lifestyle

Japan slowly learning to embrace organ donation

34 Comments
By Jessica Ocheltree

In many respects, Japan’s health system is world-class, with universal insurance, skilled doctors and a culture of social responsibility. Yet there’s one area where the country has lagged far behind other industrialized nations: organ transplants. While an average of 68 transplants are performed in the US every day, until last year Japan was clocking up just 10—every year.

One reason was the restrictive terms of the 1997 Organ Transplant Law, which only allowed donation in the case of brain death and with prior written consent, as well as the consent of the donor’s family. Moreover, children under 15 couldn’t give consent, making pediatric heart transplants essentially impossible. Last July, however, revisions came into effect that significantly relaxed the law, dropping the age restriction and the written consent requirement.

According to Misa Ganse, public relations and education director of the Japan Organ Transplant Network, the number of brain-dead donors has increased about six-fold. “Since the changes to the law went into effect about six months ago, there have been 31 cases of organ donation from brain-dead donors,” she says.

The addition of donor consent forms to medical insurance cards and driver’s licenses has also been a huge help, providing a high-profile alternative to the voluntary consent cards that were previously the only option. As Ganse says, the change “has increased the recognition of organizations dealing with organ donation and the credibility of individual consent.”

However, even with these improvements, the demand for transplant organs still far outstrips the supply. “There has been a decrease in the number of kidneys donated after cardiac arrest,” says Ganse. “And, although it’s now possible under the law, we haven’t yet had a case of a brain-dead donor under 15.”

It turns out that the relaxation of the law was only the first step in a much longer process, beginning with more effective outreach. In countries where organ donation is well established, the public hears about it in school, through the media, and from an extensive network of public health and advocacy groups.

“In Japan, a lot of people first learn about organ donation when they look at their insurance card or driver’s license,” says Ganse. “So it’s important to raise awareness, to make sure people have the correct information when they are filling out the forms, and to make sure their families are aware of and in agreement with their wishes.”

There is also work to be done within the medical field. A recent study by the Ministry of Health, Labor and Welfare found that Japanese medical facilities may not be ready for a surge in transplants. Of the 492 institutions ostensibly capable of performing transplants after brain death, only about 300 reported that they were properly prepared, and fewer than 60 said they would be able to perform transplants on people under 18.

There’s also still no consensus regarding the sensitive issue of when and how families should be approached if there is no prior written consent. Japan has only a handful of donor coordinators, who have special training in supporting grieving families while counseling them on the possibility of organ donation. Most of the time, individual institutions have to set up their own policy and training.

Still, Ganse is confident that things are now on the right track. “We hope that all of Japan will come to see that organ transplants are a socially necessary part of medical care and be able to give us their support,” she says.

To find out more about Japan Organ Transplant Network, see www.jotnw.or.jp.

This story originally appeared in Metropolis magazine (www.metropolis.co.jp).

© Japan Today

©2022 GPlusMedia Inc.

34 Comments
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Better late than never.

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universal insurance, skilled doctors and a culture of social responsibility.

You lost me at this point.

For starters how can you possibly describe as "skilled" a transplant surgeon who has barely ever performed transplants? 10 a year (now 32 in 6 months) from 492 institutions capable of performing them doesn`t exactly smack of cutting edge to me.

Culture of social responsibility? Has this writer actually ever been to Japan? Im sorry if I sound harsh but I dont see much evidence of social rsponsibility around me on a daily basis. Sure, the law is restrictive in terms of adoption, fostering, organ donation and do on, but I don`t see reams and reams of Japanese protesting about it and demanding the right to philanthropy either.

The change in the law is a good thing, but without the medical institutions being ready, or a national awareness campaign, its not going to make a big difference.

Ive just canvassed MIL for her opinions and she said for Japanese the idea of being cut up in horrible, plus they dont want to give organs to someone they dont know because they wont receive anything in return (WTF??!). She then said "And anyway, what if you change your mind later??!"

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And yes, she DID mean after death!

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Use the teachings of Zen Buddhism to back the cause. Your body is just a container for the immortal soul--why not recycle when you're done with it?

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"In many respects, Japan’s health system is world-class, with universal insurance, skilled doctors and a culture of social responsibility."

Yup, lost me. Don't get me wrong, I've met some great doctors here and some really do want to get things better, but that statement just doesn't ring true anywhere near a European nation for example.

If by 'social responsibility' they mean a bit of wa and a lower crime rate, I could support that. If they mean doctors take responsibility and offer openness discussing diagnosis and medication then I might have to decline.

