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.
