Revising the Organ Transplant Law
(From The Japan Times May 17 issue)

臓器移植法改正へ向けて

    Responding to the voices of patients waiting for transplant organs, lawmakers have submitted two revision proposals to the Diet. However, if the Diet deliberations focus only on the technical side of the matter — how to make organ transplants easier and how to increase the number of transplants — it will be difficult to receive public support and a revised law will not function as expected.

    Under the 1997 law, brain death as a valid criterion for pronouncing death is applied only to those who have agreed to be donors. Donors must give written consent that they are willing to subject themselves to brain-death diagnosis and the harvesting of their organs for transplant. Only people aged 15 or older can give such consent.

    Since children under that age cannot become organ donors for transplants in other children, many seriously sick children travel abroad to receive organs. Transplant operations are so expensive that in most cases the patients' parents and supporters try to cover costs by soliciting funds from the public.

    One revision proposal would regard brain death as actual death for every person and would allow the harvesting of organs from a brain-dead person if two conditions are met — that the person while he or she was alive did not oppose the harvesting of his or her organs and that his or her family consents to the harvesting. This would make it possible to harvest organs from children.

    The proposal, which categorically regards brain death as actual death, is a radical departure from the Organ Transplant Law.

    The second proposal while accepting the 1997 law's basic approach to the concept of brain death, would lower the age at which a person can consent to becoming a donor to 12.

    Some lawmakers are considering a third proposal, not yet submitted to the Diet, that would not only lower the age at which a person can consent to becoming a donor to 12 but allow the harvesting of organs from children between the ages of 6 and 11 if their parents consent.

    But a high hurdle has to be cleared first as most Japanese seem unlikely to accept brain death as actual death.

    The results of a survey announced April 26 by a study group with the Health, Welfare and Labor Ministry shows that only 39 percent of doctors, nurses and other medical workers regard brain death as a valid criterion for pronouncing death. The survey covered 7,456 people working at 31 hospitals authorized to remove organs for transplant from people pronounced brain dead. In contrast, similar research in seven European countries found that 82 percent of those surveyed considered it valid to regard brain death as actual death.

    A poll conducted by the Cabinet Office in August 2004 shows that 35.4 percent of the people polled were ready to become donors if they were pronounced brain dead, a slight increase from 31.6 percent in a 1998 poll.

    Apparently responding in part to a general sentiment in Japanese society, another proposal calls for making criteria for pronouncing brain death stricter than under the 1997 law. Apart from the issue of brain death, there seems to be an antipathy to organ transplants. Kidneys can be transplanted if a person's heart stops beating. But less than 200 kidney transplants take place annually in Japan.

    In discussing organ transplants from brain-dead people, it must be remembered that the concept of death is different from culture to culture due to diversified philosophical and religious traditions, and that feelings toward death are similarly different from person to person even within the same culture.

    While patients waiting for organ transplants and their family members are calling for a less restrictive approach to organ transplant, some people believe that harvesting a person's organs without his or her prior consent is a human rights violation. Still others feel it is technically difficult to diagnose a child as brain dead.

    Since death is a delicate issue, lawmakers should not rush their discussions of revisions to the Organ Transplant Law. They must persevere to build a consensus on this issue not only among themselves but among the public. A valuable lesson can be learned from the legislation process for the 1997 law, in which lawmakers with different stances on the issue of brain death managed to cooperate to enact the law with various revisions incorporated into it.

The Japan Times Weekly: May 27, 2006
(C) All rights reserved

    そんな中、臓器移植法改正2案が、移植を待つ患者の要望に応じて国会に提出された。しかし国会での論議が、臓器移植を容易にし、移植件数を増やす方法論に終始すれば、改正法は国民の支持を得られず、改正の効果もあがらないだろう。

    現行法では、脳死判定は、事前に臓器移植に書面で同意した15歳以上の提供者にのみ可能になる。15歳以下は提供者になれないため、移植を必要とした重病の子を抱えた親が、規制のない外国へ渡航して移植を受けさせるケースが増えている。

    改正第1案は、すべての場合に脳死を人の死と規定し、 本人が生前に臓器移植に反対を表明せず、家族が認める場合に臓器移植を可能にする。この改正案によって、子どもの提供者からも臓器を移植することが可能になる。

    第2案は、脳死の概念は現行法通りとして、臓器移植に同意できる年齢を12歳以上としている。さらに、国会未提出の第3案は、移植に同意できる年齢を12歳以上としながら、6歳から11歳の提供者は親の同意があれば移植できるものとしている。

    しかし、日本では欧米に比べ医療スタッフの間ですら「人の死としての脳死」や臓器移植に対する許容度が低い。脳死者からの移植を考える場合、死の概念は文化間でも、個人間でも精神的、宗教的立場によって異なることを忘れてはならない。

    臓器移植を待つ患者、家族が規制緩和を求める一方で、提供者の事前同意なしの臓器移植は人権侵害だという立場もある。

    死は微妙な問題であり、法改正について国会内だけでなく、国民の合意を得る努力が求められる。異なる立場の議員が協力して現行法を成立させたことがよい前例となるだろう。