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The Japanese Journal of Thoracic Surgery Volume 75, Issue 1 （January 2022）

胸部外科 75巻1号（2022年1月発行）

Japanese English

特集日本の心臓移植の今

わが国における心臓移植のこれからの発展に向けて Proposal to Development of the Heart Transplant in Our Country in the Future 布田伸一 ¹ Shinichi Nunoda ¹ ¹東京女子医科大学大学院重症心不全制御学分野/日本臓器移植ネットワーク ¹Department of Therapeutic Strategy for Severe Heart Failure, Tokyo Women’s Medical University Graduate School of Medicine キーワード：心臓移植 , メディカル・コンサルタント , 移植内科医 , 二つの死の基準 Keyword: heart transplantation , medical consultant , transplant physician , criteria of two death pp.37-43

発行日 2022年1月1日 Published Date 2022/1/1

DOI https://doi.org/10.15106/j_kyobu75_37

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ヒトの重症心不全治療における最後の砦となる心臓移植は，1967年に南アフリカ共和国でBarnard博士により始められ，その後，堰を切ったように各国で行われた．しかし心臓移植の成績は惨憺たるもので，すぐさまその勢いは消え失せていった．このような逆風の中，スタンフォード大学のShumway博士らは地道に実績を積み上げ，わが国で発明された今野・榊原式心内膜心筋生検鉗子を用いた拒絶診断法の応用，そして1980年代初頭に登場した画期的免疫抑制薬であるcyclosporineにより，今日の心臓移植の礎ができた．その後，欧米では順調に一般の医療として心臓移植は社会に取り入れられていったが，日本では，1968年に世界で30例目に行われたいわゆる「和田移植」によってドナー，レシピエントの適応などについてさまざまな論争が巻き上がり，欧米から遅れること30年以上を経て，2010年の改正臓器移植法（改正法）施行により，法制上でようやく欧米にかなり近づいた脳死臓器移植のスタートラインに立つことができた．

Although the first heart transplantation in Japan by Dr. Wada had influenced the establishment of heart transplantation in Japan for many years, many efforts for re-starting and establishing heart transplantation in Japan have also occurred in the past 40 years. The Japanese Society for Heart Transplantation was established in 1983, which was two years after the establishment of the International Society for Heart Transplantation. Much effort had been made to pass the Act on Organ Transplantation in 1997 and revise it in 2010.

However, very few heart transplantations are performed in our country because there have been very few deceased donors according to a 2015 report. Currently, more than 10 times the number of donors are awaiting heart transplantation in Japan.

Compared to countries using an opt-in system for organ donation such as the United States and South Korea, earlier referral of possible donors to transplant coordination teams should be incorporated in Japan to increase the possibility of organ donation. The medical consultant system developed in Japan is a unique partnership between transplant consultant physicians and local physicians that should put more effort into increasing the number of organs for donation. The current number of transplant physicians is very low. This number should be increased for pre- and post-transplant management as well as medical consultation for donation in the emergency room.

Another reason for the shortage of donors is that there are two judgement standards of death in Japan. One standard is brain death only at the time of donation for transplantation. This definition should be re-considered in various fields in Japan.