Donor card registration system in Japan: an obstacle to procuring kidneys for transplantation.
Donor cards are a simple and effective way to give a consent to organ donation in cases of unexpected death. In Japan the prevalence of donor cards is low (0.4%) compared to the United States (24.6%), although about 50% of Japanese people are reported to be willing to donate their organs after death, a figure equivalent to the United States. We hypothesized that the donor card registration system can explain the low prevalence, and an introduction of a free delivery system will increase the prevalence. From April 1992 to April 1993, 402 high school students and 3391 workers in the Tokyo metropolitan area were requested to answer questionnaires; all the questionnaires were returned. Few respondents (15.5%) knew the way in which to be registered as a donor card holder. If donor cards were delivered freely and registration to carry a donor card was not required, 48.8% replied that they would be willing to carry donor cards. The most commonly cited reason for not carrying a donor card was 'I had no opportunity to get a donor card'. This study indicates that the introduction of free delivery of donor cards will increase the prevalence dramatically if a sufficient number of opportunities are offered. We recommend that a free delivery system should be introduced in order to increase the prevalence and secure the will of the deceased rather than the will of the family.