Japan to allow organ transplantsBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7090.1297b (Published 03 May 1997) Cite this as: BMJ 1997;314:1297
The lower house of the Japanese parliament has voted to officially recognise the concept of brain death, paving the way for heart transplants to occur for the first time in the country.
Japan's major law making body voted by 320 to 148 to allow a person to be declared dead when his or her brain stops functioning. Previously, a person's heart had to stop for death to be declared, which made heart transplants impossible.
For many years the issue was considered to be too controversial to bring to parliament. Although Japan's two main religions, Buddhism and Shinto, do not ethically object to the concept of brain death, there has been considerable cultural resistance to donating or receiving organs. Many people believe that a person's body and soul are linked and that, in giving up an organ, a person gives up his or her soul. There are also superstitions about “defiling” the body before it reaches the next world.
Doctors say that this resistance to organ transplants has cost thousands of lives that could have been saved. In one of the most technologically advanced countries of the world many critically ill patients have had to be flown to the United States and elsewhere for what has become a relatively routine operation.
The upper house of parliament must still approve the bill, which is believed to be likely but not certain. However, approval by the powerful lower house is seen as a major landmark in public opinion that could have enormous effects on Japanese medicine. Pakistan and Poland are the only other major countries that do not designate brain death as actual death in law or practice.
There has not been a single heart operation in Japan since 1968, when a Japanese surgeon who performed the operation was investigated for murdering the donor. Even though the doctor was not found guilty, the long court case put a stop to all further operations.
The legalisation of brain death means that thousands of patients could be taken off artificial life support. The Health and Welfare Ministry estimates that more than 8000 people in Japan would be declared brain dead each year.