Organ Transplant in Present-Day Japan: Reasons behind Low Numbers of Deceased Donors

Main Article Content

Justyna Magdalena Czekajewska
https://orcid.org/0000-0003-2833-8815
Aleksandra Jaworowicz-Zimny

Abstract

According to the International Register of Organ Donation and Transplantation, Japan is one of the countries with the lowest number of registered deceased donors. In 2019, Japan was ranked 61st out of 70 countries. The authors of this article have decided to explore the reasons for this phenomenon. In the first part of the work, religious influences (Shinto and Buddhism), the tradition of gotai manzoku, the importance of altruism and the family in the perception of death and organ transplantation by the Japanese are considered. The second part of the article presents the arguments of Alan Shewmon, who believes that brain death is not death in the biological sense. Undermining the brain’s death criterion raises doubts concerning death of patients in irreversible coma, what in result discourages transplantology in Japan. In the third part, the authors compare the results of JOTN, IRODaT and the Fact Book of Organ Transplantation 2018 in Japan from 2010 to 2018. The aim of the article is to explain the cultural determinants of transplantology in Japan, taking into account the influence of philosophical and bioethical aspects of human death.

Downloads

Download data is not yet available.

Article Details

How to Cite
Czekajewska, Justyna Magdalena, and Aleksandra Jaworowicz-Zimny. (2021) 2021. “Organ Transplant in Present-Day Japan: Reasons Behind Low Numbers of Deceased Donors”. Diametros 18 (70):2-25. https://doi.org/10.33392/diam.1630.
Section
Articles
Author Biography

Justyna Magdalena Czekajewska, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu. Wydział Nauk o Zdrowiu. Katedra Nauk Społecznych

doktor nauk humanistycznych, filozof i bioetyk. Adiunkt w Katedrze Nauk Spłecznych Uniwersytetu Medycznego w Poznaniu, specjalizuje się w etyce medycznej, aksjologii wychowania oraz filozofii niemieckiej. Stypendystka Uniwersytetu Georg-August w Getyndze oraz absolwentka Uniwersytetu Mikołaja Kopernika w Toruniu. Autorka książki Przemiany życia rodzinnego. Studium etyczne (2014).
Share |

References

Akabayashi A., Nakazawa E., Ozeki-Hayashi R. et al. (2018), “Twenty Years After Enactment of the Organ Transplant Law in Japan: Why are There Still so Few Deceased Donors?,” Transplantation Proceedings 50: 1209–1219.
View in Google Scholar

Alvarez L.A., Moshé S.L., Belman A.L. et al. (1988), “EEG and Brain Death Determination in Children,” Neurology 38 (2): 227–230.
View in Google Scholar

Asai A. (2011), “Organ Donation from Brain-Dead Donors and the Role of the Japan Organ Transplant Network,” Japan Medical Association Journal 54 (6): 357–362.
View in Google Scholar

Asai A., Kadooka Y., Aizawa K. (2012), “Arguments Against Promoting Organ Transplants From Brain-Dead Donors, and Views of Contemporary Japanese on Life and Death,” Bioethics 26 (4): 215–223.
View in Google Scholar

BBC (2009), “Organ Donation in Shinto,” URL = https://www.bbc.co.uk/religion/religions/shinto/shintoethics/organs.shtml [Accessed 16.08.2021].
View in Google Scholar

Beecher H.K. (1968), “A Definition of Irreversible Coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” Journal of the American Medical Association 205 (6): 85–88.
View in Google Scholar

Bookmeter (2019), “Watashi wa zōki o teikyō shinai reviews,” URL = https://bookmeter.com/books/7893 [Accessed 16.08.2021].
View in Google Scholar

Cantarovich F. (2018), “The Society, the Barriers to Organ Donation and Alternatives for a Change,” [in:] Organ Donation and Transplantation – Current Status and Future Challenges, G. Tsoulfas (ed.), IntechOpen: 47–67, URL = https://www.intechopen.com/books/organ-donation-and-transplantation-current-status-and-future-challenges/the-society-the-barriers-to-organ-donation-and-alternatives-
View in Google Scholar

for-a-change [Accessed 28.02.2021].
View in Google Scholar

Conci F., Procaccio F., Arosio M. et al. (1986), “Viscero-Somatic and Viscero-Visceral Reflexes in Brain Death,” Journal of Neurology, Neurosurgery, and Psychiatry 49 (6): 695–698.
View in Google Scholar

Daar A.S. (1994), “The Body, the Soul and Organ Donation Beliefs of the Major World Religions,” Nefrologia 14: 78–81.
View in Google Scholar

Drake B., Ashwal S., Schneider S. (1986), “Determination of Cerebral Death in the Pediatric Intensive Care Unit,” Pediatrics 78 (1): 107–112.
View in Google Scholar

