A year has passed since the revised Organ Transplant Law took effect in July 2010. Now anyone, even children, can be organ donors if the next of kin consent. The changes have raised the number of donors but many patients are still waiting to receive organs.

The recent arrest of Dr. Toshinobu Horiuchi, 55, who allegedly engaged in illegal organ trading, indicates how desperate donor searches can be. Horiuchi, who was undergoing dialysis, reportedly paid a yakuza to obtain a 21-year-old man’s kidney. Horiuchi further faked adopting the donor to legally proceed with the transplant.

In Japan, kidney and liver donors are generally living.

Despite the revised transplant law, demand for organs far exceeds supply.

Following are basic questions and answers on organ transplants:

What were the conditions to become an organ donor before the revised law took effect in July 2010?

The original law, which took effect in 1997, stipulated that someone who had died could be an organ donor if there was prior written consent as well as the OK from the next of kin.

The law, however, banned anyone under age 15 who was brain dead from being a donor.

How does the current law differ from the original one?

The revised law dropped the age restriction for brain-dead donors. Now basically anyone whose heart has stopped or who has been declared brain-dead can be a donor, even without prior written consent, if the family agrees.

It also stipulates that an examination be carried out to ensure the donor was not a victim of child abuse.

Why was the revision necessary?

The high legal hurdle, including the written consent component, was seen as an impediment to donating organs.

In the 13 years before the revision, there were 1,215 donors, or about 93 per year on average. Of them, only 86 were brain-dead.

Compared with other developed countries, Japan has seen very few organ donations. According to the Japan Organ Transplant Network, there were 1.1 deceased kidney donors for every 1 million people in Japan in 2003, compared with 29.5 in the United States, 22 in Britain, 32.5 in France and 46.7 in Spain.

Why did some lawmakers oppose the revised law?

Mainly they felt the brain death issue, especially as it pertains to small children, was too controversial and sensitive to declare the physical state of death. It is particularly hard for parents to accept that their loved ones are dead if they are still breathing. The hearts of brain-dead infants can beat for years, unlike those of brain-dead adults, which stop within a few days, experts say.

They were also concerned about the possibility of harvesting organs from children who suffered parental abuse — such an extraction would be unethical.

Did the revision improve the transplant situation?

Yes. Since the new law took effect, more brain-dead people have become donors. There were 55 brain-dead donors in the year since the revision, an eightfold increase over the average before the new law arrived.

More brain-dead donors mean more functioning harvestable organs, including hearts, lungs, livers and small intestines.

Generally, this is not possible with people whose hearts have stopped. Also, if there are more donors in Japan, recipients won’t be forced to attempt transplants overseas.

Since the previous law banned brain-dead donors under age 15, many children needing organs went to the U.S. Transplants performed in the U.S. are usually very costly for Japanese patients, for example ¥200 million for a child’s heart.

But in Japan, fees will be mostly covered by medical insurance.

Has the number of child donors increased?

Not really. As for brain death, there was only one case, in April. A boy between 10 and 15 was declared brain-dead in the Kanto-Koshientsu region that month after a car accident, according to JOTN.

His heart, liver, kidneys and pancreas were harvested but data on child donors who die from heart stoppage are not available.

Are there enough donated organs for transplants now?

No. According to the JOTN, 12,781 people were registered to receive organs as of last June, including about 93 percent waiting for kidneys. But from January to June 2011, only 186 transplant operations were carried out.

How do people register to become or not to be a donor?

Registration can be made online at the JOTN website. Those who wish to express their will either to be or not to be a donor can also do so by filling out a green donor card. They are available at convenience stores, banks and city halls.

New driver’s licenses and insurance certificates also have a section where the holder can designate whether to be a donor.

What are the challenges and issues regarding organ donations in Japan?

Medical experts say there is a lack of education about organ donations and transplants in Japan.

With deeper understanding and knowledge, it is likely more people will decide whether to become a donor, they say.

The Weekly FYI appears Tuesdays. Readers are encouraged to send ideas, questions and opinions to hodobu@japantimes.co.jp