Doctors at Toyama University Hospital on Friday extracted the organs of a boy under the age of six who was declared brain dead for the first time in Japan.
The boy's heart, liver, kidneys and pancreas will be donated to recipients, Fuji TV reported.
The boy was declared dead at 2:11 p.m. on Thursday. A spokesperson for the boy's parents said that their son was a very energetic boy and even though he had left them, they hoped that the recipients of his organs would be able to have a long life, Fuji TV reported.
Organ transplants for children in Japan have lagged behind other countries due to 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. However, in 2010, under urging from the Japan Organ Transplant Network, the law was revised, lowering the age restriction.
But opponents say it is very risky declaring a child brain dead, arguing that tougher criteria are needed because children's brains have stronger powers of recovery. In the Toyama case, doctors said they conducted tests of the boy's brain waves twice over a 24-hour period and found no activity. The boy was also unable to breathe unassisted, doctors were quoted as saying.© Japan Today
Login to comment
Wow, I am actually surprised to read this. Then my question to Japan is what is a medical and a legal definition of death right now? Anyone?
I was discussing transplants with a group of youngish (17/18 year old) students a few months back and I asked them what they considered 'death' to be. Almost all of them said that they considered it to be when a person's heart has stopped and they have stopped breathing. Most of them didn't consider 'brain death' as 'real' death, even if the heart and lungs were only functional through a machine.
As I said, they were quite young, and their opinions were based on feeling rather than any logical/medical reasoning. Most of them also said that although they recognized transplants as being necessary, wouldn't want their own organs to be donated. Many held out hope that by some miracle they might one day 'recover' from brain death and so didn't want that chance taken away. Optimism of youth maybe?
My heart goes out to the family of this little one. I hope they get some comfort at this dreadful time with the knowledge that their selfless actions will have saved the lives of several other people.
Why was this child brain dead?
Light years behind... I hope this happens more often so donations can start between young kids. How many parents have lost their children because of Japan's strange rules with regards to this?
As the value of organs increase the criteria for declaring a person brain dead will get lower and lower.
Perhaps some of these children might actually recover if given the opportunity to heal.
I'm curious, what happens when the doctors demand the right to "terminate" the child to harvest the organs but the parents refuse because they hope for a recovery.
Until rather recently Japan's definition of death was determined by heart stoppage. Natural or otherwise.
I worked in a hospital group for a number of years and saw too many elderly patients on respirators in a vegetative state. No chance of recovery as all of them had, had massive brain attacks, (strokes). Once the doctors inserted the respirator it WAS, by law, impossible for them to remove them, under risk of prosecution.
I knew one family, whose father had a stroke when he was in his late 40's, he was in a vegetative state, all curled up, no responses what so ever, for nearly 30 years, dude had a super strong heart according to the doctor. It was incredibly sad to see Mom come to the hospital everyday for years to take care of her husband. They should have pulled the plug, but the doctors legally couldnt.
Screw legally I thought, do what's morally right, alas it never happened.
My point is it's about time that this is happening, give people the chance to have dignity in death.
Neversubmit has a scary point. In the land of the amakudari there needs to be several independent decision makers instead of one.
First off the doctors can not terminate without the parents or family consent. There is a bunch of paperwork that must be completed first.
Also, families can also instruct the doctors to not insert the respirator if the need occurs as well, and that too must be in writing. It's happened with both of my in-laws, we were able to get the paperwork done in time prior to Mom-in-law needing it, but when it came to Dad-in-law we were in the discussion stage regarding the procedure when he had a stroke and the doctors attempted to contact us prior to inserting it to get our ok or otherwise but since time was of the essence for them in trying to save his life they inserted the respirator as they had to do as a medical procedure to try to save his life.
Fortunately for all involved and for him as well, he passed away on his own quietly a few days later. But ALL of us in the family were plenty disturbed because we all knew that Dad-in-law didnt want to be seen that way and he looked uncomfortable as hell. Even though the doctors were telling us that it was just a nervous reaction to the invasive tube.
Doctors CAN NOT terminate a patient on their own.
There is a reason why anyone needs a transplant goes overseas to get it, there is no one in Japan that is able to do it.
Liberty Joe Lowe
@yubaru Absolutely right I told my family if I end up brain dead, pull out the plug
Surely there is a more suitable word than 'Harvest'...
