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Otani Izumi "Comment on Revison of Organ Transplantation Law on July 13": Considering Present Japanese Situation

August 2, 2009 Contributing to this Website

The bill of "Amendment" of Organ Transplantation Law was passed in the House of Councilors in Japan on July 13, 2009. It was passed in a chaos-30 minutes after the dissolution of the Lower House on July 21, 2009 was announced. How will the later generation look back this disaster that such an important issue which should be left to individual view of life and death was decided by politicians whose main concern was the political situation. Moreover, this bill defines all brain deaths as human ones, although the western countries, with much developed history of organ transplantation, have already denied the standard of "brain death equal human death".

One of the reasons which caused this situation was the problem of children's organ transplantation. Because of the criticism against organ transplantation tourism, the restriction of going overseas for transplantation becomes more strict. Still, Japanese children have no other choice but to go overseas under the present legal structure. Also, the law had been left untouched for last eleven years, although it stated the revision three years after its enforcement in 1997. The members of the House must have been urged to take some actions against such a situation.

However, the amendment of the law will not relieve the lack of donated organs as the present situation in Western countries says. The frontier bioethics and medical societies in America, where the "brain death equal human death" standard does not stand anymore, have artificially stopped the heart beating in order to take out people's organs, then actually extract their organs after a few minutes. This is called "Pittsburgh Approach", organ transplantation after arrest of the artificial cardiac. In such cases, expected donor candidates are said to be patients with severe brain damages, high level of spinal cord damages, or terminal stage of ALS (Amyotrophic Lateral Sclerosis) patients [Morioka 2009].

It had been long said that Christian areas in the Western countries supported promotion of organ donors because of religious soil and mechanistic views of human beings which regard the acts as those of Agape (love based on Christianity). However, recent studies point out that such statements were adpoted for political and policy reasons. Still, the increasing number of organ donors, considered with increasing number of physician-assisted suicide, indicates the reality of the present American situation where human lives are materialized under the name of love and dignity, then graded according to their quality and scrapped to death.

Let me reflect the history and talk about the present situation of organ transplantation in Japan. The presence of children with chronic brain death in comparison with many children waiting for a chance of organ transplantation overseas, caused a big dilemma in public. This dilemma simply reflects the one that technology of organ transplantation is based on sacrifice of other people. If so, the eleven years of "neglect" after the enforcement of the law may not have been a simple neglect. The limited number of donor-card registration probably shows the dilemma. In Japan where only a few donors are available, live organ transplant is more popular, and it has been pointed out recently that a candidate (and also a family member) who will donate his/her organ has received pressure among the other family members of a person who needs organ transplantation. Such pressure can be intensified because of this amendment allows a patient's donation of organs to his/her family members preferentially. Some members in Japan Association for Bioethic approve the (fair) organ trading. However, it just accepts the problem of life's North-South issue of Organ Transplant Tourism because the gap between the rich and the poor has been widening in Japan.

Therefore, it seems clear that medical transplantion which contains a lot of problems should not be promoted. It goes without saying that commercialization of organ exchange should not be promoted in order to promote what should not be promoted. The mass media and "public" should recognize that the egoism is covered up or hidden by using the concepts of love or gift. It is about time that the media and the public face such egoism which hides under such statements as love or gift.

I believe that the 30-year "stagnation" of Japanese medical transplantation was not the "delay" compared with the global standard, but the proof of deliberation Japan should be proud of. The amended oran transplantation law is unfortunately heading to the opposite direction, but we should develop the medical technology that requires no sacrifice from other people, as we critically consider the present situation of Western countries.

Morioka, Masahiro June 27, 2009 "Passage of Plan A of Revision of Organ Transplantation Law: Bleakness in the Frontier U.S."
Asahi Shimbun Morning Edition
http://www.arsvi.com/d/ot2009.htm#0627 (Japanese)

UP:August 10, 2009 REV:August 24, 2009
Preparer & Translation by Midori Hiraga
*Otani, Izumi *Organ Transplantation/Brain Death
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