Fackler J., Rogers M. (1987), “Is Brain Death Really Cessation of all Intracranial Function?,” The Journal of Pediatrics 110 (1): 84–86.
View in Google Scholar

Fact Book 2018 of Organ Transplantation in Japan (2018), URL = http://www.asas.or.jp/jst/pdf/factbook/factbook2018.pdf [Accessed 02.03.2020].
View in Google Scholar

Fan R., Wang M. (2019), “Family-Based Consent and Motivation for Cadaveric Organ Donation in China: An Ethical Exploration,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 44 (5): 534–553.
View in Google Scholar

Fitzgerald R.D., Dechtyar I., Templ E. et al. (1996), “Endocrine Stress Reaction to Surgery in Brain-Dead Organ Donors,” Transplant International 9 (2): 102–108.
View in Google Scholar

Fitzgerald R.D., Dechtyar I., Templ E. et al. (1995), “Cardiovascular and Catecholamine Response to Surgery in Brain-Dead Organ Donors,” Anaesthesill 50 (5): 388–392.
View in Google Scholar

Fujikawa K. (2009), “Sangiin de no zōki ishoku-hō kaisei-an no shinchōna shingi o motomeru
View in Google Scholar

yōbō,” URL = https://www.hongwanji.or.jp/news/cat5/000385.html [Accessed
View in Google Scholar

09.2021].
View in Google Scholar

Green Ribbon (2020), “Zenkoku GREEN LIGHT – UP Project [2020] [raitoappu shashin tsuika],” URL = https://www.green-ribbon.jp/action/detail.php?id=740 [Accessed 22.08.2021].
View in Google Scholar

Hall G., Mashiter K., Lumley J. et al. (1980), “Hypothalamic-Pituitary Function in the “Brain-Dead” Patient,” The Lancet 316 (8206): 1259.
View in Google Scholar

Havens N. (1994), “The Changing Face of Japanese Folk Beliefs,” [in:] Folk Beliefs in Modern Japan, I. Nobutaka (ed.), Kokugakuin University, Tokyo.
View in Google Scholar

Himeno N. (2019), “6-Sai-miman kara zōki teikyō, kokunai 12 reime nōshi hantei no joji,” URL = https://www.asahi.com/articles/ASM445JV3M44ULBJ00S.html [Accessed 17.08.2021].
View in Google Scholar

Hooper R. (2012), “Japan’s Live Organ Donors Enjoy Better Health Than ‘Normal’ Citizens Do,” URL = https://www.japantimes.co.jp/news/2012/11/11/national/science-health/japans-live-organ-donors-enjoy-better-health-than-normal-citizens-do/[Accessed 07.02.2020].
View in Google Scholar

Howlett T.A., Keogh A.M., Perry L. et al. (1989), “Anterior and Posterior Pituitary Function in Brain-Stem-Dead Donors. A Possible Role for Hormonal Replacement Therapy,” Transplantation 47 (5): 828–834.
View in Google Scholar

Ichijō S. (2017), Naze, ichiryū no hito wa go senzo-sama o taisetsu ni suru no ka?, Subarusha, Tokyo.
View in Google Scholar

International Registry in Organ Donation and Transplantation (IRODaT) (2010–2018), URL= http://www.irodat.org/ [Accessed 02.03.2020].
View in Google Scholar

Irving M.J., Tong A., Stephen J. et al. (2012), “Factors that Influence the Decision to be an Organ Donor: A Systematic Review of the Qualitative Literature,” Nephrology Dialysis Transplantation 27 (6): 2526–2533.
View in Google Scholar

Ishii M., Hamamoto M. (2009), “Bioethics and Organ Transplantation in Japan,” JMA Policies 52 (5): 289–292.
View in Google Scholar

Izawa M. (2003), “Nōshi mondai to shintō shinkō o megutte,” Shūkyō-hō ronbun jānaru 22: 185–188.
View in Google Scholar

JAORO (2009), “Zōki ishoku-hō kaisei mondai ni taisuru iken-sho,” URL = http://jaoro.or.jp/statements/bioethics/bio_04 [Accessed 10.08.2021].
View in Google Scholar

Japan Organ Transplant Network (JOTN) (2018), URL = http://www.jotnw.or.jp/english/2018data.html [Accessed 24.11.2019].
View in Google Scholar

Jinja Honcho (2020), “After Death and Ancestral Worship,” URL = https://www.jinjahoncho.or.jp/en/spiritual/index2.html [Accessed 07.02.2020].
View in Google Scholar

Kaneko R. (2019), Body Donations Surge in Japan Amid Changing Views of Death, Kyodo News, Japan.
View in Google Scholar