I didn't realise 6 years old was a watershed of some kind..... also, how to tell?
Japan is WAY LONG overdue catching up in this area, many are needlessly left on machines & lots of kids, young people die due to lack of organs for transplant, hopefully this trend will continue!
I have great respect for the parents of this boy. His tragically early death can allow others the chance if life. I truly hope this case can mark a change of thinking and stand as a wonderful example.
Yubaru -- spot on.
Jimizo -- absolutely. They are heros in my mind, as they could look through their own pain, and focus on possibly providing life to other children. I hope this gives them some comfort in their grief.
I've checked off the box on my health card to give my organs away if I ever become brain dead. Sustaining "life" is just pushing off the inevitable and rather selfish in my opinion if your organs can be given to help someone else. Unfortunately I don't think anyone will want to inherit my liver after the excessive amount of nomikais I've been to! Would very much like to know what happened to the boy in the first place.
Actually the latest advances in neurology make recovery, even from a so-called "brain dead" state possible in the near future. I'm going to keep this simple, but basically the idea in the past was that the brain was fairly static, and once an area was damaged (e.g. speech center) then that function was gone for good (i.e. you'd never speak again). What they found though was a few unusual cases where people got sick and then afterwards were able to speak. It turned out that a high fever makes the brain's structure more "plastic" and able to shift. At the moment it's a risky procedure since the temperatures required to reach this state are close to brain damage temperatures, but it's been done a few times, and it has enabled some pretty amazing recoveries.
How does this apply to brain death? Well normally what's damaged is one of the regions responsible for autonomic function (automatic functions, like beating the heart, breathing, etc). Previously we believed that this was impossible to fix, but now we know differently.
... so this kid might have had a chance in about a decade. I still think it was the right decision to disconnect him now, but in the near future the situation might be very, very different.
Waist not want not, we are the sum of the parts, others can use! Brain dead is dead. Cudo to the parents for seeing past their grief, it's beyond what can be explained, but understanding their grief is a gift for another-that is special! I hope I am never in this position. Thank you parents for seeing past the trauma and helping others.
Well...? How old is he? 5? 4? 3? 2?
Does it matter?
This can be found in a law called the Uniform Determination of Death Act. Granted it is a US law but my guess is Japan has something substantially similar. The second part of this section of the law has a good description of what it means to be brain-dead:
"Determination of Death. An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards."
Yubaru : You and I have had very similar experiences... I also lost someone very close to me because of a erroneous diagnostic by a "middle-of-the-night" intern. It's something one never forgets. This person was also in their late forties, far too young to remain for 2 years and three months in a vegetative coma.
I admire the parents of this little boy for their decision. May his soul rest in peace.
I can not find the current law, however it was until quite recently nothing close to what US law is. Japanese culturally speaking viewed the heart as being the engine of the body, and the soul.
I'll give you a rather poor example of what I mean; Ever see the movie ET? The part near the end when ET points to Elliots head and tells him he will always be there? Japanese kids are taught that ET means will be in his heart forever.
We think of it as a memory in our heads, Japanese don't, or at least medically speaking until recently quite differently.
There are still WAY too many obstacles in getting organ transplants here, particularly for children. Last here in Okinawa a JHS aged girl had to go to the US to get a heart transplant, she couldn't get it done in Japan. She would have died.
I wonder whether these opponents would have any qualms about going to the US for a transplant if their own child needed one.
@tokyokawasaki: there is a book called Harvest by Tess Geritsen. great book and writer. i know her
This is interesting, some of the comments i just can't vote up. All of them have been voted down and neither one is actually offensive, some even pose interesting questions. How odd... surely it's a PBKAC.
Gee really? That's odd, i thought "brain dead" meant total brain inactivity, zero electric signals, flatline. You're saying only the part responsible for autonomic functions needs to be dead? This is also odd...
The brain is known to recover lost areas under given circumstances, sometimes by even using other seemingly unused areas, but this is in cases of partial loss. A total loss is... a dead brain. There's a reason why stroke response must be quick.
Franchesca Miyara Yang
I have often expressed my deep desire (unknown reason, don't ask) to donate one of my kidneys and perhaps part of my liver but unfortunately I've been told I am not allowed to donate to anyone in this country unless is a direct family (blood) member. WTF?!!!
How did he die?
