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Japan at Work on Transplant Rules : Medicine: A political resolution may be in sight in this long controversy once a panel decides if human life ends with brain death.

April 22, 1990|IRENE KUNII | REUTERS

TOKYO — Dr. Juro Wada carried out Japan's first and only heart transplant 22 years ago and is still fending off charges of malpractice in a case that has created a taboo against organ-transplant surgery.

"They charged me with murder for saving a life even though my heart-transplant patient was the second-longest surviving one at the time, 83 days," Wada said with impatience in his Tokyo clinic.

"And still today patients are dying every day as we wait around for some decision to be made on organ transplants."

Now a political resolution may be in sight as controversy spreads over what has become a classic double standard: Japan welcomes organ transplants for Japanese overseas while its medical profession, fearful of prosecution, places an unofficial ban on them at home.

A 15-member panel of academics and professionals approved by Parliament has begun debate on whether human life ends with brain death. It is a critical question that will determine the future of organ transplants in Japan.

"They'll decide in about two years that brain death is official and a law will be established, but even that's too long to wait," according to Dr. Naoshi Kamada, a Cambridge- trained expert who recently testified before Parliament in favor of transplants.

Many Western countries, including Britain and the United States, have proceeded with organ transplants and tackled any ethical and legal questions as they arise. In contrast, Japan's medical community imposed an unwritten moratorium on transplants and shied away from the issue since Wada's controversial operation in 1968.

Until an alternative is found, surgeons performing heart and most other transplants require organs from donors diagnosed as brain dead, a state where the brain is not functioning but respiration and organ functions are artificially sustained.

Kamada, who performed regular liver transplants for six years in Britain, contends that organ transplants "are absolutely legal" after a ruling two years ago by the Japan Medical Assn. (JMA) that full brain death can be taken as ending life.

"The JMA ruling is enough but still doctors are not performing transplants," said an exasperated Kamada, head of experimental surgery at the National Children's Hospital.

Meanwhile, the number of Japanese traveling overseas for organ transplants is rising rapidly and the Japanese media is playing up the plight of children requiring surgery.

A 16-year-old youth now waiting in Britain for a donor organ may become the fifth Japanese to receive a heart transplant, and an estimated 50 people have received liver transplants in the United States, Australia and Britain in the last five years.

"The Japan Transplant Society and other organizations are not interested in revealing the actual figures because of the controversy it would create," Kamada said.

Kazuo Takeuchi, Kyorin University president and dean of its medical school, said there is concern about public opinion in other countries with the emergence of the double standard.

"There is a shortage of organ donations in the United States (and other countries) and I think many people there would rather see the organs used for their own than for the sake of Japanese patients."

Takeuchi, known for his work in drawing up the 1985 "Takeuchi Standard," a Health Ministry set of criteria for the clinical diagnosis of brain death, said he would support transplants here to save lives. He added that future legislation must also take into consideration the rights of the donors.

Although prosecutors finally dropped the Wada case due to lack of evidence, doctors and the media turned against organ transplants after Wada was alleged to have removed the donor's heart without properly confirming that he was brain dead.

"People lost confidence in the medical profession following the Wada case, where first of all we found that the donor had not received proper emergency resuscitation," said lawyer Tadahiro Mitsuishi, involved in drafting the position of the Japan Federation of Bar Assns. on brain death.

"No one wants to take a risk, particularly the doctors in charge," said Kamada, many of whose colleagues have left for hospitals overseas where transplants are permitted.

Since the Wada case, a Tokyo University patients' rights group headed by Dr. Katsunori Honda has brought murder or other criminal charges against three medical teams in which organs other than the heart were removed. The group claimed that in each case there was evidence of abuse of donor rights.

Medical reports showed that organs from brain-dead donors accounted for about 20% of kidneys used in transplants in 1984 by doctors defying the taboo. They dropped to around 10% after Honda's group asked prosecutors to indict a Tsukuba University medical group that conducted a kidney-pancreas transplant in 1984.

"But there may be more of these kidney transplants (using brain-death organs) than we hear about," said Mitsuishi, who also testified before Parliament.

As the government mulls the problem, a new generation of surgeons wants hospital and university ethics committees to allow them to proceed with transplants before an official ruling.

A newspaper survey in mid-March showed that 13 ethics committees polled around the country said they expected to approve transplants from brain-dead donors.

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