At the time of Goto's 2001 transplant, liver allocations were made based on both a patient's medical status and waiting time. Since 2002, livers have been allocated to patients based almost entirely on how sick they are.
It is unclear when Goto joined UCLA's waiting list. He had been in the United States two months when he received a new liver. Overall, 34% of the patients added to UCLA's liver waiting list between January 1999 and December 2001 received a new liver within three years of being listed, national transplant statistics show.
Busuttil, a former president of the American Society of Transplant Surgeons who has testified before Congress on who should receive priority for transplants, released his own statement this week. He did not directly address the transplants of the Japanese patients but said in part:
"As a surgeon, it is not my role to pass moral judgment on the patients who seek my care. . . . If one of my patients, domestic or international, were in a situation that could be life-threatening, of course I would do everything in my power to assure that they would receive proper care.
"I consider that to be part of my responsibility and obligation as a physician."
'A serious player'
On May 18, 2001, Tadamasa Goto boarded Japan Airlines Flight 0062 at Narita International Airport, bound for Los Angeles with his son Masato.
Goto, now 65, had hepatitis C and was worried it would develop into cancer, Maki, Goto's lawyer, said in an interview last week in his Tokyo office. Because Japan has an extreme shortage of organ donors, many sick patients feel they need to go abroad to seek treatment.
The FBI did not help Goto arrange his surgery with UCLA but did help him gain entry to this country, Stern said. The agency had long been frustrated by the reluctance of Japanese law enforcement to share information on yakuza members in the United States.
"For American law enforcement, it's been like pulling teeth to get criminal intelligence from Japanese authorities," said David Kaplan, a journalist who co-wrote the book "Yakuza: Japan's Criminal Underworld," published in 2003 by the University of California Press.
In his book, Kaplan describes Goto's gang, the Goto-gumi, as an offshoot of the largest Japanese organized crime group, the Yamaguchi-gumi. In an interview, Kaplan said Goto is "a serious player in the yakuza. His gang is known for being particularly ruthless and violent."
A senior member of the group and an affiliated gang member were sentenced to prison for the 1992 slashing of a Japanese director whose film portrayed the yakuza as violent thugs, according to a story in the Japan Times. Goto was not personally implicated in the case.
Goto underwent a successful transplant in July 2001. He received the liver of a young man who died in a traffic accident, Maki said. "Goto is over 60 now, but his liver is young," he said.
Several years after the transplant, in May 2006, Goto was arrested in Japan on suspicion of real estate fraud.
Maki said he and other lawyers worried that their client was not well enough to be interrogated. In addition to his liver problem, Goto was suffering from heart disease, high blood pressure and diabetes.
The lawyers asked that Goto be released immediately, but authorities rejected the request, Maki said. He said the lawyers asked that Goto be given his medication at precise times, but that did not happen either. "Goto lost his appetite, had a terrible headache, scratched his arm until it started to get infected, and he was throwing up," Maki said.
Maki used the interview to vent against Japanese prosecutors, saying he believes they were attempting to exploit his client's poor health to obtain a conviction on what Maki considered groundless charges.
He said Busuttil, along with doctors from Tokyo University Hospital and Showa University Hospital in Tokyo, examined Goto and recommended that he be released for outside medical treatment.
On May 24, 2006, some 16 days after he was arrested, the court temporarily released Goto and he entered the hospital.
Goto was acquitted of the charges in March of this year.
"The UCLA doctor [Busuttil] examined Goto during his detention and again one week after he received his not-guilty ruling," Maki said.
The law enforcement official who spoke on condition of anonymity said Goto's criminal history includes prison time. But Maki said that his client's last conviction was three decades ago, for assault, and that his previous convictions were as a youth.
Court records in Japan are kept by prosecutors who generally do not share them with anyone not party to a case.
Jake Adelstein, a former reporter at Japan's largest daily newspaper, Yomiuri Shimbun, said he received a tip about the circumstances surrounding Goto's liver transplant in 2005. Within days of making inquiries, however, Adelstein was visited by men who told him: "Erase the story or be erased," he said in an interview.