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Some desperately ill children in Japan are dying because the smaller organs they require for transplant surgery are unavailable here. When their families can afford it, children needing such operations must travel to the United States or other countries where the use of organs from brain-dead donors under the age is 15 is permitted. Sometimes even that is too late because the children must wait for organs to become available, and other potential recipients were registered before them. Now, although the issue remains emotionally charged, moves are under way to promote changes in the three-year-old Organ Transplant Law to allow such donations from children aged 15 and younger here. The proposals deserve careful study and ultimately should win public understanding and support.

The question is not as clear-cut, however, as it can seem in petitions for changes in the law from desperate groups of parents and sympathizers. Public debate on the issue is certain to be heightened by the decision of a nonpartisan group of Diet members under former Foreign Minister Taro Nakayama to review the application of the present law so that transplant operations from brain-dead donors under 15 will be possible. The group will have to concentrate its greatest attention on the question of whether the intention of children below the age of 15 can be legally recognized. The Civil Code dictates 15 as the age limit for making a last will and testament.

Japan’s Organ Transplant Law sets what are generally agreed to be the strictest conditions in the world for the removal of organs from brain-dead donors for transplant surgery. It is a misconception, however, that among these is an age limit for potential organ donors. When the Diet was deliberating the proposed legislation it decided to set the age limit at 15 in the application of the law, based on recommendations from the Health and Welfare Ministry. For certain cultural and in some cases religious reasons, many Japanese remain ambivalent or even opposed to transplant surgery. That is why the conditions set by the law require that potential donors have given previous written or other documentary consent and that family members give their approval for the operation.

However, the Diet rejected the suggestion that organ donations should be allowed with the approval of family members in cases where the potential donor’s intentions were not clear, although laws with such a provision are in effect in many other countries. Critics of that decision, which include a growing number of patients’ organizations, understandably question why the decision of family members should not be sufficient to allow the organs of a brain-dead child to be used to prolong the life of another child. The sticking point in the calls for change is this view that the wishes of any potential organ donor himself or herself, regardless of age, must be indisputably clear.

That will have to change in the case of children if the life-saving potential of the Organ Transplant Law is ever to be met. This is not only a question to be addressed by concerned lawmakers and by patients and their supporters. There is also an essential role to be played by Japan’s medical establishment, which on controversial subjects too often seems to lag behind public opinion instead of helping to shape and guide it. In what way are seriously ill children needing organ transplants being helped by the prolonged wait-and-see attitude being demonstrated by many of those who should be at the forefront of the movement?

Periodic surveys show a continuing rise in the number of people nationwide who hold valid organ-donor cards, although progress is slow. A recent study by the Prime Minister’s Office found that around 9 percent of people over the age of 20 hold the cards, with marked improvements noted among men and women in their 20s and 30s. The increase in card ownership unfortunately has not translated into an actual increase in transplant operations. The Japan Organ Transplant Network based in Tokyo recently announced that there were 235 cases nationwide over the two-year period ending in July in which organs from potential donors went unused for various reasons.

In almost 70 percent of the cases, the hearts of the potential donors had stopped, making it too late for the operation. Sadly, as many as 60 percent of the would-be donors whose organs could have been used died in medical facilities that were not equipped to perform transplant surgery on brain-dead patients. It is time to review the entire organ-donor system, not just the question of permitting donations from brain-dead children 15 and younger. Human error is causing the law to fail in its most basic aim when the known wishes of many adult potential donors are not being met.

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