Transplant expert rues cadaveric donor, social charity dearth

by Setsuko Kamiya

Surgery is an art founded on science, or so says University of Tokyo professor Masatoshi Makuuchi, who specializes in transplants and is one of the nation’s leading liver surgeons.

“What is most important is to save the lives of those who can be saved — to get the patient back home alive,” said Makuuchi, who was born into a family of surgeons and boasts not having lost a patient on whom he performed a liver operation since 1994.

As for transplants alone, 95 percent of those who received a new liver under the scalpel of the 55-year-old doctor have left the hospital alive.

Unlike the United States and other nations where organ transplants are more common and thousands of them are performed annually from cadaveric donations, almost all transplants performed in Japan are from living donors who are generally related to the recipients. Some patients have no choice but to go overseas in the hope of finding a cadaveric donor.

A major reason for this situation is that brain-death has been legally considered as death only since 1997 in Japan. Social understanding and acceptance of this new definition has yet to take root.

After the first liver transplant was performed from a brain-dead donor in 1999, only 16 such operations have been carried out.

In contrast, since 1989, when the first liver transplant from a living donor in Japan took place, between a parent and child, over 1,000 such operations have been performed.

After Makuuchi’s team of doctors at Shinshu University, his former workplace, in 1993 successfully performed the world’s first adult-to-adult live-donor liver transplant, the operation also became a measure to save the lives of terminally ill adults.

Makuuchi, who came to the University of Tokyo in 1994, has performed live-donor transplants on 154 patients since 1996, of which 86 involved adults.

But live-donor transplants involve the removal of part of a healthy individual’s organ, and as such, Makuuchi said he believes they should ideally be only a support measure to cover the lack of organs available from cadaveric donors.

He criticized media reports that describe doctors as being overeager to perform transplants from brain-dead donors, a misunderstanding that consequently breeds negative views toward brain-death and organ transplants.

Despite the demanding work, Makuuchi, who works over 80 hours a week, noted that treatments using advanced medical technology, including organ transplants from brain-dead donors, are not covered under the health insurance system. Hospitals are thus responsible for such costs as helicopter transport, and these monetary burdens discourage many hospitals from getting involved in this kind of surgery.

“At this point, performing transplants from cadaveric donations is actually extra work and cost for us,” he said. “But it’s necessary for the people whose lives can be saved by this.”

Another reason for the shortage of cadaveric organ donors in Japan, in Makuuchi’s view, is the Japanese lack of a spirit of charity and sense of social mission.

“People cannot sever themselves from society, and there should be more people willing to give something to society if something happens to them,” he said. “And society should appreciate such courage and volunteerism.”

He added that he believes there are many people willing to become donors, and they will come forward if the media provide more information about transplants.

“It’s very important for the number of people who can be saved to increase, and organ transplants should be performed at more institutions,” Makuuchi said. “I really think the media have a responsibility to change the situation.”