This paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as “reuse cardiac organ transplantation.” Medical, legal, and ethical analysis, with a main focus on ethical analysis. From the medical perspective, it is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse. We conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver.

Aim: This study aimed to clarify physicians’ awareness of and attitudes toward family presence during resuscitation (FPDR) and related factors. Subject and methods: A web-based questionnaire survey was conducted of 7859 physicians who were members of the Japanese Society of Intensive Care Medicine (survey period: October 12, 2022, to December 31, 2022). Focusing on cardiopulmonary arrest, the survey questioned their awareness and attitudes, with a comparison of exogenous and non-exogenous patients. Results: The proportion of respondents who have family present during resuscitation was 100 (25.0%) for exogenous and 105 (29.2%) for non-exogenous. The proportion who believed that the family’s acceptance of death is greater with FPDR was 255 (61.7%) for exogenous and 245 (65.7%) for non-exogenous. The proportion who believed that the family’s acceptance of death is greater with FPDR included a significantly higher number of respondents who had family present than in the proportion who believed that FPDR has no effect. The proportion who believed that the family is emotionally traumatized by FPDR was 251 (60.8%) for exogenous and 217 (58.2%) for non-exogenous. The proportion who believed that families are emotionally traumatized by FPDR included a significantly higher number of respondents who do not have family present than the proportion who believed that FPDR has no effect. Conclusion: Various international resuscitation guidelines have recommended FPDR from an early stage to alleviate grief and prevent mental disorders. However, these guidelines are not always followed in Japan.

(1) Background: To what extent is information manipulation by doctors acceptable? To answer this question, we conducted an exploratory study aimed at obtaining basic data on descriptive ethics for considering this issue. (2) Methods: A self-administered questionnaire survey was conducted on a large sample (n = 3305) of doctors. The participants were queried on (1) whether they consider that information manipulation is necessary (awareness), (2) whether they have actually manipulated information (actual state), and (3) their ethical tolerance. (3) Result: The response rate was 28.7%. Sixty percent of the doctors responded that information manipulation to avoid harm to patients is necessary (awareness), that they have actually manipulated information (actual state), and that information manipulation is ethically acceptable. (4) Conclusion: While the present survey was conducted among doctors in Japan, previous studies have reported similar findings in the United States and Europe. Based on our analysis, we hypothesize that a relationship of trust between patients and medical personnel is crucial and that information manipulation is not needed when such a relationship has been established.

The number of child abuse cases has been increasing in Japan every year. Medical institutions face issues such as coordinating with welfare offices, child guidance centers, police, and other related agencies concerning child abuse, as well as communicating with parents/guardians who are perpetrators of child abuse. This study examined the awareness and actual behavior of medical institutions regarding the support required while notifying/reporting cases of child abuse. A self-administered and anonymous questionnaire survey was conducted among the staff of the pediatrics departments, emergency departments, and general affairs departments of large hospitals in Japan. Differences in notifying and reporting child abuse cases to the child guidance center and welfare office and the police were assessed. It was found that some cases were not reported to the child guidance center or welfare office despite being considered “abuse.” Furthermore, a difference of opinion was observed among staff members, especially in judging “whether abuse is suspected or not.”

厚生労働省は，平成４年度より概ね５年毎に一般国民等を対象として終末期医療に関する調査を実施してきた。これまでに合計７回の調査が行われている。近年の調査結果を見ると，一般国民の中には，認知症を患った場合，介護施設や自宅など，医療機関以外の場所を最期の場所として希望する者も多いことが推察される。しかし，医療機関以外の場所には医師が常駐していないことから，医師による死亡診断が迅速に行えないことがあるなどの事情や，下記のように規定する医師法20条に係る誤解により，患者の中には，人生の最期の段階で医療機関への入院を余儀なくされ，そこが最期の場所になる者がいるとの報告がなされてきた。そこで，本稿では，上記の厚生労働省による調査結果を対象として，人生の最期の場所に係る一般国民の意識を確認した上で，（死亡診断・）死亡診断書について規定する医師法20条の解釈及び厚生労働省による関連通知について解説する。【医師法20条】医師は，自ら診察しないで治療をし，若しくは診断書若しくは処方せんを交付し，自ら出産に立ち会わないで出生証明書若しくは死産証書を交付し，又は自ら検案をしないで検案書を交付してはならない。但し，診療中の患者が受診後二十四時間以内に死亡した場合に交付する死亡診断書については，この限りでない。