Brain death is a condition where the brain is not working in
all three parts: cerebral, cerebellum, and brain stem (Fukuma
28). The reason why brain death has become a problem recently is
because of the progress in medical techniques, especially of the
development of the artificial respiration system. Until now, when
a patient had his or her brain damaged and the body's respiration
system stopped functioning, the patient couldn't live longer.
However, because of the artificial respiration system, the
patient's life could be prolonged extensively. Because the
patient can live longer with all the medical equipment plugged
into him or her, when to stop the treatment has became a problem.
This problem has extended to transplants, since a heart
transplant can be done most successfully when the heart is still
moving, that is when a person is brain-dead. This is why brain
death has become such a problem, as this paper will show (Fukuoka
28).
In Japan, the reason why the topic of brain death has been
kept quiet is because in 1969 a doctor in Sapporo did the first
and only heart transplant operation. And this operation was
reported in a newspaper as a social affair. The point that the
doctor announced the patient was brain-dead was premature.
Therefore, the diagnosis of brain death was too early (Watanabe
1-6). This failure made the Japanese people afraid of
transplantation, and also afraid of believing in doctors. Because
of that, transplant operations were stopped completely. Japan has
now been behind the rest of the world for more than 20 years
(Watanabe 4).
Currently, in Japan, a brain-dead patient isn't legally
recognized. Among advanced countries, Japan is the only country
that doesn't recognize brain death as death. In Japan there are
many people who can't live longer without a transplant operation.
However, only vital liver transplantation is done in Japan. Vital
transplantation means transferring an organ or tissue from one
person to another to replace a diseased organ. It is usually done
with an organ Or tissue from family members because there is less
tendency for recipient's body to reject the organ. But vital
liver transplantation is just emergency relief measures because a
brain-dead liver transplantation is illegal (Watanabe 14). A
vital liver transplantation is done mostly within families, where
the liver is taken from a healthy donor. This operation is really
difficult; both recipient and donor have some possibility to die.
When it relates to death, is it possible for parents to agree to
a vital liver transplantation for their child?
In Japan about five or six hundred people need liver
transplants. Such patients have swollen stomachs and they bleed
and vomit. But still they live each day on an intravenous drip,
waiting for an alternative liver with fear until they die.
For these patients, the last hope is to have a liver
transplant, but in Japan it's not legal, so they have to go to
foreign countries. But many of them can't. It costs from twenty
million to thirty million-yen, so only the rich, and those who
have volunteer support groups, can go (Watanabe 15). Money is not
the only problem; also there are difficulties in the recipient
foreign countries. In other countries, there are also many people
who need transplantation and are waiting in a line. But the
Japanese break into the line with huge amounts of money they
have. Because of this, people in foreign countries feel hostile
towards these Japanese (Watanabe 15). These things may be echoed
in Japan's trade disputes with the U.S. This situation should not
be allowed to continue.
But in Japan, since-as I mentioned earlier--brain-dead isn't
defined legally, brain-dead kidney transplants also can't be
performed. Therefore, as with liver transplants, only vital
kidney transplants can be done. As a result, public awareness is
very low.
Here are the results of one study. From the questionnaire
given by a researcher to the students at Chiba University, some
interesting information was revealed. One question was: Can you
say, "When the brain is dead, the patient is dead?"
The answers split fifty-fifty. For the 50% of respondents, who
said brain death is death, three out of five disagreed with organ
transplants? In other words, although these students accepted
brain death as death, they only accepted transplant 3:2 or 3 out
of 5. The ratio of students who disagreed with brain death as
death but said yes to organ transplants was 4:1 in favor of
transplants. From this, brain death and organ transplantation is
not related in the ways they are assumed to be. It would seem
that if doctors believed brain death is death, they would also
think brain-dead patients would donate organs for transplants.
But the above results don't support this. However, all persons
have the right to give or deny organ transplantation and this
must not be forgotten (Watanabe 21).
Recently in the Asahi newspaper, there was an article about a
girl who was waiting in Australia for a liver transplantation and
died before her surgery took place. There are in fact many that
go abroad for a transplant surgery. But the reality is, some of
these patients die while they are waiting because they come too
late. Even now there are many volunteer groups, but it takes a
long time to gather 10 million-yen or more. The Japanese children
who were lucky enough to go abroad and have a liver transplant
now number 51. But there are 10 times more than that who need
transplants from brain-dead patients (Watanabe 77). Families who
can not afford to go abroad or don't have courage to collect
money or even have courage to give their own liver to the sick,
will just watch their children dying day by day. For them, what
can be done?
Liver and heart transplantation should be done from brain-dead
patients and not from living donors. Japan should not rely on the
family's love too much. If this becomes common, only the children
who can receive organs from their own families will survive and
those who can't will wait for their last days in bed. This is a
cruel form of discrimination. This absurd situation only exists
in Japan and because of this Japan is behind other developed
countries. All this originates in not being able to define brain
death. In the rest of the world brain death is defined For
example in countries like Thailand, China, Hong Kong, Taiwan and
also in the Philippines (Watanabe 14-15).
