Trust, goodwill essential to increase organ donors - Japan

The Yomiuri Shimbun

Sunday will mark one year since the revised Organ Transplant Law, which aims to establish and expand medical transplantation in Japan, came into force.

The revised law focuses on increasing ways for organ donation from brain-dead patients to take place.

In the last 12 months, 55 cases of organ transplantation were carried out from brain-dead patients. This is a major increase from the number of similar cases under the old Organ Transplant Law: only 86 spread over 13 years.

This increase is attributed to the revised law, which allows the families of brain-dead patients to decide whether to donate their organs unless the patients have previously refused to donate them. This applies regardless of the prospective donor's age.

Considering the current situation, we applaud the gradual expansion of organ transplantation in Japan.

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Many problems remain

However, many problems remain. In April, the heart of a brain-dead teenage boy was donated to a patient also in his teens. However, this has been the only organ donation from a person under 15 since the revised law has made it possible. The lack of additional cases appears to be caused by insufficient public trust in medical transplantation.

Doctors have to make even more precise brain-death diagnoses on children than on adults while also carefully examining young patients' bodies for evidence of child abuse by parents. Also, there are not many hospitals ready to satisfy these conditions to perform transplants from child donors.

The current level of information disclosure is not sufficient, either. The process by which each decision to declare brain death is reached should be disclosed in more detail. Of course, this must be done in a way that would protect the privacy of people concerned.

The revised law has increased the opportunities for the transplantation of hearts and other organs that can be taken only from brain-dead donors. Regarding kidneys and some other organs, however, donations from patients whose hearts have stopped have decreased by a number equal to the increase of donations from brain-dead patients.

In Japan, over 10,000 people are waiting for kidney transplants. But the general supply of kidneys is so limited that many cannot wait and instead receive a kidney from a living family member. Over 1,000 such kidney transplants from living donors are conducted annually.

Enforcement of the revised law has not drastically increased the total number of organ donors. The Health, Labor and Welfare Ministry, in cooperation with the other government organizations, needs to solicit more understanding of organ transplants.

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Illegal organ trade

Meanwhile, the Metropolitan Police Department recently uncovered an illegal kidney-trading case. In this case, it was a doctor who purchased a kidney for himself.

The doctor, suffering from a serious kidney disease, paid a huge amount of money to a member of a crime organization to find a donor. The doctor even adopted the intended donor to receive the transplant, apparently to disguise it as one between living family members. This deplorable act shakes public confidence in medical transplantation. Similar case must be prevented in the future.

As a bar to false adoptions and other illicit methods, the health ministry should study preventive measures such as prohibiting, in principle, organ transplants between two people for a certain period of time after one adopts the other.

Medical transplantation is based on the goodwill of donors and their families.

The most important thing is to foster public trust in the nation's transplant system and to increase the number of people who wish to donate their organs when death comes to them.

(From The Yomiuri Shimbun, July 15, 2011)