Organ donors’ rights become key issue

Now that the Diet has passed a legislator-proposed bill to allow organ transplants from brain-dead donors, some patients may have a chance in the near future to receive organs in this country. The new law ends a 30-year self-imposed ban on such transplants by the medical profession.

Experts generally reacted positively to the new law, in which the definition of brain death is applied only to willing donors. However, they also urged measures to protect the rights of both donors and recipients.

“The compromise law is rational and acceptable. I think it is a good result of a political negotiation,” said Shohei Yonemoto, head of the program on life science and society at Mitsubishi Kasei Institute of Life Sciences in Tokyo.

“It has also shown that the Upper House is functioning,” he added, apparently referring to common criticism that the House of Councilors is just a rubber stamp of the Lower House. The legislation was the result of the reworking of an earlier bill in the Upper House that cleared the Lower House on April 24, after House of Councilors officials observed that politicians were divided into two groups, one supporting the notion that brain death constitutes human death and the other that brain death should not be legally recognized as human death.

The original bill caused controversy in the Upper House because it stipulated brain death as human death and a number of lawmakers maintained that the portion of the general public who were opposed to this definition should not be overlooked. Yuichi Hamabe, director of Tokyo Metropolitan Bokuto Hospital’s Life-Support Emergency Center, also welcomed the compromise, saying emergency medical centers designated to remove organs will not be thrown into chaos by the new law. “Under the law, which is intended to respect the wishes of those who voluntarily become organ donors, I think that emergency surgeons can cooperate (with transplant surgeons) to perform the treatment,” Hamabe said.

The cooperation of emergency doctors will be indispensable for organ transplants because most donors will probably be victims of traffic accidents. Yoshimori Yasuda, a heart recipient who underwent the transplant about five years ago at UCLA Medical Center, said the legislation could be accepted as a first step to allowing such transplants in Japan.

“I think the aborted, original bill, which clearly stated that brain death is human death, was much better than the compromise, which distorts the medical fact that brain death is death,” he said. Yasuda, who is vice head of TRIO Japan, an association of organ recipients, has worked to urge society and the medical community to allow transplants from brain-dead patients.

“But the compromise law is better than nothing. If the law had been turned down, we would have been obliged to start from zero again, which might have resulted in more lengthy efforts to enact legislation,” Yasuda said.

Toshihiro Suzuki, a lawyer and specialist in medical malpractice lawsuits, commented that although the compromise is an improvement on the original, there is no guarantee the limited definition of brain death will not be expanded later, resulting in a violation of the rights of people diagnosed as brain dead. “Considering the current situation at medical institutions, where most patients are not sufficiently informed about their condition, and the violation of patients’ rights is prevalent, I think this anxiety may become reality,” Suzuki said.

“Some fundamental, legal preparation should be made to conduct transplant operations fairly, without violating the rights of both possible donors and recipients,” said the lawyer, who has supported citizen group activities calling for patients’ rights legislation. “We should ensure that the treatment is allowed based solely on the goodwill of donors,” said Suzuki, adding that new legislation to protect patients’ rights should be created before allowing organ transplants in Japan.

First, to protect the wishes of such so-called goodwill donors, a registered donor-card system should be established, Hamabe of Bokuto Hospital said. “I hope the system will be created with the initiative of the Health and Welfare Ministry in an open and unbiased manner, not leaving the task to transplant surgeons,” Hamabe said.

Echoing his view, Michio Sato, an Upper House member and former superintendent public prosecutor at the Sapporo High Prosecutor’s Office, said legal endorsement is necessary for the donor-card system in order to prevent card forgery.