From a religious point of view, Japanese aren't deeply
religious people like those in other countries. This can be shown
in the mixed celebrations of Christian holidays right along side
Buddhist funeral rites and Shinto marriages. When people need
help they don't say "Buddha", but instead they will say "God".
All Japanese are not Buddhists. When the Japanese worship at
Buddhist temples, they are not necessarily conscious of Buddhist
teaching, but very often pray for worldly profits. Generally
speaking, few Japanese really think of themselves as being
Buddhists. Buddhism in Japan may well be described as a "cultural
background" rather than a religion to believe in. From such
ideas, to define something in Buddhist terms is impossible, and
not necessary. In Europe and America the church gave the go-ahead
for transplants. The citizens gathered in the church to examine
their lives. From the standpoint of philanthropy and that bond
which all human beings have in common, the church accepted that
transplants could be performed.
In 1990 at Europe's Academy of Organ Transplantation, Pope
John Paul the Second said: "To give one's organs after death, is
a expression of love. This is taken from the teaching of Christ.
Catholics should cooperate by giving organs. " These words have
really become a belief held by Catholics (Watanabe 210-211).
According to this, what is needed in Japan is a place where
feelings can be shared.
One reason why brain death isn't a big issue for the average
person is that a newspaper and a program on television don't
discuss this problem because of the government's opposition to
it. In January'92 Prime Minister Miyazawa said, "We will talk and
try to solve the problem." However, currently opinions are split
up whether we should define it or not. Many other problems such
as selling one's own organs may come up. This problem was too
difficult for the members of the Diet to solve (Watanabe 282).
They do not have enough knowledge about brain death. Therefore
the government said, "Just wait for the law to pass." In June
1993, the House of Representatives broke up, and the talk on a
brain-dead law didn't come up again for six months. Therefore the
members changed and also the discussion began from the beginning
again, including the debate held in the past (Watanabe 282-285).
On January 15th 1994, the members concluded the proposed law for
organ transplantation. This proposed law took a stronger position
on defining brain-dead as death. It stated that if the patient
can't talk, the family has the right to give or deny
transplantation. Also this law prohibited the selling of organs.
As well, parts that can be such transplants, the doctors should
fight for their own right to save lives. Only doctors can save
lives with medical treatment. When most people don't know what
brain-dead is, doctors should take the time to inform and tell
seriously and frankly on what is happening. If a doctor do this,
will be rewarded. The real courage of doctors begins with trying
to enlighten the public.
From this research it is clear there is a lot of false
information in society. When organ transplantation from a healthy
father to a son took in Japan in 1989, the newspaper and
television announced that the operation was done but it was not
good. When people hear something went well, they think everything
is in order. Furthermore, when the newspapers claim "He is
recovering," it makes the reader feel the patient is benefiting
from the operation. But this isn't true of the Japanese media.
The newspaper and television don't bother to explain the more
complex issues. In our society, television can't be separated
from our daily life so this medium should be careful about how
they should handle these very important subjects.
In Japan, what we can do before the law passes is to try to
improve the transplantation coordinator system. When a society is
trying to proceed with better organ transplantation, the first
necessary thing is accurate information. A transplantation
coordinator is a person who has a doctor's license or a person,
who is trained in the field. Their works are to make arrangements
for the transplant operations and consult with the family about
the transplantation to make everything go smoothly. In Japan, in
1990, a transplantation coordinator system was set up. At that
time there were only nineteen coordinators and the system was
hoping to locate on one person in each prefecture and metropolis.
Compare with the United States where there are more than two
thousand people serving as transplantation coordinators and an
advanced network system. This clearly shows the lack of money
that spent in the system in Japan and interest in the problem.
Hence the system is not improving.
Whether the law passes or not, the important thing is the
confidence between the patient and the doctor. The doctor has the
technical skills, however, in transplanting organs from a
brain-dead body, the important thing is not technique or
knowledge but mutual trust and confidence. Doctors have a
difficult task both physically and mentally. They are the only
one who can save us. In the questionnaire that the researcher
received back from a few of the doctors in St. Mary's Hospital,
all of them agreed with organ transplantation including the
doctors who were against brain-dead being death. From this, we
can see that they are hoping to save the lives of those who need
transplantation. There are many people who need medical help, and
those in need of transplant operations are some of them.
by Akiko Shida
Works Cited
Fukuma, Masayuki. Thinking About Brain Death. Japan:
Japan Hyolonsha, 19 87.
Hayashi, Takumi. Transplantation Between Life and
Death. Japan: Gakushiu Kenkyusha 1991 20-25.
Imanishi, Jirou. Medicine, Asahi gendai yougo Chiezo.
Japan: Asahi Shinbunsha, 1993.
"Liver Recipient Back From Australia." 1994, November 22.
Japan Times, p.2.
Proceed Japanese-English Dictionary. Tokyo: Fukutake
Shoten.
"Protection of Patients' Rights Urged." 1994, Oct. 16.
Japan Times p. 2.
"Slain Boy's Organs Save 3 Italians' Lives." 1994, Oct. 2
Japan Times. "Transplantation Story in Australia." 1994,
November 15. Asahi Newspaper, p. 13.
Watanabe, Junichl. What You Think About Brain Death
Now. Tokyo: Kodansha, 1994. 226