Kanno T., Morita I., Yamaguchi S. et al. (2009), “Dorsal Column Stimulation in Persistent Vegetative State,” Neuromodulation: Technology at the neural interface 12 (1): 33–38.
View in Google Scholar

Kato Y. (2013), “Conscience in Health Care and the Definitions of Death,” Croatian Medical Journal 54 (1): 75–77.
View in Google Scholar

Katō E. (2004), “Zōki teikyō to zōki ishoku shisutemu: Ishoku iryō no shakai-gaku-teki kenkyū,” Keiōgijukudaigaku daigakuin shakaigakukenkyūka kiyō: Shakai-gaku shinri-gaku kyōiku-gaku: Ningen to shakai no tankyū 58: 142–164.
View in Google Scholar

Kigo R., Umeki S., Kihara S. et al. (2000), „Nōshi zōki ishoku no ishiki ni tsuite no ichikōsatsu,” Kuma daikyōiku jissen-ken 17: 43–49.
View in Google Scholar

Lamb D. (1994), “What is Death?,” [in:] Principle of Health Care Ethics, R. Gillon (ed.), John Wiley & Sons Ltd., New York.
View in Google Scholar

La Moncloa (2020), “Spain Reaffirmed its Global Leadership in Organ Donation During 2019 and Now Accounts for 20% of EU Donors and 6% Worldwide,” URL = https://www.lamoncloa.gob.es/lang/en/gobierno/news/Paginas/2020/20200907organdonation.aspx [Accessed 22.08.2021].
View in Google Scholar

Lock M. (2002), Twice Dead: Organ Transplants and the Reinvention of Death, University of California Press, Berkeley – Los Angeles.
View in Google Scholar

Lizza P.J. (2018), “Defining Death: Beyond Biology,” Diametros 55: 1–19.
View in Google Scholar

McConnell J.R. (1999), “The Ambiguity About Death in Japan: An Ethical Implication for Organ Procurement,” Journal of Medical Ethics 25 (4): 322–324.
View in Google Scholar

Morioka M. (2011), “Natural Right to Grow and Die in the Form of Wholeness: A Philosophical Interpretation of the Ontological Status of Brain-dead Children,” Diogenes 57 (3): 103–116.
View in Google Scholar

Morioka M. (2001), “Reconsidering Brain Death,” Hastings Center Report 31 (4): 41–46.
View in Google Scholar

Mostafazadeh-Bora M., Zarghami A. (2017), “The Crucial Role of Cultural and Religious Beliefs on Organ Transplantation,” International Journal of Organ Tranplantation Medicine 8 (1): 54.
View in Google Scholar

Nagashima H., Matsunari H. (2016), “Growing Human Organs in Pigs – A Dream or Reality”, Theriogenology 86 (1): 422–426.
View in Google Scholar

Nakajima M. (1985), Mienai shi nōshi to zōki ishoku, Bungeishunjū, Tokyo.
View in Google Scholar

Nakajima T. (n.d.), Shintō to nōshi zōki ishoku ni tsuite, URL = https://www.izumo-murasakino.or.jp/shinto-017.html [Accessed 22.08.2021].
View in Google Scholar

Nakata Y., Goto T., Morita S. (2001), “Ethics of Organ Transplantation in Japan: An Example of Cultural Transplantation in Medicine,” Current Opinion in Anaesthesiology 14 (5): 549–552.
View in Google Scholar

Nguyen D. (2018), “A Holistic Understanding of Death: Ontological and Medical Considerations,” Diametros 55: 44–62.
View in Google Scholar

NHK World – Japan (NHK) (2018), URL = https://www.nhk.or.jp/bunken/research/yoron/pdf/20190107_1.pdf [Accessed 24.02.2021].
View in Google Scholar

Nie J.B., Jones D.G. (2019), “Confucianism and Organ Donation: Moral Duties From Xiao (Filial Piety) to Ren (Humaneness),” Medicine, Health Care and Philosophy 22 (4): 583–591.
View in Google Scholar

Ohnuki-Tierney E., Angrosino M.V., Becker C. et al. (1994), “Brain Death and Organ Transplantation: Cultural Bases of Medical Technology,” Current Anthropology 35 (3): 233–254.
View in Google Scholar

Ooba N., Setoguchi S., Ando T. et al. (2013), “Claims-Based Definition of Death in Japanese Claims Database: Validity and Implications,” Plos One 8: 1–7.
View in Google Scholar

Organ Procurement and Transplantation Network (OPTN), URL = https://optn.transplant.hrsa.gov/governance/about-the-optn/ [Accessed 15.04.2020].
View in Google Scholar

