Vote looms on legality of brain death, transplants

After years of inaction, members of the Diet must make the difficult decision of whether brain death should be stipulated as human death to pave the way for allowing organ transplants from brain-dead donors in Japan.

Two lawmaker-proposed bills that would allow organ transplants are expected to be put to a vote April 24 at a plenary session of the Lower House, nearly three decades after the first and only heart transplant was performed in the country.

The main difference between the two bills is that one calls for legal recognition of brain death as human death while the other does not make such a petition. In the former bill, brain death is defined as death of the whole brain as opposed to just death of the brain stem. All political parties except the Japanese Communist Party have allowed their members to decide for themselves whether to support one of the bills or vote against both. Members of the JCP are expected to reject both.

Senior lawmakers say this will mark the first time under the nation’s postwar parliamentary democracy that nearly all major political parties will leave each legislator to individually decide how to vote for an important bill. “We should enact the bill stipulating brain death as human death to resume organ transplants to save the lives of patients who will otherwise die,” said Taro Nakayama in support of the bill submitted by a group of 77 nonpartisan lawmakers which he represents. A Liberal Democratic Party legislator, Nakayama is also a medical doctor.

In response to the group’s move, Lower House Representative Seiichi Kaneta and 27 other lawmakers from the Democratic Party of Japan, Shinshinto and the Social Democratic Party presented the other bill as a counter-proposal. Kaneta, a DPJ member, said, “It would be inappropriate to enact such a law when the public has been widely divided over the issue.”

In an opinion poll conducted by a national daily last fall, about 53 percent of respondents said they accept the recognition of brain death as human death. Both bills are aimed at allowing organ transplants from brain-dead patients on the condition that written consent for the procedure has been given by the donor in advance. The bill drafted by Kaneta’s group states that those declared brain dead could become good-will donors even though their condition does not constitute legal death.

Yukio Edano, a DPJ lawmaker as well as a lawyer, says organ transplants involving brain-dead donors could be performed without legally stipulating brain death as human death, as seen in some parts of the world, including Britain and nearly a dozen U.S. states. Such transplants are an established practice in the U.S. and Europe, as are transplants of kidneys and corneas from cadavers.

In 1995 alone, about 3,600 heart transplants and approximately 6,200 liver transplants were performed throughout the world, according to the Health and Welfare Ministry. However, doctors in Japan have refrained from performing such transplants after the highly controversial first heart transplant from a reportedly brain-dead donor was performed at Sapporo Medical College in August 1968. It was the 30th such operation in the world.

Prosecutors spent 15 months probing the case after the recipient died in October that year, to determine if the donor was in fact brain dead and whether the recipient died as a result of an unnecessary transplant. Although prosecutors dropped the case due to insufficient evidence, the case led the public to harbor deep-rooted distrust of doctors.

Surgeons and some patients’ groups have long complained that patients who can be saved through such treatment continue to die in this country despite technical advances. “It is unfair that patients with severe heart disease and liver disorders in this country have no other choice but to die,” said Asako Yasuda of Tsukui, Kanagawa Prefecture, whose husband received a heart about four years ago in a transplant operation at UCLA Medical Center.

So far, 33 people from Japan have received new hearts overseas, mainly in Australia and the U.S., and 142 others have received livers abroad as of August 1996, according to TRIO Japan, an association of organ recipients. In response to increasing demand from medical circles and patients’ groups for transplant procedures in Japan, the government in 1990 formed an advisory panel to study the issue.

The panel in January 1992 compiled a report stating that brain death should be recognized as death and that organ transplants from those declared brain dead should be allowed. Due to the sensitive nature of the issue, however, the Health and Welfare Ministry did not take any initiative in drafting a bill for the purpose but instead left the task to lawmakers.