ORGAN TRANSPLANTS IN JAPAN
The first major organ transplant in Japan in over 30 years occurred in February 1999. The organs were taken from a woman in Kochi prefecture, with her heart ending up in a patient in Osaka, the liver going to a patient in Nagano and the kidneys being used for operations in Sendai and Nagasaki. Television shows were interrupted to report the news and news helicopters and motorcycles followed the vehicles carrying the organs.
In 1999, each transplant operation was newsworthy. By the end of the year 30 patients in had received organs from brain-dead donors. After that the operations became relatively routine and were no longer news. Before 1999, people who needed transplants either went abroad or died, and it is believed that thousand of people died that could have been saved.
The Japanese have long been resistant to transplant operations and still are to some degree. The operations in 1999 were made possible by an April 1997 decision by the Japanese Parliament to recognize the concept of brain death. Up until then a person wasn't legally dead until his or her heart stopped beating, and no organs could be taken from the body until it was dead. At that time Japan, Pakistan and Poland were the only major nations that did not recognize brain death as actual death.
Most transplants in Japan involve living patients. In 2005 there were 565 liver transplants but only four livers were taken from brain-dead donors. There were 994 kidney transplants performed the same year. More than 80 percent came from living donors and 14 percent came from patients in cardiac arrest. Only 1.6 percent came from brain dead patents.
Japan’s first heart transplant (30th worldwide) was performed by Prof, Juri Wada, a controversial figure from Sapporo Medical University who performed the operation in August 1968 eight months after the first transplant was performed, Wada took the heart from a student who nearly drowned and was declared brain dead by Wada. The heart was placed in an 18-year-old patient who died 83 days after the transplant. Later practitioners of Chinese medicine filed murder charges against Wada but the charges were dropped in 1970 because of insufficient evidence. The murder charges and the fact that it wasn’t even clear whether the patient who received the transplanted heart needed the operation gave transplants in Japan a bad name.
Beginning in 2010, people can express their desire to donate organs on their driver’s licence.
Links in this Website: HEALTH IN JAPAN Factsanddetails.com/Japan ;HEALTH CUSTOMS IN JAPAN Factsanddetails.com/Japan ; HEALTH CARE IN JAPAN Factsanddetails.com/Japan ; HEALTH CARE PROBLEMS IN JAPAN Factsanddetails.com/Japan ; ORGAN TRANSPLANTS IN JAPAN Factsanddetails.com/Japan ; HIGH TECH MEDICINE AND MEDICAL ADVANCES IN JAPAN Factsanddetails.com/Japan ; DISEASES AND HEALTH PROBLEMS IN JAPAN Factsanddetails.com/Japan ; HANDICAPPED PEOPLE IN JAPAN Factsanddetails.com/Japan
Good Websites and Sources on Health and Health Care: Statistical Handbook of Japan Health Care and Public Hygiene Section stat.go.jp/english/data/handbook ; 2010 Edition stat.go.jp/english/data/nenkan ; News stat.go.jp ; World Health Organization Japan who.int/countries/jpn ; Center for Disease Control in Atlanta CDC ; Medical Information for Foreigners pref.osaka.jp/iryo/medicalinfo ; Medical Resources by region compiled by U.S. Embassy /tokyo.usembassy.gov ; Japanese Government Organizations: Ministry of Health, Labour and Welfare mhlw.go.jp/english ; National Institute of Public Health niph.go.jp ; National Institute of Health Sciences nihs.go.jp ; National Institute of Health and Nutrition nih.go.jp/eiken
Successful Transplant Operations in Japan
In February 2008, a 55-day-year-old baby with a severe form of hepatitis received a partial liver transplant from his mother at a hospital in Tokyo. The delicate nine-hour surgery included suturing blood vessels only 1.2 millimeters in diameter.
