Heart transplantation in children in foreign countries with reference to medical, transportation, and financial issues

Heart transplantation is increasingly becoming accepted worldwide as therap y for end-stage heart failure not only in adult patients but also in pediat ric practice. The new law in Japan for organ transplantation from brain-dea d patients was established on 16 October 1998, but there is no definite law or protocol for brain death in children under the age of 6 years and child ren less than 15 years of age cannot become donors. These facts make organ transplantation from the cadavers of neonates, infants and young children a lmost impossible in Japan, even though there are children who need heart or heart-lung transplantation. The present authors have to date transferred 8 patients to the USA or Germany for heart transplantation: 4 successfully u nderwent heart transplantation, but 4 died during the waiting period overse as. There are many things to consider; not only the medical problems involv ed in transportation, but also the financial issues when transferring patie nts to other countries. This report derails the experience with the 8 cases that were transferred overseas for heart transplantation, and highlights t he problems that need to be considered.