Organ Transplantation / Brain Death

2009
[Japanese]

■■What's New

■Events

◆July 20, 2012 International Research Collaboration Event (Lecture by Prof. Dr. Raji C. Steineck "'Brain Death' as 'Equipment'), Kinugasa Campus, Ritsumeikan University

■Opinions about Revision of the Organ Transplantion Law by our Members

◆OTANI Izumi April 9, 2010 "Do not Commend the Self-Sacrificial Death: The Paradox in "Death and Life Education"
Kyoto Shimbun Morning Edition:6

◆OTANI Izumi August 2, 2009 "Comment on Revison of Organ Transplantation Law on July 13: Considering Present Japanese Situation" Contributing to this website

◆AMADA Josuke June 14, 2009 "We Need Enough Discussion on Medical Care", The Kyoto Shimubun Morning Edition:3

■■Theme Related Links

◆Annual Report on Health and Welfare 1999
http://www.mhlw.go.jp/english/wp/wp-hw/vol1/p2c3s4.html

◆Comparison between the Current Organ Transplantation Law and Four Revised Plans

◆Japan and Organ Transplants
http://www.miracosta.edu/home/lmoon/Japanorgans.html

◆Japan Organ Translant Network
http://www.jotnw.or.jp/english/index.html

◆Number of Organ Transplantation in Japan

◆Organ Donation (The Power of Two)
http://www.thepoweroftwomovie.com/organ-donation/

◆Organ Donation Euthanasia (ODE)

◆Organ Transplantation and Hematopoietic Stem Cell Transplantation
http://www.mhlw.go.jp/english/wp/wp-hw5/dl/23010229e.pdf

◆Organ Transplantation in Japan (Wikipedia)
https://en.wikipedia.org/wiki/Organ_transplantation_in_Japan

◆Organ Transplanting in Japan (Japan Organ Transplant Network)
https://www.jotnw.or.jp/english/00.html

◆Organ Transplant (The Japan Daily Press)
http://japandailypress.com/tag/organ-transplant/

◆Organ Transplants
http://web-japan.org/trends00/honbun/tj990813.html

◆Souchan Transplant Fund Raiser
http://sou-chan.net/eindex.htm

◆Support for Japan Organ Transplant Network (Astellas Pharma Inc.)
http://www.astellas.com/en/corporate/information/transplant.html

◆Takeuchi Criteria

◆The Enactment of the Organ Transplantation Law, and The revised Organ Transplant Act
https://www.jotnw.or.jp/english/04.html

◆5.2. Can the "Japan organ transplantation law" promote organ procurement from the brain dead?
http://www.eubios.info/ABC4/abc4133.htm

■■Theme Related Papers / Books etc.

◆ International Network for Life Studies
http://www.lifestudies.org/specialreport01.html
http://www.lifestudies.org/specialreport02.html

◆ YASUOKA Keiko 2013 "Rebirthable Life ： Narratives of Japanese organ transplantation by concerned parties" Journal of the Graduate School of Letters 8:73-81
http://eprints.lib.hokudai.ac.jp/dspace/handle/2115/52326

◆ KARASAWA Yoshihito 2013 "Bioethics and Organ Transplantation in Japan," Journal of Humanitarian Medicine 13 (3): 29-31
http://www.iahm.org/journal/vol_13/num_3/text/vol13n3p29.htm

◆ ICHINOMIYA Shigeko March 31, 2012 "Informed Consent for Liver Transplantation by Liver Donors: An Analysis of Donor Interviews"
Core Ethics 8:53-62　[PDF]

◆ EGAWA H. et.al. 2012 "Current status of organ transplantation in Japan," American Journal of Transplantation 12(3): 523-530.
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03822.x/full

◆ AIKAWA Atsushi 2011 "Organ Donation from Brain-Dead Donors and the Role of the Japan Organ Transplant Network," JMAJ 54(6): 357?362
http://www.med.or.jp/english/journal/pdf/2011_06/357_362.pdf

