tokyo

Long-awaited legislation designed to provide a legal framework for organ transplants has at last been passed by Japan's parliament, the Diet. But only after a bizarre compromise was reached on the legal definition of death.

For more than a decade, Japan's medical policy-makers have been trying to gain public acceptance of “brain death” as death of an individual, so that organs such as the liver and heart can be removed from brain-dead patients for use in transplants (see Nature 318, 591; 1985). Japan's first heart transplant in 1968 led to demands that the doctor responsible be tried for murder. No heart transplants have been carried out since.

The legislation that passed the Diet last week is a modification of an earlier bill passed by the Diet's lower house in April which allows organs for transplantation to be removed from “brain death bodies” (see Nature 387, 5; 1997). But the original bill met strong opposition in the upper house, where many legislators were unwilling to recognize brain death as death.

In the compromise legislation, brain-dead patients are recognized as being dead only if they have given prior written permission for donation of their organs. Otherwise, their heart must stop beating before they are considered to be dead.

Futhermore, as in the original bill, the family of the deceased must give permission for a transplant to be carried out, and the family's wishes will override those of the brain-dead patient.

There are various explanations as to why the Japanese are so opposed to accepting brain death and organ transplants. These include a strong belief that the body and soul are inseparable and a Confucian concept that the body is a gift of one's parents that cannot be given away. Nevertheless, this has not stopped many Japanese from seeking transplants overseas, even in underdeveloped countries such as the Philippines.

The legislation, while opening the door to transplants, is unlikely to lead to widespread organ transplantation, commentators say. Quite apart from an unwillingness to recognize brain death, Japanese people generally are unwilling to donate their organs. Evidence for this can be seen in the fact that kidney transplants, which can be carried out after the heart has stopped beating, are uncommon.

There is also no well-established system of donor cards in Japan. Furthermore, as donors must give prior written consent to the use of their organs, none will become available for children.