Headlines were made across Japan in April when a child pronounced brain dead became the first and so far only child to donate organs under legal changes implemented in July 2010. A Mainichi survey has discovered, however, that at least 14 other children have been pronounced brain dead over the past year but did not donate any organs.
The Mainichi survey -- conducted July 1-15 and receiving responses from 46 of the 56 medical institutions across Japan queried -- found that children had been pronounced brain dead at 11 facilities. Organ donations were not performed, however, due mainly to lack of parental consent or doctors failing to mention the possibility of donations. Particularly in cases of very small children, there was unwillingness among parents and doctors to equate brain death with the death of the patient, the survey showed.
Organ transplants from brain dead children aged 15 and under became legal under revisions to the Organ Transplant Law that went into effect on July 17 last year.
Among the 14 children revealed in the survey to have been pronounced brain dead, four did not make donations because parents would not consent, four because attending physicians could not bring themselves to suggest organ donation to the grieving family, two because doctors could not rule out that the child had been physically abused at home, and one because the doctor chose not to mention donations for medical reasons.
Regarding the fact that just one brain dead child has donated organs in the past year, half the respondents said they had expected such a low figure, citing "parents' inability to accept that their child is brain dead" and "difficulty in ascertaining the role of physical abuse in a child patient's brain death," among other possible reasons.
As of Feb. 1 this year, there are 303 medical institutions in Japan that openly perform organ transplants from brain dead donors aged 18 and over. Transplants from brain dead children are technically possible at all these facilities, though only 56 have declared their willingness to perform such procedures.
改正臓器移植法：全面施行１年 小児、脳死状態１４例 親・医師に抵抗感、判定至らず
◇本社５６施設調査
改正臓器移植法の全面施行（１０年７月１７日）以降、１５歳未満の小児からの脳死臓器提供が４月に１例実施されたが、このほかに小児患者が脳死とみられる状態になったケースが少なくとも１１医療施設で１４例あったことが、毎日新聞の調査で分かった。親が臓器提供に承諾しなかったり、医師が提供に関する説明を見送るケースが目立ち、いずれも提供には至らなかった。特に小児の場合、家族や医療現場で脳死が人の死として受け入れられない現状が浮き彫りになった。
毎日新聞は７月１～１５日、小児からの脳死臓器提供を実施すると表明している全国の５６施設を対象に郵送によるアンケートを実施。４６施設（回答率８２％）から回答を得た。
小児患者が脳死とみられる状態になった１４例のうち、親が承諾しなかった（４例）▽主治医らが悲嘆にくれる家族の様子を見て、最初から説明を見送った（４例）▽虐待を受けた疑いを否定できなかった（２例）▽主治医が医学的理由で説明を見送った（１例）－－などの理由で、いずれも脳死判定や提供に至らなかった。
小児の臓器提供がこれまで１例にとどまっていることについて、全体の半数に当たる２８施設は「予想通り」と答えた。理由として「親が脳死を受け入れられない」「虐待の見極めが困難」などの意見が挙がった。
１８歳以上の脳死臓器提供実施施設として名前を公表しているのは２月１日現在、全国で３０３施設。これらの施設は制度上は小児の脳死臓器提供も可能だが、小児からの提供実施を表明しているのは５６施設にとどまっている。【比嘉洋、久野華代、藤野基文】
毎日新聞 2011年7月18日 東京朝刊
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