◆ OLIVER Michael et.al. 2010 "Organ donation, transplantation and religion," Oxford Journals
http://ndt.oxfordjournals.org/content/early/2010/10/20/ndt.gfq628.full

◆ NOÊL Luc & MARTIN Dominique 2009 "Progress towards national self-sufficiency in organ transplants," Bulletin of the World Health Organization 87:647-647.
http://www.who.int/bulletin/volumes/87/9/09-068817/en/

◆ BAGHERI Alireza 2009 "Japan Organ Transplantation Law: Past, Present and Future," Asian Bioethics Review 1(4): 452-456
http://muse.jhu.edu/journals/asb/summary/v001/1.4.bagheri.html

◆ ISHII Masami & HAMAMOTO Mieko 2009 "Bioethics and Organ Transplantation in Japan," JMAJ 52(5): 289?292
http://www.med.or.jp/english/journal/pdf/2009_05/289_292.pdf

◆ MORIOKA Masahiro 2007 "Is it Morally Acceptable to Remove Organs from Brain-Dead Children?", Lancet Neurology Vol.6:90
http://www.lifestudies.org/braindeadchildren.html

◆ MORIOKA Masahiro 2004 "Current Debate on the Ethical Issues of Brain Death", Proceedings of International Congress on Ethical Issues in Brain Death and Organ Transplantation:57-59
http://www.lifestudies.org/braindeath02.html

◆ MORIOKA Masahiro 2001 "Reconsidering Brain Death: A Lesson from Japan’s Fifteen Years of Experience", Hastings Center Report 31, No.4: 41-46
http://www.lifestudies.org/reconsidering.html

◆ MORIOKA Masahiro & SUGIMOTO Tateo 2001 "A Proposal for Revision of the Organ Transplantation Law Based on A Child Donor’s Prior Declaration", Eubios Journal of Asian and International Bioethics 11:108-110
http://www.lifestudies.org/transplantation01.html

◆ MORIOKA Masahiro 2000 "Two Aspects of Brain Dead Being", Eubios Journal of Asian and International Bioethics 10:10-11
http://www.lifestudies.org/brain01.html

◆ KIMURA Rihito 1998 "Organ Transplantation and Brain-Death in Japan. Cultural, Legal and Bioethical Background"
Annals of Transplantation 3(3):55-58 [Full Papers] (http://www.bioethics.jp/licht_transplant98.html)

◆ TATEIWA Shin'ya September 1997 On Private Property(Shiteki-Shoyu Ron), Tokyo, Keiso-Shobo
Chapter 5, Section 3 "The line between what is human and what is not", 4

◆ MORIOKA Masahiro 1995 "Bioethics and Japanese Culture: Brain Death, Patients' Rights, and Cultural Factors", Eubios Journal of Asian and International Bioethics 5:87-90
http://www.lifestudies.org/japanese.html

◆ MORIOKA Masahiro March 6, 1989 Brain Dead Person: from the viewpoint of life studies, Tokyo Shoseki, Tokyo
http://www.lifestudies.org/braindeadperson00.html

>TOP

◆TATEIWA Shin'ya September 1997 On Private Property(Shiteki-Shoyu Ron), Tokyo, Keiso-Shobo
Chapter 5, Section 3 "The line between what is human and what is not", 4 (translation by Robert Chapeskie)

" Are we then to conclude that those who make these kinds of assertions regarding certain "properties" of human beings are not saying anything? I do not think this is the case. There is a world I could never reach, a world that exists beyond me, which I can sense is opened up for me by the other (let us call this approach B'), and I think that it is indeed true that my seeing things in this way plays a large role in my feeling that this other's life should not be taken. This is not the same thing as the others in question themselves being aware of this existence of a world belonging (only) to them. Whether or not they are aware of or can reflect on themselves, whether or not they can make judgments about what is in their own best interests, there is always some manner in which they are experiencing the world. Nonetheless, here we are assuming the presence of a "property", albeit of a most minimal nature, being present within the being in question (for this reason I have referred to this approach as B'). Earlier I stated approach A' as the assertion that, as beings born from other human beings, people are beings whose lives are not to be taken. At the same time, the fact that there is a world open only to the being in question is an important part of the composition of the other as a human being whose life is not to be taken.