In September 2008, a 34-day-old, 2.8 kilogram infant girl was given a successful liver transplant at a hospital in Tokyo using part of a liver donated by her father. The infant tied the world record for the lightest patient to undergo such a procedure. The other was an infant operated on at a hospital in Kobe.
The first heart-lung transplant in Japan was carried at Osaka University hospital in January 2009. It was deemed successful. The organs--- transported to the hospital using a taxi with a police escort---came from a man in his 30s who been pronounced brain dead after suffering severe head injures.
In June 2005, two organ recipients were married. The groom received a new pancreas and kidney. The bride received new lung. The couple met at the Japan Transplant Games in Osaka in August 2004.
In November 2006, a kidney containing a tumor was transplanted from a mother to her son. The son had been warned of the risks before the transplant. The tumor was determined to be benign after the operation. The doctors said they performed the transplant because the son’s life was in danger and no other donor could be found. See Below
People Dying Waiting for Transplanted Organs in Japan
As of 2009, there were 12,000 patients waiting to receive transplanted organs. At the same there had been 81 successful transplants using organ from dead donor while 2,500 had died waiting for organs, mainly because organs could not be secured for them in time.
Between 1999 and 2006, organs were only taken from 51 people who had been declared brain dead. By contrast the majority of livers and kidney used in transplants in the United States come from brain-dead donors (about 7,000 donors a year). .
One study found that 72 percent of people who have applied for heart transplant between 1997 and 2006 didn’t receive transplants and 57.9 percent died. Some Japanese have gone abroad to get transplanted organs.
Obstacles to Transplant Operations in Japan
There is also a lot of cultural resistance to transplant operations. Many Asians believe that the soul and the body are linked together. They believe that lost limbs and organs will mean that the deceased will be incomplete when he or she arrives in the next world. This concept of "defiling" the body make many Asians reluctant to give blood or allow the corneas, heart and other organs of the deceased to be used in transplant operations on the living. Shintoism oppose organ donations.
The first heart transplant operation in Japan---and one of the first in the world---was performed in 1968, by Dr. Juro Wada. After the operation Wada was investigated for murder. Critics alleged that the donor was not yet dead. Wada was not indicted but his reputation tarnished and the investigation deterred other doctors from similar procedures.
In Japan, there were also concerns that doctors might too aggressive in harvesting organs from someone prematurely declared dead. That is one reason why nearly two years passed between the time that brain death was legally recognized and the first transplant operation took place.
Publicity surrounding the transplant has led to an increase in demand for donor cards at supermarkets, family restaurants and even banks. Between 1997 and 1999, more than 37 million donor cards have been distributed.
Conditions imposed by the 1997 law has made it very difficult to find donors. There have been cases were the organs of donors were not allowed because the donor was not brain dead enough, family members refused to offer consent or the cards of the donors were improperly filled out.
New Transplant Laws in Japan
In June 2009, the lower house approved a transplant bill aimed ay boosting the supply of organs. Among its measures were scrapping the age limit requirements and liberalizing rules that recognized people who are brain dead as being legally dead. The transplant law that recognized brain death was approved by Japan’s upper house in July 2009.
The previous law banned transplant from those under 15 and allowed transplant from brain dead patients only if the victim had supplied a written documentation saying he or she was willing to donate his or her organs if declared brain dead and the family agreed---rules fare stricter than other countries. The rules made it particularly hard for a child or infant toe get a transplanted organ. Among those who pushed or he bill were the parents of 1-year-old son who died waiting for a heart transplant in the United States.
In July 2010, the Organ Transplant law was revised to allow organ donation by children under 15 who have legally been declared brain dead. Six months after the law went into effect six children met the brain-dead criteria to donate their organs but in every case their families refused to give doctors permission to use the organs. The mother of baby who was declared brain dead after a car accident told the Yomiuri Shimbun, “I know it’s a good thing to do, but I don’t want [organs] surgically removed from my child.
Japan’s transplant law allows organ donors to give priority to family members as recipients for their organs.
