Organ transplants from brain-dead donors are becoming more frequent in Japan. The organ transplant law in Japan came into effect in October 1997 and the first transplant took place in February 1999. The increasing frequency of transplants is due, largely, to the dissemination of donor cards, which indicate a persons willingness to donate his or her organs in the case of brain death. There seems to be a rapidly deepening understanding of the issue of organ donation and transplantation among the people of Japan.

According to medical experts, brain death accounts for less than 1% of all deaths, or somewhere between 3,000 and 8,000 cases a year in Japan. The pool of potential donors is also limited by a number of conditions. The  organs of brain-dead persons can be donated only if the hospital where treatment was received is one of the 353 designated organ-donation facilities in Japan; the brain-dead person possesses a donor card; the consent of the patient’s family is obtained; and the donor does not have and infectious diseases. For this reason, organ transplants from brain-dead donors were expected to take place perhaps once a month at the most.

No transplants took place for nearly a year and a half after the enforcement of the law, however, and there was growing concern that the procedure would not take root in Japan. It was not until February 1999 that the first transplants were carried out, with the heart, liver, kidneys, and corneas of a brain-dead woman in her forties being successfully transplanted to a total of six patients.

The spread of donor cards has been an important factor contributing to growing awareness of transplant related issues. As a condition for the removal of organs, the Organ Transplant Law stipulates that the person must have written confirmation of his or her willingness to donate, so the Health Ministry and others have been making efforts to distribute the cards widely. The holder of a donor card indicates on the card whether he or she (1) agrees to donate organs after brain death, (2) agrees to donate organs after the heart ceases to function ,or (3) does not wish to donate organs. In the case of either (1) or (2), the holder also circles the organs that he or she agrees to donate. Once the carrier signs the card, it becomes valid as written evidence under the law.

Since the enforcement of the law, the Japan Organ Transplant Network, which undertakes the registration and selection of patients to receive donated organs, and the Health Ministry have been distributing the cards in municipal government offices, public health offices, and other facilities around the country. Donor cards are available in convenience stores, and there are donor seals that can be attached to a driver’s license. English-language cards have also been made for foreigners living in Japan.