CrickyJUN. 15, 2012 - 01:15PM JST Something new...medical fraternity not happy about something new, let's hope it becomes more prevalent in the SYSTEM. A loss is painful but the benefits for others are life saving. Remember you don't take your organs to heaven.
Well "brain dead" is normally applied as a label when there's been no oxygen for a long time and there's extensive damage to the brain. This is very unusual, as the human brain can go without oxygen for a really long time. Basically you're looking at one of three causes normally, eitherDrowning - And you need to stay down for at LEAST 5 minutes (even longer if the water is cold) before you're looking at brain death. Electrocution - Disrupts the heart rhythms and the heart can't get beating again. Again there's plenty of time to react and administer CPR, as the heart is often beating arrthymically and supply some (but not enough) circulation. Brain damage - Physical trauma to the brain that results in autonomic functions being damaged.
At the end of the day 1 and 2 are just causes for 3. In a hospital the doctors then test and say something like, "The patient cannot breathe on their own". Some brain damage may have been present before that point, but total brain death (zero neural activity) takes a LOT of damage. If the body has been without oxygen long enough for all the brain tissue to die then chances are that their internal organs are similarly damaged and useless for brain transplant.
What I'm getting at is that the term "brain dead" is improperly misunderstood by non-medical people. If you go and look up the medical definition (as opposed to going to wikipedia) you'll see it is much more complex:
In short "brain death" isn't zero activity, but rather damage to areas of the brain that mean that recovery is nearly impossible (at this stage of medical technology).
Ronald F Stark
Through death comes the gift of life! Donating organs to save the lives of others is the ultimate gift one can give. I have the highest respect for the parents of this young boy. May his soul rest in peace, as he lives on in others, and may his parents remember him in their hearts forever.
So even if the brain is not totally wikipedia-dead, if you go without oxigen for long you're clinically-as good as dead. I see your point but i'd rather avoid differentiating as it creates (in my opinion) a creepy gray zone where vegetables can be sustained years on end while plugged into machines.
I wish they would change the law to allow consensus between doctors and relatives to turn off these machines. If 3 separate doctors and the family agree there is very little chance of abuse.
A relative of ours is languishing in a hospital bed right now with a massive stroke (who the hell puts a patient on Warfarin and then doesn`t monitor them for 10 years anyway??!). There is absolutely no chance of recovery, and she has been there for 4 months now. It is a massive burden on the hospital, the immediate family (our cousins) and I would say the patient herself. Let her go.
Make that 3 separate doctors from 3 separate hospitals and i'll agree. Just because they're doctors doesn't mean they're saints.
I know exactly what you're going through... I just hope some day, very soon, the "rules" will change...
While I am happy for the girl, I cant help but wonder when I read these cases if there isnt a needy yank who perhaps DIED because of the non-US person...............
Like I said above hopefully this trend continues & quickly so Japanese dont feel the need to leave Japan for organ transplants!
Frungy, see combinibentos post and leave it to the medical professionals. "And an isoelectric electroencephalogram" essentially means 'and a flat EEG' ie. no brain activity.
I applaud the parents of this child, its a tough decision in a country where brain death is still a strong point of contention.
I am a medical professional. A "flat" EEG does indicate no brain activity... but that doesn't mean that recovery is impossible. A deep coma might produce a "flat" EEG, but even this highly unlikely. Normally there is "background noise" even when a patient is ruled "brain dead", since, as I tried to point out, complete brain death is highly unusual and there are usually some brain cells still firing. I've never yet seen a truly "flat" EEG except when it was attached to a corpse (long dead), a similarly inanimate object.
Unless the damage to the brain is significant I have no doubt in the future that we would be able to reboot the brain with minimal damage. However the brain is very complex and it would be very easy to mess up the neurons and change your personality, motor skills, memory. Just think of the brain as an organic RAM and when you switch off it wipes the slate clean, but we all know forensics can reconstruct even remedial traces of electrical activity. Just wait till they are able to hook the brain up to a computer and back it up. That will screw things up. It will eventually happen be it the next century.
They can already read short-term memory reading a computer and obtain (admittedly low resolution at this stage) black and white images of recent memories. I don't think we'll need to wait until next century, probably only two or three decades.
What a headline! Apparently people are declared brain dead more than once.
Frungy, 'as I tried to point out, complete brain death is highly unusual'. As a medical professional I think you would understand this has happened to everyone that ever lived.
