Organ donation in Japan: A longitudinal study of quality of life of living liver donors.

摘要

Japan is a highly developed country with a gross national product second only to the United States. Yet in the field of organ transplantation involving organ donation from victims who died from trauma such as automobile accidents and brain hemorrhage, Japan is behind all western countries and many developing countries. Removing organs from deceased donors was prohibited in Japan until 1997.Currently cadaveric organ donation remains minimal and, as a result, patients in need of heart transplantation must often pay for surgery performed abroad. One of the saddest sights on Japanese streets is a child standing on the street with a poster saying "Please donate money for a transplant in the US."Japanese surgeons are among the most skilled. In spite of the fact that there are almost no organ donations from deceased victims, surgeons have become extremely successful in developing new techniques for organ donation from living donors. To operate surgically on a healthy person is unprecedented in medical practice and is contrary to the solemn advice of Hippocrates who said, "first do not harm (Gillon, 1985)."The purpose of this dissertation was to longitudinally explore the quality of life (QOL) and health status of living donors after the donation.The phase 1 study was done in 2002 which measured QOL of living liver donors (n=46) by utilizing a QOL tool, the Short Form 36 RTM (SF-36RTM) and a researcher made questionnaire. This study showed that the majority of donors (69%) said they completely recuperated from the operation, while 32% said they did not. Moreover, living donors scored lower on the SF-36RTM than their controls when measured within a year after their surgery, and donors who were more than two years post-surgery had higher scores meaning their health status and QOL was better than those within a year after surgery.For this phase 2 study, the same living donors were invited to participate, including those donors whose recipient died, because the death of the recipient must clearly represent a significant emotional trauma to the donor. The same QOL tool, SF- 36RTM, and the researcher made questionnaire were used in this phase 2 study, and the change in their QOL and health status over seven years were examined.There were no donor deaths in the donor population, though nine donors were admitted to a hospital for a variety of reasons. The majority of donors (61.9%) said they had completely recuperated from the operation, while 12 donors (33.3%) said they still had some symptoms. The donors who scored lower on the SF-36RTM from the phase 1 study scored higher for this phase 2 study. However, many still have minor complications and some lost their income or changed their job after this surgery. Also, donors whose recipient died after the surgery showed a lower QOL score even after many years.The significance of this study indicates that most living liver donors see themselves as having recuperated well, though some still had long-term problems.