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I've actually had some conversations about organ donation with people in the office and some of my Japanese friends.

One thing that was quite interesting to me was that people who have children said that when their children are brain dead, as parents, it is probably extremely hard to make the decision to donate the children's organs, and even if they know the children will not speak or open their eyes again, they still don't want to stop the heart. As long as the kids' bodies are warm, they don't want to stop the heart -- so, VERY tough to decide to donate organs of their kids even if it means that some other children might survive.

However, most of them said that THEY want to donate their organs if they are brain dead. And some of them showed me the donor card that they carry in their wallets. I have mine, too. They said that they would like to donate their organs if it means someone else will live using their organs.

I am not sure how older generation think about this whole thing. My guess is the older they are, the more against they are about organ donation.

To be very very honest, I cannot be 100% confident if I can say yes IF one of my kids die (brain dead) and asked the question... Thinking about this makes my heart ache..

I don't want my parents to go through the pain IF I'm one day brain dead, and that is why I carry my donor card so that they know it is MY decision and not theirs.

Small kids cannot make the decision and so the decisions are all up to the parents/families. And because it is not their body, it is their beloved children's, the decision is tough even if they know it's a good thing..

I will talk to my children when they are 18 and so that they can make the decision to carry or not carry the donor card. Most people don't have to face the decision, but I think it is a very important topic for every family to discuss.. What-if..

Sorry my post is so long but I get so emotional when it comes to topics like this...

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My friend died last year because she was waiting for an organ. The staff at my local hospital didn't even know where to get a donor card from. They should push organ donations much more, it is ridiculous that anyone is even thinking about not donating his organs nowadays.

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Cripes!! Locals don't even like second-hand houses or cars, how are thyey going to get down with a second hand organ!!

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There's a 19 year old kid from my area who has to be sent to the U.S. for a heart transplant at a prohibitively expensive cost - somewhere in the hundreds of millions of yen. I see his relatives and friends at almost every major event asking for donations. It's sad that he obviously cannot get a transplant here.

Ive just canvassed MIL for her opinions and she said for Japanese the idea of being cut up in horrible, plus they dont want to give organs to someone they dont know because they wont receive anything in return (WTF??!).

Speaking of donations, I've heard this excuse too. I find the culture of gift-giving/receiving here very polite, but it hasn't seem to have bred much of a charitable mindset, even when it comes to things that are of no use anymore. I've also heard a religious belief that if one's body isn't "whole" when one dies, you won't be able to pass into reincarnation/the afterlife; my friend gave this as the reason why she doesn't have pierced ears (I'm assuming she's probably not an organ donor).

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Charity is not a recognized concept in Japan. Politeness and kindness are different traits, and charity is not valued in Japanese society. However if Japanese can donate a smile, they would do it easily.

In many respects, Japan’s health system is world-class, with universal insurance, skilled doctors and a culture of social responsibility.

Yes, Japan does have some skilled doctors, but the general level of Japanese medicine is quite poor, and the treatments due to lagging government approval years behind the West.

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The way I see it, if you don't want your child's organs donated to another child after death, don't complain when your own sick child can't get a donated organ. I find most of the Japanese public to be grossly ignorant and selfish about this issue. A decent and prosperous society is one where sharing and helping strangers is a matter of course.

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This is a very easy topic for me,the answer is "no". I will not donate nor donate from my child. By the same token I do not expect an organ to come my way. If I had the option to sell my organs so my family could benefit, I may consider it but nah, Id rather be cremated with all my body parts. :)

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Pscops-

I will not donate nor donate from my child. By the same token I do not expect an organ to come my way.

can you be 100% sure and can say the same exact thing if your child is seriously ill and can survive if she/he gets organ donation? you think your child should just die because you don't want to accept donation? would you not think that your child probably wants to live and have his/her own family when he/she grows up?

you not wanting to donate is one thing, but i hope you have an open mind when/if it comes to your children (if you have any).

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Agree with Fishy.

Not wanting to donate organs or blood is one thing. But by your logic you can't even get any bigger operation done as you will need blood(donated by others).

And why should you decide what your kids can receive, etc?

Luckily most likely your requests will be overwritten by medical, etc laws.

