At age 56, Toshinobu Horiuchi was a desperate man. He had suffered
kidney failure and needed a transplant. As a doctor, based in Tokyo, he knew
better than most that he faced a long wait.
In Japan, nearly 13,000 people, according to the Japan Organ Transplant
Network (JOTN), were waiting for a kidney transplant last year, but in the
first half of 2011 only 186 kidney transplants were carried out. It's a
shockingly poor statistic: Japan has some of the lowest rates of organ
transplantation in the developed world.
Horiuchi refused to join the waiting list. Money, he thought, could get
him what he wanted. He went underground, paying the yakuza first ¥10 million,
then when that deal failed, another ¥8 million, for a kidney. Gangsters
procured him a kidney from a 21-year-old unemployed man. However, apprehended
and so thwarted before the transplantation could go ahead, Horiuchi was jailed
in January for three years. It's just one story, but it vividly demonstrates
how bad the problem of organ shortage is in Japan.
Some more data from the JOTN: There were 1.1 kidney transplants from
dead donors for every 1 million people in Japan in 2003 — compared with 46.7 in
Spain, 32.5 in France, 29.5 in the United States and 22 in Britain. Put simply:
People are dying in Japan who would be saved if they lived elsewhere. Moreover,
until 2010, organ transplants from children were prohibited in Japan, meaning
that parents of sick children had to travel abroad in search of treatment for
their offspring — if they could afford it.
The problem is mainly cultural. According to the ancient rites and
beliefs of Shintoism, death is impure. An organ received from a dead person may
be considered tainted, and in both Buddhist and Shinto tradition a dead body
should remain intact. As well as those religious reasons, there is mistrust of
the definition of "brain death" that is accepted in the West. Organ
donation from dead donors in Japan was only legalized in 1997 with the passing
of the Organ Transplant Law, and it has yet to really catch on.
There are several possible solutions to the problem — the obvious one
being to educate people about death and the potential benefits of organ
transplantation from their own or their loved ones' otherwise useless cadavers.
Yasutsugu Takada, of the Ehime University Graduate School of Medicine in
Shikoku, is at the forefront of another solution: Use living organ donors. Around
70 percent of transplanted kidneys and 80 percent of liver donations performed
in Japan are from live donors. In the U.S., 68 percent of kidney transplants
and 98 percent of liver transplants in 1998 involved deceased donors.
Living-donor liver transplantation (LDLT) is Takada's specialty. "With
LDLTs being performed at increasing rates, it is important to understand the
long-term outcomes for living donors," Takada says. He and his colleagues
have just published a report showing that the health-related quality of life
(HRQOL) for donors following living-donor liver transplantation (LDLT) was
better than the HRQOL for the overall Japanese population. "Our study is
the largest to investigate living liver donors' quality of life and to
determine potential risk factors following transplantation," says Takada,
whose results are published in the journal Liver Transplantation (DOI
reference: 10.1002/lt.23509).
His team contacted 997 living donors who had each provided a piece of
their liver for transplantations performed at Kyoto University Hospital between
1990 and 2004. Some 578 people responded, and analysis of their questionnaire
answers suggests that they are healthier than "normal" Japanese. "Kyoto
University Hospital is one of the high-volume transplant centers in Asia. As
such, we are keenly aware of the necessity and responsibility to report donors'
long-term quality of life," says Takada. "Our findings suggest that
careful follow-up and counseling are necessary for donors at risk of a poor
quality of life."
For people with liver disease, help from a living donor can be a great
solution. For the donor, it is actually a perfectly acceptable operation,
thanks to the liver's amazing regenerative powers. This is why we can drink
alcohol regularly, subjecting our poor livers to damage from poisonous booze,
and still not keel over dead. But for those who drink too much over years and
end up with cirrhosis of the liver, a transplant of part of a healthy person's
liver can save their life. Living-donor liver transplantation is a relatively
recent medical development. It was first carried out in Chicago in 1989, when a
sick girl named Alyssa Smith received part of her mother's liver.
It is actually a more demanding operation for the surgeon than
transplantation of a liver from a cadaver. This is where the cultural reasons
for Japan's low rates of transplant actually have an advantage. Like any
operation, the one to remove part of the liver from a living donor comes with
risks. Donor death from LDLT occurs in around 1 percent of cases in Europe, 0.3
percent in the U.S. — but currently nearly zero percent in Japan. Surgeons in
Japan have become expert at performing the procedure. But there are still risks
So why were nearly 13,000 people in Japan waiting for a kidney
transplant last year — but only 186 transplants carried out in the first half
of 2011? "Given the risks for living liver donors, we should make every
effort to increase the number of deceased donors," Takada tells me.
"Although there are still many problems to do with expanding the number of
deceased donors, I believe it will increase gradually." In Japan, if you
want to donate body parts after your death, carry an ishihyōji kado (donor
card) — available at ward offices, post offices and even convenience stores.
Source: Japan Times
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