VZCZCXRO5878
RR RUEHHM RUEHLN RUEHMA RUEHPB
DE RUEHKO #2691/01 1360932
ZNR UUUUU ZZH
R 160932Z MAY 06
FM AMEMBASSY TOKYO
TO RUEHC/SECSTATE WASHDC 2137
INFO RUEHZN/EST COLLECTIVE
RUEHFK/AMCONSUL FUKUOKA 6223
RUEHNAG/AMCONSUL NAGOYA 6189
RUEHNH/AMCONSUL NAHA 8855
RUEHOK/AMCONSUL OSAKA KOBE 9441
RUEHKSO/AMCONSUL SAPPORO 7387
RUEAUSA/DEPT OF HHS WASHINGTON DC

UNCLAS SECTION 01 OF 03 TOKYO 002691 
 
SIPDIS 
 
DEPT FOR EAP/J MIDHA AND OES/IHA 
DEPT PASS TO WHITE HOUSE OSTP 
DEPT PASS TO NIH/NIAID WESTERN 
DEPT PASS TO CDC 
DEPT PASS TO FDA 
HHS FOR OGHA/BHAT AND ELVANDER 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: AMED TBIO SOCI JA
SUBJECT: CORRECTED COPY - JAPAN: GETTING ORGANS IN FOREIGN 
COUNTRIES 
 
REF: A)98 TOKYO 9778 
     B)99 TOKYO 3388 
     C)TOKYO 2688 
 
TOKYO 00002691  001.2 OF 003 
 
 
¶1.  This is a corrected copy of ref C. 
 
¶2.  Summary.  On April 21, a Ministry of Health, Labor and 
Welfare (MHLW) study group conducted a survey to study the 
number of Japanese citizens seeking organ transplants in 
foreign countries.  The study revealed that at least 522 
individuals had organ transplant operations done overseas. 
The actual number is likely underreported, because the 
study excluded cases where the individual died after 
having a liver or kidney transplant and only surveyed a 
limited number of medical institutions.  The reasons 
behind the increased number of individuals having the 
procedure done abroad for a full range of organ 
transplants include a shortage of donors and long waiting 
periods, legal problems that make it difficult for 
children to receive organs, and the fact that many 
patients can now obtain medical information on organ 
donors through the Internet.  There is concern that some 
patients may be purchasing their organs from unwilling 
donors such as prisoners and those who find themselves in 
dire straits.  As a result, health professionals 
established a committee to look at the ethical issues 
behind receiving organs abroad.  In order to increase the 
number of potential donors in Japan, members of the 
Liberal Democratic Party (LDP) and New Komeito submitted 
two amendment bills to the current Diet session.  End 
Summary. 
 
---------------- 
Survey Procedure 
---------------- 
 
¶3.  A study group of the Ministry of Health, Labor and 
Welfare (MHLW) led by Professor Eiji Kobayashi of Jichi 
Medical University conducted the survey between January 
and March of this year.  The team collected data on the 
number of patients who are undergoing medical treatment 
after having had an organ transplant operation done 
abroad.  The group limited its survey to Japanese medical 
institutions where member doctors of the Japan Society for 
Transplantation work.  For heart transplants only, the 
group reported on all cases including those where the 
transplant recipient died.  For other types of 
transplants, the report did not include cases where the 
organ recipient subsequently died.  The survey covered 17 
institutions for heart transplants, 123 institutions for 
liver transplants and 154 institutions for kidney 
transplants.  The response rate was 100 percent, 97 
percent, and 90 percent respectively. 
 
----------------- 
Heart Transplants 
----------------- 
 
¶4.  The survey reported that 103 patients (64 males and 39 
females) had heart transplant operations done in foreign 
countries between 1984 and 2005.  Eighty-five patients had 
operations done in the U.S., followed by nine patients in 
Germany, seven patients in the UK, and one patient each in 
Canada and France.  Eighteen deaths were also reported, 
but the survival rate five years after surgery was 70.3 
percent, higher than most international rates.  Thirty-two 
patients were younger than 10 years old, 22 patients were 
between the ages of 10-17, and 49 patients were 18 years 
of age or older.  After Japan's organ transplant law took 
effect in 1997, the number of individuals undergoing 
surgery has been steadily increasing. 
 