Whenever we draw or do not draw a line [between what is and is not to be killed], and whatever kinds of lines are drawn, the reasons for these decisions always come from within us. It is an "I" that thinks of the other as human and therefore a being which is not to be killed and it is also an "I" that thinks the opposite. To this extent both positions are the same. We must keep this in mind whatever point of view we take. Those who propose various "qualifications" for beings that are not to be killed do not understand this or are ambiguous on this point. What we claim or attempt to claim is not that a being without certain qualifications does not have a right to live, but rather that beings without certain qualifications may be killed. This much even those who put forward these qualifications must accept. This being the case, whichever of these views you adopt all of them can only be described as arising from within human beings. All of them involve my relationship with the other. Both B and A', the idea that the death of beings who lack certain qualifications is acceptable and the idea that it is not, are ideas conceived of by us. If the method of discourse begun in chapter four and continued in this chapter is one which makes any kind of judgment (for example, that human beings are to be given special status at least to the extent that they are to be considered a set of beings which are not to be killed) regarding our existence (for example, regarding the set of beings which are not to be killed), it would be on the side of approach A'. Whereas B has been already put forward by others as a clearly stated perspective A' has not, and since I furthermore think that the sense asserted by A? exists as a very fundamental value within I have therefore attempted to put it into words.

There is also B', and what it expresses can be thought of as having special meaning even given the fact that all of these ideas are things we have thought up ourselves. In chapter four I said that there are beings in the world which are not me (I referred to them as "other") and claimed that because of this otherness there is value in accepting the existence of such beings. I would not want to obscure this. But I think that when we consider the existence of what is other not only in this sense but in the stronger sense of the existence of other human beings, along with the simple fact of the existence of something which is not me and the existence of something which is born from a human being, the fact that another world exists within this kind of being is also an important part of our conception of this human other. I think that when we think there is a world inside this other we feel more strongly that its life must not be taken. It is true that even this sense is something conceived of by us, but I think that it is slightly different from something that is merely a conception; the existence of the other appears as a stronger reality and something which cannot be surpassed or overcome. It could be said that what occurs in this other world is also found in the world of what I see and feel, but we are nonetheless aware of the fact that there in the other is a world we ourselves can never experience. Although I can never have direct knowledge of it I believe that in the other there is a world different from my world. I know that at very least a world exists only within the other in the same sense that my world exists only within me.

Stating things in this way is separate from the debates surrounding approach A - separate from arguments over, for example, whether young infants are not qualified to be considered humans. In practice the domain of what is to be considered a being which must not be killed indicated by approach A' largely overlaps that indicated by approach B'. There are connections between children being born and beginning to live and a world beginning to exist within them. However, if we subtract the state described in approach B' (a world exists within the person in question) from the situation found in approach A' (the person in question is considered a human being because he or she appeared within a human being) a resulting "blank" state is not inconceivable. In such cases we cannot say that a world exists within the other. Even in such cases I am liskely to think of this being as a person and as an other. Since there is only blank space within the person in question, only I am thinking about this other's existence, all that remains is my thinking of it as other, and thus to this extent I think what occurs here can be seen as different from my thinking something based on or conforming to this other itself.