Transplant Operations in 2010 and 2011
In May 2011, a woman in her 20s was given a kidney from her brain dead mother in the first case of a relative being given priority over people waiting on a transplant list.
In August 2010, a big deal was made when organs from a brain dead man who didn’t express his desire to donate organs in writing, were given to recipients around Japan, under the revised Organ Transplant law which went into effect the month before, with seemingly every body part that could be transplanted---including the heart, lungs, livers, kidneys and pancreas--- going to a different person.
The authorization was made by the family of the donor---a Tokyo man in his 20s, who died in a traffic accident and had expressed his desire to donate his organ while watch a television show on the issue. The heart went to man in Osaka. The liver was taken by taxi to Tokyo University Hospital;. The lungs went to Okayama. One kidney and the pancreas was taken to Aichi. The other kidney was flown to Gunma Prefecture.
Heart Transplanted from Youngest Donor
“In June 2012, Jiji Press reported: “Japan’s nation's first-ever operation to transplant an organ donated from a brain-dead child aged under six ended successfully. The boy's heart was transplanted to a girl aged under 10 suffering from dilated cardiomyopathy at Osaka University Hospital in Suita, Osaka Prefecture. The donation of the heart was critical because adult-to-child heart transplants are extremely difficult as an adult heart is too big for a child. Previously, children requiring heart transplants have had no choice but to go abroad to receive organs, at a huge expense. [Source: Jiji Press, June 16, 2012]
“The boy, who was suffering from hypoxic encephalopathy, or an insufficient supply of oxygen to the brain, was declared legally brain-dead at Toyama University Hospital in Toyama. It is not known whether he wished to donate his organs for transplant. But his parents agreed to the donation of his heart, lungs, liver, pancreas, kidneys, small intestine and eyes, according to the Japan Organ Transplant Network. [Ibid]
“The boy became Japan's first organ donor under the age of 6. Criteria for confirming brain death are stricter for children under 6 than for those older.The operation to harvest his organs started after noon at Toyama University Hospital. Around 1:30 p.m., a medical team from Osaka University left the hospital to transport the heart to Osaka. Other organs were also removed from his body. The boy's liver will be transplanted to a girl under age 10 suffering from a hepatic deficiency at the National Center for Child Health and Development in Setagaya Ward, Tokyo. A female patient in her 60s with chronic glomerulonephritis will undergo transplant surgery to receive the boy's kidneys at Toyama Prefectural Central Hospital. [Ibid]
“The revised Organ Transplant Law, which took full effect in July 2010, allows people aged under 15 to become organ donors, reversing a previous ban. The latest transplants are the second set from a brain-dead donor aged under 15 since the law went into effect.In April 2011, organs from a brain-dead boy aged between 10 and 14 at the time of death were donated for transplant. [Ibid]
Overseas Transplant Operations
According to a 2006 survey, 522 Japanese had received transplants overseas: in the United States, China, the Philippines and other places even though there are laws that ban such activities in Japan. Filipinos that sold their kidneys to Japanese recipients generally were paid between ¥125,000 and ¥400,000.
Police have shut down brokerages that help Japanese get transplants. In October 2007, a Japanese man was detained in China for brokering human organs there for Japanese clients.
Australia and British stopped accepting Japanese seeking transplants. Germany accepted Japanese transplant patients for a while but stopped the practice in 2009 because the widespread belief that harvested organs should be given to Germans not Japanese. The United States, which has a rule that 5 percent of available organs can be transplanted to non-Americans, is one of the last places in the developed world that Japanese can go for a transplant.
In March 2008, an 8-year-old boy from Nagoya received a multiple organ transplant---a stomach, pancreas and large and small intestines---in an 11 hour operation at a Miami hospital. A month before the operation the boy and his mother went to Miami and rented an apartment and waited.
