The World Health Organization's plan to change their guiding principles on organ transplantation will affect member countries such as Japan. Under current rules that place stringent restrictions on organ transplants in Japan, often forcing Japanese to travel abroad to receive organ transplants, it is unavoidable that Japan's laws and the behavior they encourage are regarded as self-centered by other nations.
The World Health Organization plans at a general meeting in May to incorporate a clause in its guiding principles on organ transplantation, requesting member states to carry out organ transplants entirely in their own countries. The motivation for this clause is the WHO's criticism of Japan's current situation.
Faced with pressure from the international community, the Diet is to start full-scale deliberation on bills to revise the Organ Transplant Law soon after the Golden Week holiday period.
At the time of voting, both the ruling and opposition parties are expected to allow their members a free vote on the proposed revisions. Each of the Diet lawmakers has to face up to the serious question of what they consider brain death to be and when organ transplants should be permitted.
The current Organ Transplant Law came into force in October 1997. But only 81 transplants have been carried out in the 11-1/2 years since, a fraction of the several thousand organ transplants conducted each year in the United States and several hundred every year in many European nations.
Infants let down by system
In Europe and the United States, when it is not clear whether a person declared brain dead wanted to be an organ donor, donation is still possible if the family agrees to it on the brain-dead person's behalf.
In Japan, however, it is an absolute requirement for the brain-dead person to have left in writing his or her intention to donate, such as in the form of an organ donor card. Even with this, however, an organ donation can still be stopped if the family of the brain-dead person opposes it.
Under the Civil Code, the will to donate organs is legally recognized only when a donor is aged 15 or older.
However, it is almost impossible to transplant organs removed from people aged 15 and older into infants due to the differences in organ size.
This has resulted in a constant stream of Japanese infants being taken overseas to receive organ transplants, often after parents have made pleas for supporting funds.
Japanese adults also have headed abroad for operations, some seeking organ transplants in China, where it appears most organs are sourced from those executed for their crimes.
The WHO's guiding principles will urge people to refrain from going overseas for the purpose of organ transplants.
New bills proposed
So far, three bills to revise the law have been submitted to the Diet.
Bill A stipulates that if a person has not made clear whether to give permission to undergo a brain-death diagnosis or to become an organ donor if declared brain dead, the decision will be entrusted to his or her family.
In doing so, the bill relaxes the conditions on organ transplants, bringing them broadly into line with the United States and European countries.
Bill B calls for no changes to the current rules except to lower the age at which one can make a legal decision to permit a transplant to 12.
Bill C seeks to more strictly define brain death and increase the restrictions on organ transplants.
In addition to the three bills, a fourth likely will be submitted to the Diet after the holidays, which will call for organ donations to be permitted from those aged under 15 if his or her parents give consent.
Many points of contention remain to be discussed, including how to correctly categorize brain death and how to provide a structure that could be used to determine whether a child has become brain dead due to abuse.
This is a difficult issue involving viewpoints on life and death. But one thing is certain, Japanese people can no longer keep heading overseas for organ transplants.
We cannot delay any longer in reaching a decision that "the relay of life" that is organ transplantation should be conducted entirely within Japan.
(From The Yomiuri Shimbun, May 6, 2009)
(May. 6, 2009)
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