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The Japanese have grappled with the ethical, legal, and moral issues surrounding brain death for over thirty years. The controversy surrounding this issue persist even though the 1997 Organ Transplant Law legalized organ procurement. A complex mix of historic events, cultural, bioethical factors and issues hinder widespread acceptance of this practice. While almost half of Japanese people accept brain death as consistent with death, organ procurement from brain death donors is not widely accepted in Japan. Several factors contribute to this position including distrust of physicians, past improprieties in determining brain death, insufficient resources such as staff and technology to adequately apply brain death criteria and traditional cultural beliefs concerning life and death. Whether or not Westerners accept the rationale for the ongong Japanese debate about the use of brain-dead donors is not the primary issue. There is a need to explore the social and cultural context of this controversy to better understand and facilitate cross-culture discourse, therefore, the cultural aspects of transplantation should not be viewed as barriers to be overcome, but opportunities for understanding complex social and biomedical issues associated with the practice of organ transplantation.

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I want to donate my organs if I die. But I'm afraid that the hospital would take "brain death" as true death and effectively kill me. I don't want any chance at living to be taken away. There is always the smallest chance that I could survive. No matter how small, I want it.

That's why I'm afraid to mark myself as an organ donor. I have no problem donating when I am dead, but not when I still cling to life in even the smallest way. Is there a way to make that distinction on the organ donor card?

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Firstly, in the UK I always carried a donor card, in fact I still had it in my wallet for a few years here, just in case. If I have something go wrong, I want others to have a chance. If it was my child who was ill I would give my own life/body parts for them, no questions (I hope).

"And why should you decide what your kids can receive, etc? " Well, because he/she is their parent - society doesn't get to make the choice and it isn't democratic (by the same token, parents punished for child crimes works for the same reason).

If there are religious reasons why people object, that's fine, we all live with our own conscience and that's theirs.

I think the blood transfusion issue is valid - why is that OK but organs not? I have a Jehova's Witness friend in the UK who needed an operation and had to spend a few months building up a store of his own blood as he is not allowed to have transfusions of other people's blood (sry, I 'm not fully conversant on that belief system). It seems odd to me, but he's prepared to take the 'good' and 'bad'.

Anyway, I think ultimately this for many here comes from fear of what is a new concept relatively (it's only 10 yrs? since the first organ transplant here?). Sure, the non-charity concept and in/out of group feeling play a part, but if that's what's going to save your child, that's a very tough decision.

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HermioneGranger.

"Brain Death" is the medical term to diagnose True Death. No brain activity and the body starts to decay.

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True or not, I remember stories of brain death wrongly diagnosed, wich means people later "miraculously" emerged from "death". So, as I don't want to take that risk, no organ donation from me either.

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In many respects, Japan’s health system is world-class, with universal insurance, skilled doctors and a culture of social responsibility.

I think we can stop reading at this point.

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What bothers me the most about this issue is how many people in Japan refuse to be donors, but then when they or a loved one needs a liver or heart, they are more than happy to go to America. How many Americans do you see receiving organs from Japanese people? Where is the reciprocity????

Further, I love (dripping in sarcasm) when people in Japan then have the gall to complain about the price of said organ (and procedure) in the States. Open your hearts people or stop complaining! You can't have it both ways!

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Zenny11--"Brain death" refers to a lack of brain activity. But you could still be very much "alive" if you have machines keeping you from dying. As long as your heart, lungs, and so on are compelled to keep moving, you're not going to start to decay. Some people are kept very much alive for years, even though their brains have ceased to function.

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Monkeyz.

Granted but those people will never open their eyes, talk or move of their own again.

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From the Wiki:

Brain death is the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of brain oxygenation. It should not be confused with a persistent vegetative state.

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I personally am undecided.

From my own research on the subject, I have found out that quite often though a person is "brain dead" (and therefore kept alive in the body) when they go to remove the organs very often there is an unexpected spike during the incisions, which almost certainly is due to pain felt by the "donor." While this is not a reason to not donate, It does scare the crap out of me.

Saying that I do give blood regularly. So maybe Im contradicting myself by that.

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Himehentai.

How can a person feel pain when there is no brain-activity? Not sure what you mean by spike?.

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In many respects, Japan’s health system is world-class, with universal insurance, skilled doctors and a culture of social responsibility.

I agree that whoever wrote this is living in some kind of imaginary dreamland. I agree with IvanCoughalot. It's time to stop reading after that.

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well ... they don't give any pain medication to those who are brain dead, but generally they remain hooked up to their monitors, life support etc.

