Six years after the implementation of the Organ Transplant Law, moves are afoot to alter one of its core conditions for using organs from brain-dead donors — the donor’s prior consent.
Heading the movement is Taro Kono, a member of the House of Representatives who made headlines by donating part of his liver to his father, former Foreign Minister Yohei Kono, in a transplant operation last year.
Since the law took effect in 1997, there have only been 23 organ transplants from brain-dead donors. Some medical experts who say the legislation is meaningless unless the strict conditions are eased see Kono’s actions as a chance for the law to be revised.
“The fact is, in the world of Japanese medicine, there is no way to save a patient other than to slit open the belly of a perfectly healthy person and remove an organ,” Kono told a nonpartisan gathering of Diet members studying bioethics issues in late July.
The issue of transplants from brain-dead donors was so controversial that political parties allowed lawmakers to vote on the legislation based on their own conscience, rather than along party lines. Several stiff conditions were put in place to ensure that the process would be ethical and transparent.
As a result, according to critics, the chances of receiving an organ from a brain-dead donor in Japan are very slim. But the alternative — live donor transplants — can hurt a healthy person, Kono said.
Kono has submitted to the Liberal Democratic Party’s committee on brain death, bioethics and organ transplants a draft of amendments to the Organ Transplant Law that would enable organs to be transplanted with the consent of the family of the deceased. The transplant operation would proceed only if there was no clear indication that the person did not want his or her organs to be donated.
Also under the amendments, children could become organ donors. At present, the law bans organ donations from people under 15, effectively closing the door to children who require transplants and forcing them to seek medical help overseas.
A government survey conducted last year showed that only 9 percent of people surveyed had cards indicating their consent to donating organs in the event of brain death. Under such circumstances, according to critics, it is unlikely that the number of organ transplants from brain-dead people will increase anytime soon.
Easing the criteria so that familial consent would suffice would help make up for the small number of people who have expressed their willingness to make an organ donation, Kono said.
But the idea has met with stiff opposition from lawmakers across the political spectrum. Many see the “personal consent” requirement as one of the major pillars of the law and are hesitant to review it. The LDP panel has not accepted Kono’s proposal, and it has been put on the back burner.
“Securing the consent of the individual is the foundation of the transplant law,” said Takashi Yamamoto of the opposition Democratic Party of Japan. “If it is to be scrapped from the list of conditions, it should not be done through amendments to the law but should instead require the drafting of new legislation.”
Yamamoto, an opponent of transplants from brain-dead donors, said Japan’s present medical environment does not allow patients to gain sufficient information regarding their condition. They are at a disadvantage compared to doctors, he said.
“If the individual’s intentions are not respected, they may be forced into donating organs even if it is not what they wish,” he said.
The health ministry has meanwhile made no active effort to study the issue, especially as the political schedule is unclear with a general election rumored for the fall.
“Prior consent was one of the most pivotal issues when the law was enacted, and it would be difficult to change it,” a Health, Labor and Welfare Ministry official said.