Arguments Against Promoting Organ Transplants From Brain‐dead Donors, and Views of Contemporary Japanese on Life and Death

Abstract

As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain-death determination and organ extraction, and the appropriateness of priority transplants for relatives. In the four months of deliberations in the National Diet before the new law was established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain-dead donors are unacceptable because they result in organs being taken from living human beings. Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain-dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain-dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based.

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“…A society's, including its scientists', interpretations of these relationships can greatly influence the choice of projects pursued and the way research is conducted, and delimit the ultimate applications of neurotechnologies. Cultural views on death or brain death are not universal (Asai et al, 2012;Yang and Miller, 2015), nor are views of the inviolability of life, as evinced by gene editing of human embryos first in China and subsequently in the UK and US (Liang et al, 2015). Cultural differences have had a marked impact on what is considered permissible in national funding for research.…”

Liver Allocation to Non-U.S. Citizen Non-U.S. Residents: An Ethical Framework for a Last-in-Line Approach

“…At present, OPTN does not maintain data on the individual countries from which NCNRtx patients originate. Nevertheless, it can be surmised that a sizable proportion of these persons come from countries with notably inferior domestic transplant infrastructure , such as Saudi Arabia, Egypt , and Japan . Assuming this scenario to be accurate, it would be permissible under a survival benefit–based model to include considerations of the patient's ability to adhere to accepted posttransplant care and treatment once they return to their home country.…”

“…It is worth reflecting on whether justice is actually served by refusing transplants to patients from wealthy countries such as Japan whose cultural norms are in conflict with organ donation. The Japanese opposition to organ donation stems from centuries‐old customs and practices that are incompatible with the comparatively new concept of “brain death” . Notably, Japanese funeral and “deathbed” customs cannot be adequately preserved if organs are procured from the body, regardless of a declaration of brain death .…”

“…The Japanese opposition to organ donation stems from centuries‐old customs and practices that are incompatible with the comparatively new concept of “brain death” . Notably, Japanese funeral and “deathbed” customs cannot be adequately preserved if organs are procured from the body, regardless of a declaration of brain death . For people who reside in such countries, whether or not they share the prevailing beliefs, they must look to other countries for access to transplantation.…”

“…Indeed, it was the result of external pressures (i.e. the recommendations put forth in the Declaration of Istanbul and by the World Health Organization) that led Japan to recognize brain death as legal death and to revise existing law to permit organ donation by decedents who had not previously opted out and whose family consented to the donation .…”