J.Jpn. Surg. Soc.. 126(1): 38-45, 2025

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Feature topic

PEDIATRIC LIVER TRANSPLANTATION IN AN ERA OF A DECLINING FERTILITY RATE IN JAPAN

Japan’s declining birthrate, influenced by late marriages and lower marriage rates, resulted in approximately 727,000 births and a total fertility rate of 1.20 in 2023. Despite various government measures since 1994 to address the birthrate, a fundamental solution has yet to be found. While the number of children is decreasing, advances in medical technology have led to an increase in the number of children requiring medical care, thus increasing the demand for pediatric care. However, pediatric care is highly unprofitable, with many medical facilities reporting losses under the reimbursement system, leading to the closure of pediatric wards.
The National Center for Child Health and Development launched a pediatric liver transplantation surgery program in 2005 and had performed 872 liver transplants by July 2024. However, only 3.9％ of all pediatric liver transplants are from brain-dead donors, indicating a low priority for organ donation.
To maintain a sustainable pediatric liver transplantation system, it is crucial to raise awareness of brain-dead organ donation, consolidate and monetize transplant facilities, and create an attractive work environment for young physicians. As the number of patients indicated for pediatric liver transplantation decreases due to the declining birthrate, these measures are essential for the future of pediatric liver transplantation.

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