Kobayashi Eiji
Division of Development of Advanced Treatment, Center for Development of Advanced Medical Technology, Jichi Medical University.
Nihon Rinsho. 2010 Dec;68(12):2229-33.
In May, 2008, the Istanbul Declaration calling for completely against organ traffic and for self-sufficiency in organ donation was presented by a Steering Committee convened by The Transplantation Society (TTS) and the International Society of Nephrology (ISN) under the cooperation with WHO. The chief principles are to spread cadaver transplant worldwide for prevention of improper organ donation, and to protect and secure living organ donors. On the other hand, in Japan brain-dead transplantation had been legalized in 1997. Since the first Organ Transplant Law went into effect without sufficient common view of brain death as legal death, autonomy of donor has taken top priority, and it imposed donors on preconditions to sign a donor card indicating the willingness to donate their organs. However, the lowest rate of organ donation has been kept annually. All heart transplant in children had been done in other countries. In 2009, the point issue of self-sufficiency in organ donation in the Istanbul Declaration directly affected the revised law in Japan. Now, the newly passed law reaches a world standard. It is a start line to reconsider the reason why the brain-dead transplant has not been accepted by Japanese society and to move self-sufficiency in organ donation. There is also a pressing need to develop new medical treatment or technology which requires no organ donation.
2008年5月，由移植学会（TTS）和国际肾脏病学会（ISN）在世界卫生组织的合作下召集的指导委员会提出了《伊斯坦布尔宣言》，呼吁全面反对器官交易并实现器官捐赠的自给自足。主要原则是在全球推广尸体移植以防止不当器官捐赠，并保护和保障活体器官捐赠者。另一方面，在日本，脑死亡器官移植于1997年合法化。由于第一部《器官移植法》在没有将脑死亡视为法定死亡的充分共识的情况下生效，捐赠者的自主权被置于首位，并且该法要求捐赠者签署表明愿意捐赠器官的捐赠卡作为前提条件。然而，器官捐赠率一直处于每年的最低水平。所有儿童心脏移植均在其他国家进行。2009年，《伊斯坦布尔宣言》中器官捐赠自给自足的关键问题直接影响了日本的修订法律。现在，新通过的法律达到了世界标准。这是重新思考脑死亡器官移植未被日本社会接受的原因并推动器官捐赠自给自足的起点。同时，迫切需要开发无需器官捐赠的新医疗方法或技术。
