Editorial
Changes to organ transplant law must go further to protect donors
Proposal A, one of four revision proposals for the Law on Organ Transplantation, was passed unceremoniously at a plenary session of the House of Representatives on Thursday. More than a few people are undoubtedly bewildered by the quick decision.
The bill is one that for years has remained in a state of limbo. It doesn't appear that thorough deliberation of the various proposals has taken place, nor does it seem that Diet members and the public have reached a real understanding of the issues. We can only hope that the House of Councillors will sort through and engage in exhaustive debate of the various issues involved.
Under the current transplant law, organs can be harvested from a brain-dead individual only when consent has been given by both the person and the person's family. The law regards brain death as legal death only in cases that presuppose organ transplantation, and prohibits those from children under 15.
Although the existing transplant law was passed after much debate, those who advocate organ transplantation from brain-dead donors argue that the rigidity of the current law inhibits organ donation. Children who require small organs cannot receive transplants in Japan, and many choose to go abroad for such procedures.
The latest bill revisions were spurred by the World Health Organization's (WHO) plans to develop guidelines on expanding domestic organ transplantation as a preventative measure against organ transplant trade. As a proposal largely in accordance with the move, Proposal A aims to increase adult organ donations and make domestic organ donations by children possible by legalizing such donations with family consent, provided the deceased had not ruled out organ donation before death.
Removal of organ donors' consent from the criteria under which organ transplant is permitted, however, does not necessarily imply that the number of organ donations will grow. The family of a potential donor has to make a decision based on what they believe would have been the individual's wish, and for such an assessment to be possible, families would have had to engage in prior conversations about brain death and organ transplantation. This is also true under the existing transplant law for families who are trying to go through the transplant process. In reality, however, efforts to raise the public's interest in and awareness of the pertinent issues have been lacking.
In the case of children, not only is brain death difficult to diagnose, there is the added challenge of making sure that brain deaths caused by child abuse do not go undetected. A clearly defined system of determining donors' causes of death, regardless of age, is essential in securing the public's confidence in brain death organ transplantation.
Furthermore, we can expect to face obstacles stemming from a provision in Proposal A that allows relatives of a donor to be given priority in organ transplants -- which seems to go against the basic principle of "fairness" laid down in the current law. How are we to define "relatives," anyway? Such questions must be carefully deliberated.
Regardless, it is problematic that neither the current law nor Proposal A include provisions on live organ transplantation. Many live organ transplants are conducted in Japan, and in some cases donors suffer various drawbacks, such as medical complications. At present, only medical associations offer guidelines and provisions on live organ transplants, but donor protection is something that should be regulated by law.
For patients waiting for transplants, the passing of Proposal A may be welcome news. However, in both brain death organ transplants and live organ transplants, consideration for donors and their families must not be forgotten. Nor should we engage in debate without a comprehensive understanding of the big picture that the WHO's newly proposed guidelines represents.
(Mainichi Japan) June 19, 2009