The point behind the discussion is that a set of perameters for brain death have been agreed by the medical and legal profession and enacted in law in many countries. I think the scientific evidence behind that decision would indicate that its highly unlikely someone would recover from brain death.
This article doesn't clearly state whether the boy was pulled off support and allowed to continue breathing on his own until his heart stopped naturally or whether the doctors medically terminated him after the parents signed to consent form so as to "harvest" his organs at the ideal time.
My position is that like smoking, sex and alcohol, a child is too young to provide consent and the default answer is NO, until old enough to provide informed consent.
poor little boy.
And what I was pointing out was that while in the past recovery from "brain death" was highly unlikely we're not nearing new techniques that might make it possible. At the core of this misunderstanding is the popular misconception that "brain death" means that all the brain tissue is dead or damaged (characterised the "flat line" EEG image). In reality the damage is normally limited to certain critical areas, and the EEG shows activity, just not normally in one of the recognisable patterns.
The parameters for "brain dead" will probably be redefined within the next decade as recovery from "brain death" becomes possible. If it were my child, even at this stage, I'd insist on using experimental techniques such as heating the brain or stem cell conversion rather than accepting the "brain dead" diagnosis.
now nearing, not "not nearing"
Frungy, I don't agree there's a misunderstanding, I think people accept the current concept of brain death as a point from which there is no return. If at some point in the future medicine advances enough to render the current definition inappropriate, peoples understanding and attitudes will change again.
And I'm telling you that point has already been reached in experimental trials, and will be mainstream medical technology within the decade. I also corrected your misconception about what a "flat" EEG really is. Despite correcting these two mistakes that you made from ignorance you refuse to acknowledge your mistake. Refusal to learn is an incurable condition. not brain death.
Frungy, I don't see what you've 'corrected' you agreed that a flat EEG indicates no brain activity, its a fact that the flat EEG is one of the measures used to determine death. That I dont agree with you everyone is thick and can't understand medical issues shouldn't be seen as a personal affront and isnt a good reason to be rude. As for the rest, well see. If your claims are proven correct, the medical and legal parameters for death will change within the decade.
What a short memory you have Swiss Toni,
You incorrectly defined a "flat" EEG as "no brain activity". I corrected you that this wasn't the case, and that there IS brain activity, just not in one of the recognisable patterns indicating organised brain activity. The key take-home message here is the brain is not entirely dead, and there is salveagable tissue that can be restasked to take over the activities of the dead tissue. You can live and function with half your liver. Likewise brain surgery can remove an entire hemisphere of the brain and the patient can live a reasonably high quality of life with half a brain. There's a tremendous amount of redundancy in the brain. In short, "brain dead" is a misnomer, deliberately so to comfort relatives of so-called "brain dead" patients. In reality the brain is largely alive in the overwhelming majority of cases.
So that's where you were wrong Swiss Toni. And as to your allegations of rudeness, your very first post wasn't very polite, nor have your subsequent ones been.
Frungy, I defined 'isoelectric electroencephalogram' and as this is a general news discussion board, provided in context example. I suppose my use of the word essentially passed you by. The point I made is correct, particularly in reference to the news story and how death is determined. The take home message of the story is that the doctors where able to keep the boys organs alive and their transplant will give his parents some comfort. I have no problems with recommending people leave technical medical issues to the professionals and dont see it as impolite at all. If you are a medical professional, nor should you. If you see such things as a challenge, you'll be in competition your whole life.
Swiss Toni - You provided an incorrect definition, "no brain activity" (which is neither essentially nor in any other way true), and when corrected by someone who knew better you assumed a defensive position and didn't acknowledge your mistake, nor apologise, but kept attacking. ... I certainly hope you listen a little more when your doctor tries to tell you something that contradicts your preconceptions, because the manner in which you disregarded my clarification was undeniably arrogant. I offered hope for any parent who might read this and find their child in a similar situation in the future. That sort of hope is important, and you treated it like it wasn't. That's not only disrespectful to me, but also to all those reading here and to life itself.
Frungy, again I defined Isoelectric electroencephalogram. Your complaint is in error. The fact that I won't collapse under your brow beating and patronising attempts to lecture isn't arrogance, I simply resist your continuing attacks. I've not dashed anybody's hopes and your assertion that I've been disrespectful to life itself is extremely ridiculous. As for my being disrespectful to all to those reading here, I suspect at this point it's just you and me.