A total of 87 lung transplants has been performed for the 9 years since 1998 in Japan. Because of the shortage of brain-dead donors, living-donor lobar lung transplantation accounted for two-thirds of lung transplantation in Japan. The most common indication was primary pulmonary hypertension. The distributions of procedure type and indication were characteristic for Japan. Despite the limited number and the short follow-up period, the survival for Japanese recipients was better than the international average, and the quality of life after lung transplantation was excellent. To increase the number of available pulmonary grafts, we have tried various strategies, such as active use of marginal donors, careful donor management, and development of new preservation solutions, but the shortage of brain-dead donors remains a serious problem. The current transplant laws need to be reconsidered.
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