Why are cadaveric renal transplants so hard to find in Japan? An analysis of economic and attitudinal aspects

Abstract In view of the fact that in Japan treatment of end-stage renal disease depends dis-proportionately heavily on hemodialysis and almost negligibly on transplants from cadeveric donors (hemodislysis 44.4/100000; renal transplants 0.31/100000 per year; cadaveric renal transplants 0.11/100000 per year (1983 data)), we analysed the cost-effectiveness of hemodialysis and renal transplantation, predicted economic gains under expected changes in variables and described attitudes of the Japanese hampering cadaveric renal transplantation. Adjusted life expectancy of transplant recipients (live and cadaveric combined) under the current technical conditions is longer then that of those on hemodialysis (18.3 vs. 14.7 years) and the cost per year for maintaining the transplant is approximately one third of hemodialysis ($12000 vs. $32000). If the proportion of cadaveric transplant recipients would increase to the levels of the USA (hemodialysis 30.8/100000; transplants 2.6/100000 per year; cadaveric transplants 1.9/100000 per year (1983 data)) along with improvement in graft survival rate, the life expectancy for transplant recipients in Japan could increase by 2 years, thus reducing the annual cost even further. The current number of patients starting hemodialysis (11500 cases per year) coupled with their life expectancy predicts the number of patients on hemodialysis to reach equilibrium at around 174000 in a decade (Japanese population 110 million). Based on current price, their annual cost will be about 5.3 billion dollars. Medical expenditure of this magnitude for such a small fraction of people is expected to become an increasingly strong economic incentive for cadaveric renal transplantation.