Ozawa-de Silva C. (2018), “Stand by Me: The Fear of Solitary Death and the Need for Social Bonds in Contemporary Japan,” [in:] The Routledge Handbook of Death and the Afterlife, C. Cann (ed.), Routledge, Abingdon, Oxon and New York.
View in Google Scholar

Poltransplant (2016), URL = http://poltransplant.pl/Download/Biuletyn_2016_www.pdf [Accessed 15.04.2020].
View in Google Scholar

Reischauer E.O., Jansen M.B. (1995), The Japanese Today: Change and Continuity, Belknap Press of Harvard University Press, Cambridge (MA).
View in Google Scholar

Rowe M. (2009), “Death, Burial, and the Study of Contemporary Japanese Buddhism,” Religion Compass 3 (1): 18–30.
View in Google Scholar

Schrader H., Krogness K., Aakvaag A. et al. (1980), “Changes of Pituitary Hormones in Brain Death,” Acta Neurochirurgica 52 (3–4): 239–248.
View in Google Scholar

Shewmon A. (1997), “Recovery From “Brain Death”: A Neurologist’s Apologia,” The Linacre Quarterly 64 (1): 31–96.
View in Google Scholar

Shewmon A. (2001), “The Brain and Somatic Integration: Insights into the Standard Biological Rationale for Equating “Brain Death” with Death,” Journal of Medicine and Philosophy 26 (5): 457–478.
View in Google Scholar

Soyama A., Eguchi S. (2016), “The Current Status and Future Perspectives of Organ Donation in Japan: Learning From the Systems in Other Countries,” Surgery Today 46 (4): 387–392.
View in Google Scholar

Tai M.C.T. (2009), “An Asian Perspective on Organ Transplantation,” Tzu Chi Medical Journal 21 (1): 90–93.
View in Google Scholar

Tendaishū (1995), “Tendai no shuchō nōshi oyobi zōki ishoku ni tsuite,” URL = http://www.tendai.or.jp/shuchou/01.php [Accessed 22.08.2021].
View in Google Scholar

“The Declaration of Istanbul on Organ Traffi cking and Transplant Tourism” (2008), Clinical Journal of the American Society of Nephrology 3 (5): 1227–1231.
View in Google Scholar

United Network for Organ Sharing (UNOS), URL = https://unos.org/ [Accessed 15.04.2020].
View in Google Scholar

Veatch R.M. (2018), “Would a Reasonable Person Now Accept the 1968 Harvard Brain? A Short History of Brain Death,” Hasting Center Report 6: 6–9.
View in Google Scholar

Watanabe Y. (2003), “Nōshi zōki ishoku mondai to aru bukkyō-sha no taiō – “Watashi wa zōki o teikyō shinai” ni okeru Yamaori-shi no shuchō o megutte,” Seimei Rinri 13 (1): 140–149.
View in Google Scholar

Watanabe Y. (2014), “Naze Nihonde wa zōki ishoku ga netsukanai no ka iryō fushin, hōritsu no fubi dakede wanai hontō no gen’in – Tōkyōikadaigaku Hachiōji iryō sentā shōkakigeka ishoku geka Shimazu Motohide kyōju ni kiku,” URL = https://diamond.jp/articles/-/62001?page=2 [Accessed 22.08.2021].
View in Google Scholar

Watts J. (1999), “Tokyo Media Coverage of First Transplantations Fuels Public Distrust in Japan,” The Lancet 354 (9174): 229.
View in Google Scholar

Wetzel R.C., Setzer N., Stiff J.L. et al. (1985), “Hemodynamic Responses in Brain Dead Organ Donor Patients,” Anesthesia & Analgesia 64 (2): 125–128.
View in Google Scholar

Wijdicks E.F. (2013), “Brain Death,” [in:] Handbook of Clinical Neurology, M.J. Aminoff, F. Boller, D.F. Swaab et al. (eds.), Elsevier, Amsterdam: 191–203.
View in Google Scholar

Yamaori T. (2000), “Zōki ishoku wa bukkyō no seishin ni hansuru,” [in:] Watashi wa zōki o teikyō shinai, Kondō M., Miyazaki T., Nakano M. et. al., Yōsensha, Tokyo: 147–164.
View in Google Scholar

Yasuoka M.K. (2015), Organ Donation in Japan. A Medical Anthropological Study, Lexington Books, Lanham – Boulder – New York – London.
View in Google Scholar

Yōrō T. (2000), “Holistic Talk. Kaibō gakusha Kitasato Daigaku Kyōju Yōrō Takeshi-shi” interview by Karise Misa, Digital Transplant 17, URL = http://mnt.jotnw.or.jp/community/d_transplant/vol17/17_03.html [Accessed 09.05.2020].
View in Google Scholar