Presentation Information
[SY-87-03]Clinical ethics consultation focused on organ transplantation: a new challenge for general hospital psychiatry in Japan.
*Katsuji Nishimura1 (1. Department of Psychiatry, Tokyo Women's Medical University School of Medicine (Japan))
Keywords:
Transplant psychiatry,Clinical ethics consultation,General hospital psychiatry
In recent years, general hospital psychiatry in Japan has increasingly been involved in clinical ethics consultations, especially in organ transplantation. Due to organ shortages, Japan relies heavily on living donors—unlike many Western countries. In 2022, 88.9% of kidney and 79.6% of liver transplants were from living donors, mostly family members. This situation raises ethical concerns, including the risk of coercion within families and challenges in evaluating donors with impaired decision-making capacity (e.g., due to mental illness or dementia).Following a 2006 case of organ selling, the Japan Society for Transplantation revised its ethical guidelines, requiring interviews by “third parties” (e.g., psychiatrists) to ensure that donor decisions are made voluntarily. In response, the Japanese Society of General Hospital Psychiatry published A Guideline to Confirm Decision-Making Involved in Living Organ Donation in 2013. This guideline goes beyond assessing decision-making capacity, also focusing on whether donors are free from external pressure or coercion.A 2014 nationwide survey showed that 70% of kidney and 90% of liver transplant programs conducted such third-party interviews, with psychiatrists involved in most cases (90% and 83%, respectively). Clinical ethics consultation has thus become a key area of responsibility for general hospital psychiatry in Japan.