What are we to make of this state ? This question is connected to the difficulties that arise when we think about "brain death". Putting aside all of the questions which are being addressed and must be addressed in regard to the biological facts regarding this subject and the verifiability of these facts in practice, and disregarding the dangers of assuming it is possible to measure something which is so difficult to measure and the additional danger of the fact that this dangerousness is bound up with the various interests of those around the person in question, what are we to conclude if it were possible to confirm cases of brain death in which the mind of the person in question is completely blank and there is no possibility of their making any kind of recovery? I think some people would be able to turn off the life support systems of the person in question. Here it is an 'I' that comes to the judgment that this is not a problem. I (we) am also the one who will use his or her organs, and the desire for these organs to be used in this way does indeed come from me (us). Those who on the other hand do not address the problem in the same way also do so according to their own inclinations; once again the judgment in question is made by an 'I'. It is also I (we) who do not think of the body of such a person as a corpse or inanimate object and who continue to think of them as a being which has not died (a being whose life must not be taken) and require the so called "three signs of death" to confirm they are no longer alive. Of course it is in no way the case that the former point of view is correct because it is "scientific" and the latter is incorrect because it is not. "Science" can only provide information regarding the biological state of the person in question, and since both approaches to dealing with this kind of situation arise from our ideas or attitudes it can be said that to this extent they are of equal value.

In addition to this it can also be said that within this blankness all unique or distinctive qualities of the being in question are lacking. Therefore to think that the latter point of view is based on some kind of "cooperation" with the being in question would be mistaken. To cooperate with this being is impossible; on the contrary, could it not in fact be said that this idea, if it is an idea which can only come from me (a criterion or set of criteria different from those based on using the being in question for some purpose or allowing them to die because their continued existence would be somehow inconvenient) is an idea which is in fact more "egocentric" than the other approaches discussed?

What are we then to think having acknowledged the above? On the one hand there are those who when faced with a being in a state of blankness feel that this is a life which must not be taken. We cannot say that in these instances these people's way of thinking is strange or bizarre. If what I have stated earlier is accepted it is indeed true that we (at least some of the time) experience this kind of sense as well. And of course in this case no positive reason will arise to take the lives of those in a state of blankness. B' not being the case does not provide a positive reason to accept the elimination of the being in question. It only serves to weaken the reason that such eliminations should not occur. Do we give priority to A'? To what extent do we take into consideration the fact that the stronger (narrower) condition B' places on what should determine whether the being in question should not be killed is not satisfied in these cases? There is no absolute answer regarding which approach should be taken here. We can think of this as being the case because both points of view are deeply rooted in our actual experience.

Putting aside the topic of organ transplants from people in a state of brain death which is not being addressed here, we can always simply wait for the time required to pass from B' to A', and as a result leaving the answer to this question undetermined is in practice not so problematic. But it is possible to take our consideration of it a bit further. It is possible to continue thinking of a being as alive and not wanting to destroy it not only after brain death but also after the complete cessation of all biological and physiological life. We may even be able to preserve their body as if it were alive. But what becomes clearer and more explicit in such cases is that these attempts to preserve the being in question arise solely as a result of our own thoughts and desires. Is this attempt to preserve this body, which has already ceased to be something lived in and received by the being in question, not in fact an activity which aims to separate this body from that being which had received it and lived with it and attempt to bring it within my own domain? Can I really be said to posses the right to do this?

At very least, if the individual in question wants to renounce any life that might continue after the world of their experience ceases completely or any preservation of their body after their life has ended, then from the perspective of the claim that we must respect the existence of the other itself and not only the other in the sense of something related to the self we must no doubt adhere to the will of the person in question. "(pp.191-195)

UP:July 16, 2009 REV:July 17, 2009/July 23, 2009/July 28, 2009/July 30, 2009/August 10, 2009/September 2, 2009/October 9, 2009/October 13, 2009/May 6, 2010/May 24, 2010/December 13, 2010/March 1, 2012/May 15, 2012/June 4, 2012/July 19, 2012/July 13, 2015, 20160526

Prepared by:Minoru Kataoka

TOP / HOME(English) / HOME(Japanese)