in organ transplants is whether everything has been done to prevent a patient from becoming brain dead.

The survey found that only nine of the hospitals, or less than one-third of them, said they had pediatric intensive care units capable of providing advanced treatments to seriously ill child patients. The nine hospitals have a combined total of 85 such beds.

An effective way to prevent patients with serious head injuries from becoming brain dead is to cool the body to prevent nerve cells from dying.

This is especially the case with child patients who need round-the-clock care in pediatric ICUs to prevent infection.

Shizuoka Children's Hospital, which treats about 200 critically ill patients annually, has 12 beds in its pediatric ICU. It has saved patients on the verge of brain death using the cooling method.

Ikuya Ueta, chief of the hospital's child intensive care center, said, "Even patients with serious head injuries can fully recover, if they are quickly transported here."

The survey showed that of the 29 hospitals, Osaka City General Hospital and nine others do not have pediatric ICUs.

The remaining 19 hospitals have a total of 157 beds in their pediatric ICUs. In 10 of the hospitals, these ICUs have been used only for patients who have undergone surgery or for other reasons, not for treating patients with serious injuries. These hospitals have a total of 72 beds in their pediatric ICUs.

Aichi Children's Health and Medical Center is scheduled to start operating a pediatric ICU in three years, and said it would not provide organs for transplant until then.

But this may be delayed depending on the hospital's financial situation.

Osamu Uemura, vice chief of the hospital, said, "The government needs to help improve the system if it wants to increase child organ transplants."