The National Diet of
Japan is engaged in deliberations on bills to revise the Act
on Organ Transplantation. In addition to the three bills which
have already been submitted to the Diet, there is reportedly
a movement to propose another bill in order to resolve the conflicting
views of Diet members. The new bill eliminates the age limitation
to be a donor, and, for a “legally deceased” child
under 15 years of age (i.e., not having yet reached the age
of 15 years) to be a donor, the new bill requires the following:
(1) the consent of family members and (2) confirmation by a
third party, such as the ethics committee of a hospital, that
the child has not been abused.
The underlying motivation for the introduction of these bills
is the fact that the number of organ transplants from brain
dead donors has not increased since the enactment of the current
Act on Organ Transplantation more than ten years ago. In addition,
the current Act bans the extraction and transplantation of organs
from brain dead children, and the World Health Organization
is going to adopt a resolution supporting the Istanbul Declaration
endorsed by the Transplantation Society which opposes traveling
overseas for organ transplants.
However, it is unacceptable to revise the Act to uniformly
define brain death as the death of a human being and to deny
self-determination. The current Act was based on the premise
that the self-determination of those who wish to be donors when
their brains die should be respected even though Japanese society
had not developed a common recognition that brain death was
equivalent to the death of a human being. The Japan Federation
of Bar Associations (JFBA) has been calling for the drafting
of bills in line with the aforementioned premise. The JFBA has
also been pointing out that since the enforcement of the current
Act, evidence has emerged that the bodies of many brain-dead
patients, especially those of children, live for long periods
of time, and such information should be clearly provided to
the public so that public consensus can be reached on whether
brain death should be considered the actual death of a human
being. Regrettably, our opinions have not been seriously taken
into consideration by the Japanese government.
It is a reversal of priorities to redefine death in order to
provide for an increase in organ transplants. We agree that
the current situation where children are not able to receive
organs is a critical issue to be discussed. However, accurate
information on brain death is required, especially as some specialists
are pointing out the limitations and difficulty in determining
brain death in children. In addition, a new technique has been
recently reported for the treatment of infants with dilated
cardiomyopathy (who previously had no option other than cardiac
transplantation to be cured). The current Act is based on the
premise that within a few days, brain death results in actual
death (i.e., display of the following socially-accepted symptoms:
absence of pulse, spontaneous respiration, and pupillary response
to light). However, it is known that some brain-death patients
survive for a longer period (i.e., their hearts continue beating
for more than 30 days). Thus, the definition of brain death
also needs to be reviewed.
At this time, the JFBA is unable to accept revising the Act
which would define uniformly brain death as the actual death
of a human being, and would deny self-determination and approve
the extraction of organs from brain-dead children under 15 years
of age with the consent of family members and the decision of
an ethics committee or other body.
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