Organ Transplant in Present-Day Japan: Reasons behind Low Numbers of Deceased Donors
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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.
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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.
Alvarez L.A., Moshé S.L., Belman A.L. et al. (1988), “EEG and Brain Death Determination in Children,” Neurology 38 (2): 227–230.
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.
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.
BBC (2009), “Organ Donation in Shinto,” URL = https://www.bbc.co.uk/religion/religions/shinto/shintoethics/organs.shtml [Accessed 16.08.2021].
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.
Bookmeter (2019), “Watashi wa zōki o teikyō shinai reviews,” URL = https://bookmeter.com/books/7893 [Accessed 16.08.2021].
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-
for-a-change [Accessed 28.02.2021].
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.
Daar A.S. (1994), “The Body, the Soul and Organ Donation Beliefs of the Major World Religions,” Nefrologia 14: 78–81.
Drake B., Ashwal S., Schneider S. (1986), “Determination of Cerebral Death in the Pediatric Intensive Care Unit,” Pediatrics 78 (1): 107–112.
Fackler J., Rogers M. (1987), “Is Brain Death Really Cessation of all Intracranial Function?,” The Journal of Pediatrics 110 (1): 84–86.
Fact Book 2018 of Organ Transplantation in Japan (2018), URL = http://www.asas.or.jp/jst/pdf/factbook/factbook2018.pdf [Accessed 02.03.2020].
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.
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.
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.
Fujikawa K. (2009), “Sangiin de no zōki ishoku-hō kaisei-an no shinchōna shingi o motomeru
yōbō,” URL = https://www.hongwanji.or.jp/news/cat5/000385.html [Accessed
09.2021].
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].
Hall G., Mashiter K., Lumley J. et al. (1980), “Hypothalamic-Pituitary Function in the “Brain-Dead” Patient,” The Lancet 316 (8206): 1259.
Havens N. (1994), “The Changing Face of Japanese Folk Beliefs,” [in:] Folk Beliefs in Modern Japan, I. Nobutaka (ed.), Kokugakuin University, Tokyo.
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].
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].
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.
Ichijō S. (2017), Naze, ichiryū no hito wa go senzo-sama o taisetsu ni suru no ka?, Subarusha, Tokyo.
International Registry in Organ Donation and Transplantation (IRODaT) (2010–2018), URL= http://www.irodat.org/ [Accessed 02.03.2020].
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.
Ishii M., Hamamoto M. (2009), “Bioethics and Organ Transplantation in Japan,” JMA Policies 52 (5): 289–292.
Izawa M. (2003), “Nōshi mondai to shintō shinkō o megutte,” Shūkyō-hō ronbun jānaru 22: 185–188.
JAORO (2009), “Zōki ishoku-hō kaisei mondai ni taisuru iken-sho,” URL = http://jaoro.or.jp/statements/bioethics/bio_04 [Accessed 10.08.2021].
Japan Organ Transplant Network (JOTN) (2018), URL = http://www.jotnw.or.jp/english/2018data.html [Accessed 24.11.2019].
Jinja Honcho (2020), “After Death and Ancestral Worship,” URL = https://www.jinjahoncho.or.jp/en/spiritual/index2.html [Accessed 07.02.2020].
Kaneko R. (2019), Body Donations Surge in Japan Amid Changing Views of Death, Kyodo News, Japan.
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.
Kato Y. (2013), “Conscience in Health Care and the Definitions of Death,” Croatian Medical Journal 54 (1): 75–77.
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.
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.
Lamb D. (1994), “What is Death?,” [in:] Principle of Health Care Ethics, R. Gillon (ed.), John Wiley & Sons Ltd., New York.
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].
Lock M. (2002), Twice Dead: Organ Transplants and the Reinvention of Death, University of California Press, Berkeley – Los Angeles.
Lizza P.J. (2018), “Defining Death: Beyond Biology,” Diametros 55: 1–19.
McConnell J.R. (1999), “The Ambiguity About Death in Japan: An Ethical Implication for Organ Procurement,” Journal of Medical Ethics 25 (4): 322–324.
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.
Morioka M. (2001), “Reconsidering Brain Death,” Hastings Center Report 31 (4): 41–46.
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.
Nagashima H., Matsunari H. (2016), “Growing Human Organs in Pigs – A Dream or Reality”, Theriogenology 86 (1): 422–426.
Nakajima M. (1985), Mienai shi nōshi to zōki ishoku, Bungeishunjū, Tokyo.
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].
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.
Nguyen D. (2018), “A Holistic Understanding of Death: Ontological and Medical Considerations,” Diametros 55: 44–62.
NHK World – Japan (NHK) (2018), URL = https://www.nhk.or.jp/bunken/research/yoron/pdf/20190107_1.pdf [Accessed 24.02.2021].
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.
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.
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.
Organ Procurement and Transplantation Network (OPTN), URL = https://optn.transplant.hrsa.gov/governance/about-the-optn/ [Accessed 15.04.2020].
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.
Poltransplant (2016), URL = http://poltransplant.pl/Download/Biuletyn_2016_www.pdf [Accessed 15.04.2020].
Reischauer E.O., Jansen M.B. (1995), The Japanese Today: Change and Continuity, Belknap Press of Harvard University Press, Cambridge (MA).
Rowe M. (2009), “Death, Burial, and the Study of Contemporary Japanese Buddhism,” Religion Compass 3 (1): 18–30.
Schrader H., Krogness K., Aakvaag A. et al. (1980), “Changes of Pituitary Hormones in Brain Death,” Acta Neurochirurgica 52 (3–4): 239–248.
Shewmon A. (1997), “Recovery From “Brain Death”: A Neurologist’s Apologia,” The Linacre Quarterly 64 (1): 31–96.
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.
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.
Tai M.C.T. (2009), “An Asian Perspective on Organ Transplantation,” Tzu Chi Medical Journal 21 (1): 90–93.
Tendaishū (1995), “Tendai no shuchō nōshi oyobi zōki ishoku ni tsuite,” URL = http://www.tendai.or.jp/shuchou/01.php [Accessed 22.08.2021].
“The Declaration of Istanbul on Organ Traffi cking and Transplant Tourism” (2008), Clinical Journal of the American Society of Nephrology 3 (5): 1227–1231.
United Network for Organ Sharing (UNOS), URL = https://unos.org/ [Accessed 15.04.2020].
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.
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.
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].
Watts J. (1999), “Tokyo Media Coverage of First Transplantations Fuels Public Distrust in Japan,” The Lancet 354 (9174): 229.
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.
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.
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.
Yasuoka M.K. (2015), Organ Donation in Japan. A Medical Anthropological Study, Lexington Books, Lanham – Boulder – New York – London.
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].