The family of Japanese infants who underwent a heart transplant in the United States was given a bill of $1.6 million. The family of another had to give a deposit of $400,000 before the hospital would agree to do the operation.
Organ Transplant Controversy in Japan
In 2006 there was a controversy over the use of diseased organs in kidney transplants performed on patients at a hospital in Uwajima in Ehime Prefecture. In some cases patients received cancerous kidneys that had the cancerous parts removed or received kidneys from patients with cancer. In other cases, the patients could have been treated using means other than a kidney transplant.
The doctor who did the operations said he did so because he “just wanted to help the patients” by using organs that otherwise would have been disposed of. Critics accused him of experimenting on human subjects. Perhaps the greatest sin committed by doctors was not fully informing the organ recipients of the nature of the kidneys they received.
The death of one man who died of liver failure and acute pancreatitis was blamed on his receiving a transplanted kidney from a person with Hepatitis B. Another kidney came from a patient with syphilis.
The practice of using disease-affected kidneys for transplants and paying donors for their organs is to resume at Uwajima Tokushukai Hospital in Ehime Prefecture under strict guidelines.
Japanese Gangsters Involved in Organ Trade
In June 2011, the Yomiuri Shimbun reported, Police in Tokyo arrested Toshinobu Horiuchi, a 55-year-old Tokyo hospital director, suspected of paying a gang member ¥10 million to find a kidney donor for the director, according to sources. The Metropolitan Police Department also arrested Kazuhisa Takino, a the gang member, who belongs to a group that is part of the Sumiyoshi-kai crime syndicate; the gang member's common-law wife; a former gang member who was chosen to be the donor; and the hospital director's wife.”[Source: Yomiuri Shimbun , June 24, 25 2011]
“According to investigative sources, Horiuchi had been suffering from renal failure. The director and his 48-year-old wife allegedly paid a total of 10 million yen over several occasions from October 2009 to April 2010 to the gang member, 50; his common-law wife, 37; and the former gang member, 47, the sources said.” [Source: Yomiuri Shimbun , June 24, 2011]
“The Japan Society for Transplantation stipulates in its ethics code that organ transplants from live donors should only be conducted among relatives. To evade this requirement, the five allegedly submitted a false application for adoption to the Edogawa Ward Office in January 2010, the approval of which made the former gang member the director's heir.” [Ibid]
“Around May 2009, the Horiuch’s wife told the common-law wife, who was an acquaintance of hers, that she was trying to find a way for the director to receive an organ transplant, the sources said. The common-law wife allegedly relayed the information to the gang member, with whom she was living. About a month later, the director, his wife, the gang member and the common-law wife all met, the sources said. At this time, the gang member asked the director to pay him 10 million yen for finding a donor, they said.” [Ibid]
“The gang member later introduced the former gang member to the director as a donor, and the surgery was scheduled to take place in June 2010 at a hospital in Itabashi Ward, Tokyo, according to the sources. However, the gang member allegedly demanded Horiuchi pay another 10 million yen if the surgery succeeded, and the director refused. Although the negotiations broke down, the gang member has not returned the initial 10 million yen to the director, the sources said. According to the sources, Horiuchi had planned, but failed, to have a kidney transplant in the Philippines around 2008. The Metropolitan Police Department suspects that this failure prompted Horiuchi to ask Takino to find kidney donors. Horiuchi found another donor in his 20s and underwent an organ transplant in July 2010 at Uwajima Tokushukai Hospital in Uwajima, Ehime Prefecture, they said.” [Ibid]
“In December 2006, a patient and his common-law wife received suspended jail terms for giving 300,000 yen and a car to an acquaintance in return for a kidney that was transplanted at Uwajima Tokushukai Hospital.” [Ibid]
Text Sources: New York Times, Washington Post, Los Angeles Times, Daily Yomiuri, Times of London, Japan National Tourist Organization (JNTO), National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.
© 2009 Jeffrey Hays
Last updated July 2012