The number of organ donations after
brain death has significantly increased since the revised Japanese Organ Transplant Law took effect in July 2010. Sixty-one
lung transplantations were conducted throughout Japan in 2013, including 20 living-donor
lung transplantations and 41
brain-dead-donor
lung transplantations (23 bilateral lungs, 17 single lungs, and 1
heart-lung transplantation). The number of lung transplant candidates newly registered at the Japan
Organ Transplantation Network also increased to 126 in 2013, suggesting a severe donor shortage in Japan. More than 60 % of offered
brain-dead-donor, lungs were used for
transplantation, indicating the effort of Japanese lung transplant centers to overcome the challenge of donor shortage. After
lung transplantation, patients generally enjoyed a good quality of life with excellent survival of 86.2 % at 1 year, 79.6 % at 3 years, and 73.7 % at 5 years post-
transplantation. There was no significant difference in patient survival between living-donor and
brain-dead-donor
lung transplantation. Early mortality of lung transplant recipients within 90 days was attributable to graft failure followed by
infection, while long-term mortality was mostly explained by chronic lung allograft dysfunction (chronic rejection),
infection, and
malignancy. Eight lung transplant centers are currently approved to conduct
lung transplantation in Japan (Tohoku, Dokkyo, Chiba, Kyoto, Osaka, Okayama, Fukuoka, and Nagasaki Universities). These centers are expected to continue to make a special effort to save
critically ill patients waiting for
lung transplantation.