Organ Transplant Law revision may increase donors, burdens
(From The Japan Times July 19 issue)

改正移植法施行で増える可能性と負担

The revised Organ Transplant Law went into force July 17. The revision is aimed at increasing the number of organ transplants in Japan. But it may increase the burden on doctors, especially at emergency medicine departments.

Before the revision, organs could be taken, with family approval, only from people aged 15 or over who had accepted brain death as actual death and indicated in writing their intention of becoming a donor. Now, organ transplants are possible from a brain-dead person of any age if the person has not openly rejected becoming a donor and if his or her family members approve.

Under the revised law, if a person is declared brain dead, the chance of his or her family members having to decide whether to allow removal of organs for transplants may increase.

It will be wise of people to make clear to their family members in daily conversations whether they are willing to become a donor. Their statements on the issue become the basis for their family members' judgment in case of brain death. People can also use "green cards" distributed by the Japan Organ Transplant Network to indicate their agreement or non-agreement to become donors.

One problem caused by the revised law concerns how to handle children who are unable to form an opinion about whether to become a donor. Utmost care must be taken to ensure that their human rights are not violated. It must be remembered, too, that children's brains have a stronger chance of recovery than adult brains. An effective system also must be put in place to prevent transplants of organs from victims of child abuse.

At hospitals designated as capable of removing organs for transplants, the burden on doctors may increase because they will have to ask relatives of brain-dead patients whether they consent to removing organs for transplants. The government should consider setting up in each area a team specializing in brain-death diagnosis, legally required prior to a transplant operation, to relieve doctors of the burden of conducting the diagnosis.

臓器移植を増やす目的で施行された改正臓器移植法は、緊急医療の場での医師の負担を増やすことになるかもしれない。旧法では、脳死の際には移植のために臓器を提供すると本人が書面で同意し、その本人が15歳以上で脳死し、家族の同意があった場合のみドナーとなることができたが、改正後は年齢制限がなくなり、本人が提供拒絶の意思を示していない限り、家族が同意すれば提供できる。脳死者の家族が移植についての決断を迫られるケースが増える可能性が高い。提供の意思表示ができない子供の場合、人権保護に細心の注意が必要だ。子どもの脳死判定は大人より難しく、虐待を受けて脳死になった子どもが提供者になることを防ぐ制度も必要だ。

指定病院では、医師が家族に摘出の同意を求める負担が増す可能性がある。政府は、手術に必要な脳死判定の専門家チームを各地域に設け、医師の負担軽減に努めるべきだ。