Transplant Ethics Debated In Japan Definition Of Death, Burial Customs Obstacles To Surgery
Masanori Suzuki says a prayer of gratitude every night for the kidney transplant he received in the United States 12 years ago.
“It’s as though I live with an American I don’t even know,” said Suzuki, 54, one of the few Japanese to have had a transplant operation overseas.
Hundreds of Japanese die each year awaiting heart and liver transplants, which are routine in the United States but are not done in Japan because of laws about when death occurs and traditions regarding human remains.
Only one heart transplant has been performed in this country, and that was 30 years ago. Patients can only get part of a liver from a living donor and hope it will grow in them. And only 800 kidney transplants are done a year, most from living donors, compared to more than 10,000 a year in the United States.
For Japanese in need of a heart or liver, the only glimmer of hope may come from the few organs donated at one of the four U.S. military hospitals in Japan and transplanted into Japanese patients.
“It could be the breakthrough transplant,” said surgeon Hikaru Matsuda, the spokesman for 4,000 doctors who want to perform more transplant operations in Japan. “We hope it will get people thinking about why we have to turn to a foreign country.”
In the past two years, at least three Japanese have received transplants of kidneys and a cornea from U.S. military donors.
The latest American organ donor was a 5-year-old boy who loved “The Lion King,” pizza and his rock collection.
Alex Van Cleave, the son of a naval officer at the Yokosuka base near Tokyo, died after an accidental fall while going to school four months ago. Two Japanese youngsters - one 10 years old, the other 19 - received his kidneys.
Many surgeons hope the story of little Alex will help win over a skeptical Japanese public.
There are no laws banning transplant operations in Japan, but there is a big obstacle: the definition of death.
In Japan, death is declared after the heart stops beating. At that point, the heart and liver die quickly and cannot used in transplants. Doctors elsewhere use machines to keep the heart of brain-dead patients beating so their organs can be donated, but Japanese doctors often will not sign death certificates for brain-dead patients.
Doctors also face strong resistance from families who don’t want their loved ones cut open, even though most Japanese are cremated. In addition, Japanese watchdog groups have for years filed complaints with prosecutors seeking murder charges against doctors who performed transplants. But none of the complaints have resulted in criminal charges.
Jimmy Jones, a pediatric surgeon at the U.S. Naval Hospital on the southern island of Okinawa, is working with Japanese doctors to outline procedures for future American organ donors and Japanese recipients.
“It has been a challenge. It has been fun. And I think we have made a difference,” Jones said.
Jones has already helped coordinate two successful transplants on Okinawa with organs donated from naval hospitals.
Legislation now before Japan’s parliament would clearly define the rules that doctors should follow in extracting organs from brain-dead patients for transplant operations. However, a similar bill failed last year and it is not clear if this new bill has any chance of passing.
Its supporters include Satoru Todo, a professor of surgery at Hokkaido Medical University. He recently returned to Japan after 13 years at the University of Pittsburgh, where he performed more than 1,200 liver transplants from brain-dead donors.
“The biggest difference is that the United States is a society made up by the people. Japanese society is made up by the powers above,” Todo said, explaining his nation’s hesitancy on the issue of transplants.
Suzuki, who received an American kidney, is harsher.
“There is no spirit of giving in Japan,” he said.
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