EDITORIAL: Organ transplant law

The revised Law on Organ Transplantation, which relaxes conditions for organ transplants, took effect Saturday.

Under the revised law, organ transplants from brain-dead patients are allowed on condition the person's family gives permission, even if the patient never made clear it was his or her intention to donate upon brain death.

This is a radical shift from the original law, which set tough conditions for organ transplantation, including written consent from the donor.

Since the law was enacted in 1997, a total of 86 organ transplants from brain-dead donors have been conducted in Japan. That is much fewer than in many other countries.

The revision was prompted by the view that easing conditions would increase the number. It also opens the door for organ transplants from children under 15.

In the past, Japanese children had to travel abroad to receive heart transplants or similar operations. But the World Health Organization adopted new guidelines to discourage organ transplants abroad, which put pressure on Japan to fix the problem.

Despite the changed law, however, the nation's medical community still faces many challenges concerning organ transplants.

In a recent Asahi Shimbun survey of organ transplant hospitals nationwide, only 15 percent of those institutions that responded said they were able to handle organ transplants from children.

Even if hospitals planning to ready themselves to handle such cases are added, the figure still comes to only 40 percent.

The brain of a child has strong resilience, and it generally takes longer to diagnose a child as brain dead.

It is also necessary to confirm that a child's brain death was not caused by abuse.

Behind the low percentage of hospitals prepared to handle transplants from children is the fact that such operations will add to the heavy workload already facing medical staff.

The new rules also place a heavier burden on the families of a brain-dead child. They face a tough decision concerning organ donations, unless their child has clearly expressed a will to refuse to donate.

The revision will make it even more important for families to discuss the issue and confirm how each member feels about organ donation in case they should ever face such a decision.

The less-than-adequate Diet debate on the revision left no doubt that there is strong support for the original law, which placed priority on the willingness of each donor where this issue is concerned.

Now, every driver's license and health insurance card issued will have a space to express the holder's intentions regarding organ transplant. This will also encourage people to think about the issue.

A family should never be subjected to psychological pressure to consent to organ donations. The role of neutral transplant coordinators, who help families decide and support those who give consent, will become even more important.

The support system needs to be enhanced with effective measures, such as training of more transplant coordinators and other related experts.

To make more people willing to donate organs or consent to organ transplants from brain-dead family members, it is essential to ensure that every possible medical effort is made to save people fighting for their lives.

In Japan, the emergency medical care system for young children is particularly weak, with mortality among children aged 1-4 being markedly higher than in other industrial nations.

Enhancing the emergency medical service system is a burning challenge that should be tackled immediately, irrespective of the issue of organ transplantation.

The part of the revision that allows preference to be given to family members in choosing recipients of organs came into force in January.

Some experts have expressed concern about this rule from the viewpoint of fairness, which they argue requires decisions be made based on a recipient's level of medical need. Those in most need ought to have first chance at an organ, their reasoning goes.

There is still much to be done to build a trustworthy system for organ transplantation, including further review of the law.

--The Asahi Shimbun, July 19