Row over infant organ transplantation and endangered small lives in Japan

May 19, 2009

Row over infant organ transplantation and endangered small lives in Japan


Should Japan remove a ban on infant-to-infant organ transplantation? and if so, how to diagnose would-be young donors as brain dead? This is a major area of discussion about a proposed revision to Japan’s 12-year-old organ transplantation law. A total of 81 organ transplant operations from brain dead patients have been carried out in Japan since a relevant law took effect in October 1997. But Japan bans operations from those aged less than 15 years.
The current law requires donors’ prior consent in writing and their families’ agreement. It is very difficult to diagnose seemingly brain dead young patients, physicians say, because children have strong recuperative power. This is a major reason for not allowing heart and other organ transplantation from infants. Experts also stress the difficulty of locating brain dead patients linked to child abuse cases. As a result, dozens of children are believed to be dead in Japan every year without chances of receiving organ transplant operations.
A waka poem composed by Ki Tsurayuki, one of the greatest poets in the Heian period, about his dead daughter goes:

The waves lapping the beach.
Please bring me a memory eraser shell.
And I will get on the beach and pick up one
to put my child out of my mind.
(A personal translation)

The bivalve mentioned in the poem, a tradition says, buries sad memories if one keeps it. The daughter died when Tsurayuki was governor of Tosa, the current Kochi Prefecture, western Japan. He made the poem on his voyage back to Kyoto, Japan’s capital in the Heian period from the late eighth century. His young wife disagreed. Her poem follows:

I will never pick up a memory eraser shell.
I will keep my feeling of love as a memento of my dear daughter
who was like a white jewel.
(A personal translation)

His wife’s name is unknown, as is the case with most women at his time.
The remaining way for Japanese children suffering from serious cardiac diseases to survive is to receive heart transplant operations abroad, but this requires massive money, estimated at tens of millions of yen or more.
Three bills for revision of the organ transplantation law have been before Japan’s parliament, but none of them are likely to be acted upon. The bills are aimed at improving the situation surrounding Japan’s organ transplantation, but by different approaches. People on campaigns for increasing opportunities for organ transplantation for infants call for removing the limit on donors' ages.
A fourth, compromise proposal has been recently prepared, but it fails to satisfy these people. Among them is a young father whose one-year-and-four-month-old son died before receiving a heart transplant operation. The latest proposal calls for scrapping the age limit but authorizing organ transplantation from children only when parents agree. The father stresses that it will be actually very hard for parents to acknowledge their small children are brain dead.
Tsurayuki served in Tosa when he was in his 60s. Tosa was a remote, underdeveloped country at his time. The poet regretted that he could not save his daughter’s life because good physicians were not available there. She was the apple of his eye.
It is far from certain if a solution will be found for opening the way for domestic organ transplantation for infants. But it should become unable for Japan before long to rely on organ transplantation, especially for infants, in other countries. Japanese must make more serious efforts to establish a consensus on how to save their endangered small lives.