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total was 284 procedures. Figure 1A shows the general trend over this period. The effect of the amendments is plain to see; the maximum number was 11 in 2008, but after the amendments this rose to a high of 44 in 2015. There is a 2-stage screening process for registering for Htx with the Japan Organ Transplant Network (JOT). Firstly, the potential recipient must be certified as suitable by the relevant medical institution. Approval is then required from the Heart Transplant Candidate Registry Committee of the Japanese Circulation Society. The Heart Transplant Candidate Registry Committee was set up in 1997, when the Organ Transplant Act came into effect. The number of newly referred patients was initially around 40–60 cases per year. After the amendments came into force, however, applications rose sharply, to over 160 per year (Figure 1B). Since May 2015, 3 institutions [National Cerebral and Cardiovascular Center, (NCVC), Osaka University and University of Tokyo] with experience of more than 50 Htx procedures can register a candidate on the waiting list based on their own assessment of suitability for Htx.3 JOT has been processing Htx applications since October 1997. Active waiting candidates have risen sharply from 8 in 1997 to 35 in 1999, 100 in 2007, and 512 at the end of June 2016. Initially, only 3 institutions were authorized to perform Htx procedures in Japan: NCVC, Osaka University and Tokyo Women’s Medical University. Six more have been added: University of Tokyo, Kyushu University, Saitama Medical University (now Saitama Medical University International Medical Center), Tohoku University, Hokkaido University and Okayama University, which brought the total to 9. In addition, when the amendments to the Organ Transplant Act were introduced, allowing organ harvesting from infants and children, 3 institutions were authorized to perform Htx on children up to 10 years of age: NCVC, Osaka University and University of Tokyo. Tokyo Women’s Medical University was added to this list in 2013, bringing T he Japanese Organ Transplant Act came into effect in October 1997 and the first heart transplant (Htx) procedure under this Act was performed in February 1999.1 The number of procedures increased steadily to around 10 per year, but then rose sharply to 44 in 2015 after a revision of the Act in July 2010.1–3 However, the number of Htx procedures remains low in international terms and the mean waiting period exceeded 1,150 days at the end of June 2016 because of a rapid increase in newly registered patients on the waiting list. A bridge to transplantation (BTT) using a left ventricular assist device (LVAD) plays a greater role than before in managing the listed patients, and the total number of CF-LVAD implantation patients enrolled in the Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) increased to 656 at the end of June 2016. Because of the severe organ shortage, more marginal donor hearts are being transplanted than in other developed countries, but the outcomes of patients with these marginal hearts have not been well reported. This report is based on the latest statistics of Htx recipients and donors compiled by the Committee of Heart Transplantation Regitry of the Japanese Society for Heart Transplantation, which were correct as of June 30, 2016, to clarify the effects of recipient or donor factors on patient survival after Htx.

Registry Report on Heart Transplantation in Japan (June 2016)