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The Organ Transplant Law went into effect in 1997. Between February 1999 and March 2006, organs from 44 brain-dead people were used for 167 transplants, which involved hearts, lungs, livers, pancreases, kidneys and small intestines. But the number is extremely small compared with the United States, where about 2,000 heart transplants are carried out every year.

Responding to the voices of patients waiting for transplant organs, lawmakers have submitted two revision proposals to the Diet. However, if the Diet deliberations focus only on the technical side of the matter — how to make organ transplants easier and how to increase the number of transplants — it will be difficult to receive public support and a revised law will not function as expected.

Under the 1997 law, brain death as a valid criterion for pronouncing death is applied only to those who have agreed to be donors. Donors must give written consent that they are willing to subject themselves to brain-death diagnosis and the harvesting of their organs for transplant. Only people aged 15 or older can give such consent. Since children under that age cannot become organ donors for transplants in other children, many seriously sick children travel abroad to receive organs. Transplant operations are so expensive that in most cases the patients’ parents and supporters try to cover costs by soliciting funds from the public.

One revision proposal would regard brain death as actual death for every person and would allow the harvesting of organs from a brain dead person if two conditions are met — that the person, while he or she was alive, did not oppose the harvesting of his or her organs and that his or her family consents to the harvesting. This would make it possible to harvest organs from children. The proposal, which categorically regards brain death as actual death, is a radical departure from the current Organ Transplant Law.

The second proposal, while accepting the 1997 law’s basic approach to the concept of brain death, would lower the age at which a person can consent to becoming a donor to 12.

Some lawmakers are considering a third proposal, not yet submitted to the Diet, that would not only lower the age at which a person can consent to becoming a donor to 12 but also allow the harvesting of organs from children between the ages of 6 and 11 if their parents consent.

But a high hurdle has to be cleared first as most Japanese seem unlikely to accept brain death as actual death.

A survey result announced on April 26 by a study group with the Health, Welfare and Labor Ministry shows that only 39 percent of doctors, nurses and other medical workers regard brain death as a valid criterion for pronouncing death. The survey covered 7,456 people working at 31 hospitals authorized to remove organs for transplant from people pronounced brain dead. In contrast, similar research in seven European countries found that 82 percent of those surveyed considered it valid to regard brain death as actual death.

A poll conducted by the Cabinet Office in August 2004 shows that 35.4 percent of the people polled were ready to become donors if they were pronounced brain dead, a slight increase from 31.6 percent in a 1998 poll.

Apparently responding in part to a general sentiment in Japanese society, another proposal calls for making criteria for pronouncing brain death stricter than under the 1997 law. Apart from the issue of brain death, there still seems to be an antipathy to organ transplants. Kidneys can be transplanted if a person’s heart stops beating. But less than 200 kidney transplants take place annually in Japan.

In discussing organ transplant from brain-dead people, it must be remembered that the concept of death is different from culture to culture due to diversified philosophical and religious traditions, and that feelings toward death are also different from person to person even within the same culture.

While patients waiting for organ transplants and their family members are calling for a less restrictive approach to organ transplant, some people believe that harvesting a person’s organs without his or her prior consent is a human-rights violation. Still others feel it is technically difficult to diagnose a child as brain dead.

Since death is a delicate issue, lawmakers should not rush their discussions of revisions to the current Organ Transplant Law. They must persevere to build a consensus on this issue not only among themselves but also among the public. A valuable lesson can be learned from the legislation process for the 1997 law, in which lawmakers having different stances on the issue of brain death managed to cooperate to enact the law with various revisions incorporated into it.

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