Family-first organ donor rule feared unfair / Allowing people to give kin priority for receipt of organs may erode trust in system

Kunio Kobinata / Yomiuri Shimbun Staff Writer

As part of a revision of the Organ Transplant Law, donors will be permitted from Jan. 17 to give priority for the receipt of their donated organs to their relatives, before other changes are brought in.

The lawmaker-sponsored revision to the law, passed in July, will go into full effect in July next year and will abolish the current minimum age of 15 for donations from brain-dead organ donors.

As a result, organ transplants from brain-dead children will become possible.

Also, while the current law requires would-be organ donors to draw up a written statement expressing their will to donate before they die, the revised law will enable donations to be permitted by family members if a prospective donor's wishes are not recorded.

Because of the strict conditions it imposes, the current law has been ridiculed as "the law for impeding organ donations." The revisions will bring the law into line with those of most Western nations and is expected to greatly improve the situation in Japan, where people seeking transplants have often had to travel overseas to get one.

The revised law also contained a provision allowing a donor's relatives to be given priority for receiving organs.

Lawmakers had said that giving such priority must be allowed in consideration of people's strong desire to save the lives of family members.

The lawmakers who sponsored the legislation included Taro Kono, a Liberal Democratic Party member of the House of Representatives who is the eldest son of former lower house Speaker Yohei Kono. The younger Kono donated part of his liver to his father.

In Diet deliberations on the bill, discussions focused mainly on whether brain death should be regarded as death. Allowing donors to give priority for provision of their organs to relatives was not discussed deeply.

The system allowing relatives to be given priority was implemented earlier than other parts of the revision because the necessary preparations were thought to be simple and could be made quickly.

However, in reality, the change to the law is not as simple as it first seemed.

The Health, Labor and Welfare Ministry will draft a guideline on the revised law, including a definition of who can qualify as a relative, by early January, after holding a public hearing.

But the scope of the new system giving priority to kin for the receipt organs should not be too broad, to ensure public trust in the organ transplant system is not undermined.

In Japan, organ transplants from brain-dead donors have been permitted despite various concerns because equity regarding organ donations forms part of the basic philosophy of medicine.

The operations have gone ahead based on the precondition that organs have been donated entirely as a form of goodwill to third parties, not acquaintances of the donor.

Receipt of a donated organ also is based on the premise that patients whose lives cannot be saved by other means than organ transplants will be prioritized based on their level of need.

Patients seeking a donated organ must register with the Japan Organ Transplant Network, after which the priority order and timing of the transplant is determined.

Giving priority to relatives would result in kin receiving transplants before people who require one more urgently. The principle of fairness that governs the organ transplant system would be shaken.

Another problem is that the scope of relatives deemed eligible to qualify for a donation under the system could widen.

The ministry plans to ensure that the system does not involve a wide range of relatives. The ministry's expert panel on organ transplants has publicized a draft of the revised guideline in which the range of relatives made eligible under the donation priority system is limited to parents, children and spouses--the first degree of affinity.

The ministry said it imposed this limit because cases may arise in which donor cards are falsified and marriages or adoptions falsely registered with the aim of receiving a priority organ transplant.

But some experts have insisted that the feelings of family members should be considered. They argue that siblings should be listed as eligible because many previous organ transplantation have involved living donors who were the siblings of a recipient.

If siblings are included, grandparents and grandchildren also would have to be included because they all share a second degree of affinity.

If the system is expanded to include even more degrees of affinity, the number of relatives eligible to access the priority system increases greatly, and the procedures that would need to be taken to confirm family ties exist between a donor and recipient will be time-consuming yet necessary if the system is to be correctly managed.

In reality, complicated confirmation procedures of this sort will prove impossible as organ transplants should be carried out very promptly.

The ministry panel also proposed that adopted children and common-law spouses be excluded from the range of eligible relatives, and patients seeking organ transplants would have to submit their family registration documents to confirm certain family ties exist when they register with the network.

Tohoku University Prof. Noriko Mizuno, a member of the panel's working group and Civil Code scholar, said: "Measures must be taken [to prevent unwanted outcomes]. For example, the guidelines should stipulate that organ donation procedures should be halted if the slightest suspicion arises about the process."

A key purpose of the revised law should be to increase the number of organ transplants from brain-dead donors. It should not create an environment of suspicion.

To fulfill the purpose of the revised law, priority organ donation to relatives should be implemented extremely carefully. However, in the future, the priority system itself may need to be reexamined.