Japan attempts to define death

Press, 2 December 1985, Page 45

Japan attempts to define death

By

ELISABETH RUBINFIEN

of Reuters through NZPA Tokyo As Western nations forge ahead with organ transplant technology, Japan lags behind trying to decide — just what is death? Doctors. politicians, lawyers and laymen are heatedly debating whether death comes when the heart stops beating or when the brain gives up. In the second case, when exactly does “brain death” occur? A successful transplant means removing organs from bcdies in which the aeart still beats, a notion emotionally repugnant in Japan where heartbeat is viewed as the key to life. The more obscure concept of brain death does not find ready popular acceptance. Japan is not alone in grappling with this question

but it has recently come to the fore. New transplant techniques could bring longer life for some 1000 potential heart recipients in Japan, 5000 men and women hoping to be freed from kidney dialysis machines, and countless patients needing livers and other organs. “Society at large is quite strict about transplants and the law is completely undecided,” said a Ministry of Health and Welfare (MHW) spokesman, Keiji Tanaka. “We must educate people to build a consensus about death and transplantation,” he said. Soon the Ministry will release the first official guidelines for defining brain death after studying standards at hospitals. After that a group of 70 politicians, lawyers and doctors will urge the Govern-

ment to establish brain death as the measure of legal death. Many European nations and most states in the United States have legally accepted the brain death criterion. More than 1000 heart transplants and 600 liver transplants have been done outside Japan. “Here, even though people can understand brain death from a scientific standpoint, emotionally they can’t accept it,” said Dr Hisao Manabe. president of Osaka’s National Cardiovascular Centre. “Brain death means the heart is still beating and people feel strongly that it is still alive.” “Japanese are less scientific and more emotional in their thinking and therein lies the difficulty,” he said. Japan has largely avoided

i the issue since the furore ■ raised by the country’s only heart transplant 18 years i ago. > In 1968 a doctor gave a youth the heart of a i drowned man declared “brain dead”. Local residents accused him of murder, saying he removed the ; organ before the man was really dead. The doctor was never ini dieted, but the psychological , scar on Japan’s medical community remained, made worse by the fact that the s boy who received the heart died later anyway. Last February, three doc- , tors were charged with i murder for taking various organs from a brain-dead woman with her husband’s consent. The case is still , pending. , “The reaction of the local community was rather exI treme,” said Mr Tanaka.

“But that shouldn’t matter because consensus here comes down to agreement between the donor, the recipient and the doctor." Some doctors say another problem can arise when a potential recipient is unwilling to take organs from a stranger. “It's a mental block,” said one private Tokyo doctor. “Especially in the less sophisticated countryside areas, families are concerned that the donor mayhave inferior blood.” On the donor side, even when death is agreed upon, a potential donor’s family will hesitate to offer his organs because of age-old ethical and religious beliefs, doctors say. A natural aversion to harming the living body is intensified by a religious tradition which teaches that life and death are part of a cycle and the corpse must be preserved intact for the next stage, said Dr Manabe. “A lot of people are willing to be donors, but even for autopsies you really have to talk to the family to make them see they could do a lot of good,” said the Tokyo doctor. Some newspaper polls show attitudes are shifting, with 40 per cent of those sampled accepting the criterion of brain death and willing to donate their organs. At least 50 hospitals are now preparing facilities and training for advanced transplantation. A recent Medico-Legal Society poll of doctors found that, whereas three-quarters accepted brain death, 80 per cent said the public was not yet ready for promotion of heart transplants. The shortage of organs and the lack of Japanese doctors experienced with transplants has driven a few patients to seek life-saving liver and heart transplants overseas and some doctors are concerned that this trend could grow. “It is troubling because foreign patients are also waiting for organs,” said Dr Manabe. “If Japanese want organs, they must give them. Japan must straighten out its own problems.”