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As donor shortage is extremely severe in Japan because of the very strict Organ Transplantation Act, special strategies for maximizing organ transplant opportunities should be established. Since November in 2002, special transplant management doctors were sent to donor hospitals in order to assess donor’s organ function and to identify which organ could be transplanted. They also intensively cared for the donor to stabilize hemodynamics and to improve cardiac and lung function by intravenously giving anti-diuretic hormone and pulmonary toileting by broncho-fiberscope. Out of a consecutive 384 brain dead donors, 284 (74.0%) donor hearts were transplanted and the patient survival after heart transplantation at 5, 10 and 15 years were 92.7, 89.6 and 81.8 %, respectively in Japan. These strategies may increase heart availability and improve post-transplant outcomes.
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