When in the process of removing the organs often the heart rate and blood pressure spike. This also sometimes happens in non-brain dead patients during normal surgery, but usually when they are too lightly anaesthetized (SP?) In a normal surgery this is when an anaesthnatist (again, sp) would step in and up the drugs because its a sign they are in pain.

Also occasionally there have been situations where the supposedly "brain dead" jerk, or wave their legs about. I cant remember his name for the life of me, but there was a British doctor who exposed this and spoke out against organ donation without medication for the donor, and now it is frequently given in the UK, if not for the donor then for the theatre staffs peace of mind.

I don't know how a person can feel pain if there is no brain activity, I don't know if its just a reflex or whatever, but I certainly don't think that todays technology can ever touch on the complexities of the human body or brain. And I certainly think that at least some of the people diagnosed brain dead were possibly not, or something else. I mean ... its like these stories you head of people who are "Actually" dead and then wake up alive in their coffins. Gives me the heebies...

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himehentai

though a person is "brain dead" (and therefore kept alive in the body) when they go to remove the organs very often there is an unexpected spike during the incisions, which almost certainly is due to pain felt by the "donor."

Just to continue giving you the heebiejeebies, the dead - as in no life support, no heart beating, no brain activity, in the morgue - also jerk about on occasion, kicking and flailing their arms around.

People who want to be buried (or cremated) with the bodies intact are of the belief that their earthly remains will reappear in heaven or future lives. While this might be true, no one has proof either way, it assumes that the body that reappears will be the healthy young one, not the cancerous, decrepit, 90-year-old senile one.

Personally, I hope all my useful organs are harvested and that the memory of my life lives on in those who knew me.

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of course they do borscht. I totally understand that - its a reflex though. However the dead by your description also don't have any heart activity when you cut into them.

I can definitely assure you that my reasons why I am undecided on organ donation have NOTHING to do with religion. It has more to do with lack of confidence about how far medicine has evolved. As I said, I don't think we know even close to everything about the human brain, and what it really means to be "brain dead."

I also don't think its possible in every case to guarantee that the doctor will definitely work as hard to save a donor who is dying... I mean .. doctors are humans too - They are just as likely to be touched by the story of a child in the next room who will die if they don't receive organ (X) as any of us.

Personally ... my organs are probably gonna be pretty useless by the time Im finished with them anyways. However - live donation (Ie -donating a kidney to a family member) I would seriously consider. And also blood donation is great.

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I also don't think its possible in every case to guarantee that the doctor will definitely work as hard to save a donor who is dying... I mean .. doctors are humans too - They are just as likely to be touched by the story of a child in the next room who will die if they don't receive organ (X) as any of us

It would be a violation of the Hippocratic Oath that all doctors must take if they were to work to less than the best of their abilities to save a dying person, donor or not. Besides, the doctors don't get to decide who the organ goes to. There is a waiting list for each organ: organs have been rush-transported great distances for this purpose, and also the donor must be a blood/tissue match. Finally, the criteria for a "donor organ" is very strict - the person must have died in a specific way (people who die in car crashes often can't donate, as their organs get damaged by the crash; the same goes for people who have overdosed on medicine or drugs) and must also be within a certain physical condition (not too overweight or underweight, no damaging diseases). Even if you have a heart attack or stroke, the chemical changes and stress your body undergoes is sometimes enough to render your organs unacceptable.

My dad worked as an anaesthesiologist before he retired, and from his whole career, he could count the number of organ donors the hospital was able to get organs from on both his hands. This is why Japan needs to encourage the procedure - there are plenty of organ donors around the world, but very few viable organs.

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Do Japanese doctors take a hippocratic oath?

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Miamum, that is a good question. Due to all the stories I have heard in the news, and on this site, I often wondered the same thing. So your question prompted me to look online. And according to an August 2007 article with Minnesota Medicine written by a Japanese MD and a western physician researching the issue, they wrote:

In Japan, as in all of Asia, there has never been a history of taking any medical oath; that is to say, there has never been a statement of ethical beliefs or commitments to “profess” at graduation. At Keio in 2004, only a small percentage of medical students had ever heard of the Hippocratic Oath. And an even smaller percentage could identify content from any medical oath.

Regrettably, the answer to your questions appears to be NO.

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i hope they accept any organ donation to anyone whether they're dying, sick or wanting something they lost. i want to live in japan when i'm older, and i'm considering donating my ovaries when i'm done having kids. i know there is someone there who wants to have kids but can't, and i won't have any use for them after i have kids. if i can't do it there, i'll just get it done in the US

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