5．脳死臓器提供の手術手技および呼吸循環管理—ドナー臓器の評価，管理と摘出手術

Brain-dead organ donations and cardiorespiratory monitorings during transplantations

我が国でも1999年2月に脳死下臓器移植が再開されたが，20年あまり経った現在でも，提供件数は極めて少ない。そのため，ドナーならびにそのご家族の意思を反映するためにも，可能なかぎり多くのドナー臓器が利用できるように考慮し，欧米に比較して多くのマージナルドナーからの臓器移植を行わなければならない。2002年11月以降は，メディカル・コンサルタント（MC）が第1回法的脳死判定以降に提供病院に派遣され，ドナーの全身状態，各臓器機能の評価を行い，第2回法的脳死判定以降から脳死の病態を考慮しながらドナー管理の支援を行っている。

Although brain-dead oragan donation has increased in Japan since the renewal of the Organ Transplantation （Tx） Act in 2010, organ transplants are extremely limited due to a shortage of donor organs. Therefore, adequate and optimal utilization of all suitable donor organs is mandatory to increase graft availability. Since November 2002, special transplant management physicians （medical consultants）, mainly cardiothoracic surgeons, have been sent for procurement. They assess donor organ function and identify which organs are useful for transplantation. They also care for the donor, stabilize the donor hemodynamically using anti-diuretic hormone （ADH） （a bolus infusion in a dose of 0.01U/kg followed by a drip infusion in a dose of 0.01U/Kg/hr） and reduce intravenous catecholamine administration as much as possible. This leads to improved donor cardiac and pulmonary function by preventing and treating lung infection before the procurement team arrives at the donor hospital. Using this approach, the number of organs transplanted per donor in Japan is higher than that in other developed countries （5.5 vs 3-4 organs） and the outcomes of organ transplantation in Japan are acceptable. These strategies may be useful to maximize organ transplant opportunities.