Japan’s Brain-Death Bill Fuels Debate--and Hope for the Ill

TOKYO — Because Japan’s first and only heart transplant operation almost 30 years ago prompted criminal investigations, the debate over when death legally occurs has raged on here since, making human organ transplants nearly impossible.

But last week, the lower house of Japan’s parliament passed a bill that says an individual is dead when there is no detectable brain activity--a legal definition that would open the door for organ transplants and create new hope for tens of thousands of Japanese who need them.

Japan’s reluctance to allow the removal of organs from brain-dead patients, as is routinely done in most industrialized countries, has forced some who are desperately ill to seek transplants abroad and left hundreds of others to die every year.

In Japan, where ancient beliefs hold that cutting a corpse defiles an individual’s spirit, death now is legally defined as occurring at the moment when the heart stops. Doctors here can perform kidney, cornea and some liver transplants because those organs deteriorate less rapidly after the heart stops or they can be obtained from living donors.

But fewer than 800 kidney transplant operations take place annually in Japan, even though 15,000 Japanese waited for them last year; an estimated 4,000 patients are said to need heart or liver transplants.

In the U.S., where the issue is left to states to decide, the norm generally is to consider individuals dead and their organs available for transplantation when there is no detectable brain activity. About 10,000 kidney transplants are performed annually in the United States.

The Japanese brain-death bill, which would ease what experts say may be the world’s strictest regulations on transplants, has yet to pass the upper house of parliament.

The bill’s controversial nature and divided public opinion have made the legislation’s fate difficult to predict. A poll this week by the Yomiuri Shimbun daily showed that 46% of those surveyed supported a brain-death standard, down from 54% one year before.

But so sensitive is the matter that, for the first time in this nation’s postwar history, all but one of Japan’s political parties let members decide for themselves rather than vote along party lines.

The media spotlight on cases such as that of Miyuki Monobe--an 8-year-old Japanese girl who died in Los Angeles last month while awaiting a transplant--has been credited with raising public awareness and prompting lawmakers to act. She flew to Los Angeles but died before a suitable heart could be found for her.

Frustrated with watching their patients die while legislators haggle, some doctors are already gearing up for organ transplants.

But analysts say even if the bill passes, the small number of brain-dead patients who meet the law’s strict criteria--written consent by the donor and next-of-kin approval--would mean a negligible increase in donors.

The transplant situation here is also difficult because the new law would restrict donors to those who are 6 or older, meaning there would a sharply limited number of organs available for child recipients.

Controversy over the brain-death standard began brewing in 1968, when the surgeon who performed Japan’s first heart transplant was investigated for murder. The case was later dropped, but not before it worsened the public distrust of the Japanese medical community.

But Tsuyoshi Awaya, a medical sociologist, noted that the biggest obstacle now to a greater number of donations in Japan is simply the lack of a philanthropic ideal. The Japanese “would donate organs to a friend or a relative but not to a stranger,” he said.