UCLA Medical Center and its most accomplished liver surgeon provided a life-saving transplant to one of Japan's most powerful gang bosses, law enforcement sources told The Times.
In addition, the surgeon performed liver transplants at UCLA on three other men who are now barred from entering the United States because of their criminal records or suspected affiliation with Japanese organized crime groups, said a knowledgeable law enforcement official who spoke on condition of anonymity.
The four surgeries were done between 2000 and 2004 at a time of pronounced organ scarcity. In each of those years, more than 100 patients died awaiting liver transplants in the Greater Los Angeles region.
The surgeon in each case was Dr. Ronald W. Busuttil, executive chairman of UCLA's surgery department, according to another person familiar with the matter who also spoke on condition of anonymity. Busuttil is a world-renowned liver surgeon who co-edited a leading text on liver transplantation and is one of the highest-paid employees in the University of California system.
There is no evidence that UCLA or Busuttil knew at the time of the transplants that any of the patients had ties to Japanese gangs, commonly called yakuza. Both said in statements that they do not make moral judgments about patients and treat them based on their medical need.
U.S. transplant rules do not prohibit hospitals from performing transplants on either foreign patients or those with criminal histories.
The most prominent transplant recipient, Tadamasa Goto, had been barred from entering the U.S. because of his criminal history, several current and former law enforcement officials said. Goto leads a gang called the Goto-gumi, which experts describe as vindictive and at times brutal.
The FBI helped Goto obtain a visa to enter the United States in 2001 in exchange for leads on potentially illegal activity in this country by Japanese criminal gangs, said Jim Stern, retired chief of the FBI's Asian criminal enterprise unit in Washington.
Goto got his liver, Stern said, but provided the bureau with little useful information on Japanese gangs.
"I don't think Goto gave the bureau anything of significance," Stern said. Goto "came to the States and got a liver and was laughing back to where he came from. . . . It defies logic."
Although Stern was not involved with the deal, he said he learned the details when he became unit chief in 2004 and continues to be troubled by what happened.
After the transplant, Goto was again barred from reentering the U.S., said the first law enforcement official, who was not authorized to discuss the matter publicly and therefore requested anonymity.
But Goto continued to receive medical care from Busuttil in Japan. The doctor traveled there and examined Goto on more than one occasion, said Goto's Tokyo-based lawyer, Yoshiyuki Maki -- and evaluated Goto while he was in custody in 2006.
Busuttil's medical opinion was cited in a successful court petition to have Goto released for medical care at a Tokyo hospital, Maki said.
The Times is not naming the other three transplant recipients in this article because neither they nor their lawyers could be reached.
Several transplant experts and bioethicists contacted by The Times said they were troubled by the transplants, especially because organs are in such short supply in this country. In the year of Goto's surgery, 186 people in the Los Angeles region died waiting for a liver, U.S. transplant statistics show.
Some, but not all, of the experts said a transplant center has an obligation to determine whether a patient would be a worthy custodian of an organ and to protect potential donors' faith in the system.
"If you want to destroy public support for organ donation on the part of Americans, you'd be hard pressed to think of a practice that would be better suited," said Arthur Caplan, a bioethicist at the University of Pennsylvania.
In a statement, the UCLA Health System said it could not comment on specific cases because of federal patient privacy laws. Generally, it said it complies with all the rules and regulations of the United Network for Organ Sharing, the federal contractor charged with ensuring the safety and fairness of the U.S. transplant system. Last year, UCLA performed more liver transplants than any other U.S. hospital.
"UCLA's processes for evaluating a patient -- both for mental and physical suitability for organ transplants -- are the same regardless of whether the individual is a U.S. citizen or a foreign national," the statement said.
Hospitals and doctors in the U.S. have the final say on which patients get added to their waiting lists and have the discretion to refuse patients with unhealthy lifestyles that could compromise the transplant's success. Patients may be refused on other grounds as well, including an inability to pay.