CORRECTED COPY - JAPAN: GETTING ORGANS IN FOREIGN

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SUBJECT: CORRECTED COPY - JAPAN: GETTING ORGANS IN FOREIGN
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REF: A)98 TOKYO 9778
B)99 TOKYO 3388
C)TOKYO 2688

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1. This is a corrected copy of ref C.


2. Summary. On April 21, a 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 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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3. A study group of the Ministry of Health, Labor and
Welfare (MHLW) led by Professor Eiji Kobayashi of Jichi
Medical University conducted the survey between January
and March of this year. The team collected data on the
number of patients who are undergoing medical treatment
after having had an organ transplant operation done
abroad. The group limited its survey to Japanese medical
institutions where member 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 died. The survey covered 17
institutions for heart transplants, 123 institutions for
liver transplants and 154 institutions for kidney
transplants. The response rate was 100 percent, 97
percent, and 90 percent respectively.

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Heart Transplants
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4. The survey reported that 103 patients (64 males and 39
females) had heart transplant operations done in foreign
countries between 1984 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 deaths were also reported,
but the survival rate five years after surgery was 70.3
percent, higher than most international rates. Thirty-two
patients were younger than 10 years old, 22 patients were
between the ages of 10-17, and 49 patients were 18 years
of age or older. After Japan's organ transplant law took
effect in 1997, the number of individuals undergoing
surgery has been steadily increasing.


5. 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
were carried out in Japan until the 1997 law took effect.
During the same time period, only one to four Japanese

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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.


6. 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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7. According to the survey, 2,982 patients are currently
undergoing 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. The survey
does not provide the exact breakdown of patients by
country, but 20 medical institutions reported that they
are treating liver-transplant recipients who had work done
in Australia, 19 institutions reported that they had
patients who had the procedure done in the U.S., and 14
institutes reported that their patients had traveled to
China for the operation. The survey did not obtain
information on cases involving death of the patient after
the transplant.

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Kidney Transplants
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8. There are currently 8,297 patients who are undergoing
medical treatment in 136 Japanese medical institutions
after having a kidney transplant operation. Out of the
8,297 patients, 198 individuals had the transplant
operation done abroad, according to the data provided by
63 institutions. Forty-eight medical institutions
reported that their patients received their new kidneys in
China, while 20 institutions reported the source as the
Philippines. Eighteen institutions said that their
patients had a transplant operation done in the U.S. The
survey did not obtain information on cases involving death
of the patient after the transplant.

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Ethical Debates
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9. On April 21, the Japan Society for Transplantation
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 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 Organ Transplant Law

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10. 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.


11. 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 a 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.

DONOVAN