JAPAN: GETTING ORGANS IN FOREIGN COUNTRIES

UNCLAS SECTION 01 OF 03 TOKYO 002688

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SUBJECT: JAPAN: GETTING ORGANS IN FOREIGN COUNTRIES

REF: A)98 TOKYO 9778

B)99 TOKYO 3388

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1. Summary. On April 21, a study group of the Ministry
of Health, Labor and Welfare (MHLW) study group conducted
a survey to study the number of Japanese citizens seeking
organ transplants in foreign countries. The study report
revealed that at least 522 individuals had organ
transplant operations done overseas. The actual number is
likely underreported, because the study excluded cases
where the individual died after having a liver or kidney
transplant and only surveyed a limited number of medical
institutions. The reasons behind the increased number of
individuals having the procedure done abroad for a full
range of organ transplants include a shortage of donors
and long waiting periods, legal problems that make it
difficult for children to receive organs, and the fact
that many patients can now obtain medical information on
organ donors through the Internet. There is concern that
some patients may be purchasing their organs from
unwilling donors such as prisoners and those who find
themselves in dire straits. As a result, health
professionals established a committee to look at the
ethical issues behind receiving organs abroad. In order
to increase the number of potential donors in Japan,
members of the Liberal Democratic Party (LDP) and New
Komeito submitted two amendment bills to the current Diet
session. End Summary.

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Survey Procedure
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2. The survey was conducted by aA study group of the
Ministry of Health, Labor and Welfare (MHLW) led by
Professor. Eiji Kobayashi of Jichi Medical University
conducted the survey from between January to and March of
this year. The team gathered collected data on the number
of patients who are having undergoing medical treatments
after having had an organ transplant operation dones
abroad. The group limited its through survey to
inquiring Japanese medical institutions where member
medical doctors of the Japan Society for Transplantation
work. For heart transplants only, the group reported on
all cases including those where the transplant recipient
died. For other types of transplants, the report did not
include cases where the organ recipient subsequently
diedRegarding organ transplant of a heart, all cases
including dead cases were reported. The survey covered 17
institutions for heart transplants, 123 institutions for
liver transplants and 154 institutions for kidney
transplants. The respondent response rate was 100
percent, 97 percent, and 90 percent respectively.

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Heart Transplants
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3. The survey reported that 103 patients (64 males and 39
females) had heart transplant operations done in foreign
countries from between 1984 through and 2005. Eighty-five
patients had operations done in the U.S., followed by nine
patients in Germany, seven patients in the UK, and one
patient each in Canada and France. Eighteen death
casesdeaths were also reported, but the survival rate
after five years after surgery was 70.3 percent, higher
than most international rates. By the group of ageThirty-
two, 32 patients in the group ofwere younger than 10 years
old, 22 patients in the group of agewere between the ages
of 10-17, and 49 patients werein the group of age older 18
years of age or older. After 1997 when the Japan's organ
transplant law took effect in 1997, the number of
individuals undergoing surgery has been steadily
increasing.


4. The first heart transplant operation in Japan took
place in 1968, but ended in failure. This led to public
discord over the definition of what constituted brain
death. As a consequence, no heart transplant operations

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were carried out in Japan until the 1997 law took effect.
During the same time period, only one to four Japanese
were receiving operations abroad per year. Since 1999,
however, the number of Japanese patients undergoing the
surgery in both Japan and foreign countries has been on
the rise.


5. Kobayashi writes in the report that many patients
undergo heart transplant operations overseas because of
the rigid organ transplant law and the shortage of donors
in Japan. Other factors for the full range of organ
recipients include the shortage of donors and long waiting
periods, legal problems that make it difficult for
children to receive organs, and the fact that many
patients now can obtain medical information through the
Internet on potential organ donors.

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Liver Transplants
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6. According to the survey, 2,982 patients are currently
have aundergoing follow-up medical treatment in 83
Japanese medical institutions after having a liver
transplant operation. Of the 2,982 patients, 221
individuals had a transplant operation done in a foreign
county, reported by 43 medical institutions. The survey
does no't provide the exact breakdown number of patients
by countryies, but 20 medical institutions reported that
they are treating a liver-transplant recipients in who had
work done in Australia, 19 institutions reported that they
have a liver-recipient in the Ushad patients who had the
procedure done in the U.S., and 14 institutes reported
that their patients had a liver transplant operation in
traveled to China for the operation. The survey couldn't
did not obtain information on cases involving death of the
patient after f dead cases after the operationsthe
transplant.

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Kidney Transplants
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7. CThere are currently 8,297 patients have awho are
undergoing medical treatment in 136 Japanese medical
institutions after having a kidney transplant operation.
Out of the 8,297 patients, 198 individuals had thea
transplant operation done abroad, reported byaccording to
the data provided by 63 institutions. Forty-eight medical
institutions reported that their patients received their
newa kidneys in China, while . Twenty20 institutions
reported the source as the Philippines. Eighteen
institutions said that their patients had a transplant
operation done in the U.S. The survey couldn't did not
obtain information on cases involving death of the patient
after f dead cases after the operationsthe transplant.

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Ethical Debates
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8. On April 21, In order to continue the survey, the
Japan Society for Transplantation has established a
committee to consider the safety and ethics of receiving
organ transplant operations in foreign countries. There
is concern that some patients may be purchasing their
organs from unwilling donors such as prisoners and those
who find themselves in dire straits. For example Yuki
Hasegawa of Toho University reported in an attached report
that some in China feel that those on death row should pay
for their crimes through organ donations, and in India, a
kidney donation can support a family of four for ten
years. A February 4 edition of the Asahi Newspaper
devoted much space to the issue of organ donations by
prisoners in China. The article quoted an interview with
a senior PRC health official who admitted that more than
90 percent of the organs used for transplants were from
prisoners sentenced to death. The Sankei Newspaper
reported on a study conducted by Professor Tsuyosi Kuriya

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of Okayama University who also said that more than 90
percent of the organ donors in China were prisoners on
death row.

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Amendment of the Oorgan Ttransplant Llaw
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9. From 1997 (when Japan's new law took effect) to
September 2005, only 41 transplants have taken place that
used organs from brain-dead patients. As of February
2006, there were 85 heart patients, 119 lung patients, 109
liver patients and 12,112 patients needing new kidneys
listed on the Japan Organ Transplant Network's official
list of recipients awaiting transplants.


10. In order to increase the number of potential donors
and help reduce the number of individuals waiting for
organs, members of the Liberal Democratic Party (LDP) and
New Komeito have submitted two amendments in the current
Diet session. The current law requires donors to have a
donor card that shows their willingness to donate their
organs in addition to their family's consent. One of the
proposed amendments will designate an individual as
deceased if there is brain death and will allow organ
donation with family consent, provided that the donor does
not specify in his or her will that he or she does not
want to donate their organs after death. The other
amendment will keep the current definition of brain death
as is, but will lower the age of donors from 15 years of
age to 12. (Note: The current law does not define brain
death as actual death. It provides that organs can be
taken from a dead body including from the body of a brain-
dead person for the purpose of transplants, but under very
strict conditions.) Because the Diet members drafting the
changes could not reach an agreement on the definition of
brain death, they submitted the two different amendments.

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