Challenges in advanced heart failure care in Japan: Bridging the gap in durable mechanical circulatory support utilization and heart transplantation

In Japan, the incidence of heart failure has escalated to become a major cause of morbidity and mortality. Advanced therapeutic interventions, such as heart transplantation and durable left ventricular assist devices, have become a focus of interest in recent decades. However, the unique sociocultural landscape of Japan, coupled with a historically controversial background of organ transplantation, has impeded progress in these areas. This has resulted in a notable donor shortage and the absence of a robust framework for heart transplantation. This review aims to highlight the specific challenges faced in advancing heart failure care in Japan and proposes strategic solutions to overcome these barriers.