¶5.  The first heart transplant operation in Japan took 
place in 1968, but ended in failure.  This led to public 
discord over the definition of what constituted brain 
death.  As a consequence, no heart transplant operations 
were carried out in Japan until the 1997 law took effect. 
During the same time period, only one to four Japanese 
 
TOKYO 00002691  002.2 OF 003 
 
 
were receiving operations abroad per year.  Since 1999, 
however, the number of Japanese patients undergoing the 
surgery in both Japan and foreign countries has been on 
the rise. 
 
¶6.  Kobayashi writes in the report that many patients 
undergo heart transplant operations overseas because of 
the rigid organ transplant law and the shortage of donors 
in Japan.  Other factors for the full range of organ 
recipients include the shortage of donors and long waiting 
periods, legal problems that make it difficult for 
children to receive organs, and the fact that many 
patients now can obtain medical information through the 
Internet on potential organ donors. 
 
----------------- 
Liver Transplants 
----------------- 
 
¶7.  According to the survey, 2,982 patients are currently 
undergoing follow-up medical treatment in 83 Japanese 
medical institutions after having a liver transplant 
operation.  Of the 2,982 patients, 221 individuals had a 
transplant operation done in a foreign county.  The survey 
does not provide the exact breakdown of patients by 
country, but 20 medical institutions reported that they 
are treating liver-transplant recipients who had work done 
in Australia, 19 institutions reported that they had 
patients who had the procedure done in the U.S., and 14 
institutes reported that their patients had traveled to 
China for the operation.  The survey did not obtain 
information on cases involving death of the patient after 
the transplant. 
 
------------------ 
Kidney Transplants 
------------------ 
 
¶8.  There are currently 8,297 patients who are undergoing 
medical treatment in 136 Japanese medical institutions 
after having a kidney transplant operation.  Out of the 
8,297 patients, 198 individuals had the transplant 
operation done abroad, according to the data provided by 
63 institutions.  Forty-eight medical institutions 
reported that their patients received their new kidneys in 
China, while 20 institutions reported the source as the 
Philippines.  Eighteen institutions said that their 
patients had a transplant operation done in the U.S.  The 
survey did not obtain information on cases involving death 
of the patient after the transplant. 
 
--------------- 
Ethical Debates 
--------------- 
 
¶9.  On April 21, the Japan Society for Transplantation 
established a committee to consider the safety and ethics 
of receiving organ transplant operations in foreign 
countries.  There is concern that some patients may be 
purchasing their organs from unwilling donors such as 
prisoners and those who find themselves in dire straits. 
For example Yuki Hasegawa of Toho University reported in 
an attached report that some in China feel that those on 
death row should pay for their crimes through organ 
donations, and in India, a kidney donation can support a 
family of four for ten years.  A February 4 edition of the 
Asahi Newspaper devoted much space to the issue of organ 
donations by prisoners in China.  The article quoted an 
interview with a senior PRC health official who admitted 
that more than 90 percent of the organs used for 
transplants were from prisoners sentenced to death.  The 
Sankei Newspaper reported on a study conducted by 
Professor Tsuyosi Kuriya of Okayama University who also 
said that more than 90 percent of the organ donors in 
China were prisoners on death row. 
 
------------------------------------- 
Amendment of the Organ Transplant Law 
 
TOKYO 00002691  003.2 OF 003 
 
 
------------------------------------- 
 
¶10.  From 1997 (when Japan's new law took effect) to 
September 2005, only 41 transplants have taken place that 
used organs from brain-dead patients.  As of February 
2006, there were 85 heart patients, 119 lung patients, 109 
liver patients and 12,112 patients needing new kidneys 
listed on the Japan Organ Transplant Network's official 
list of recipients awaiting transplants. 
 
¶11. In order to increase the number of potential donors 
and help reduce the number of individuals waiting for 
organs, members of the Liberal Democratic Party (LDP) and 
New Komeito have submitted two amendments in the current 
Diet session.  The current law requires donors to have a 
donor card that shows their willingness to donate their 
organs in addition to their family's consent.  One of the 
proposed amendments will designate an individual as 
deceased if there is brain death and will allow organ 
donation with family consent, provided that the donor does 
not specify in his or her will that he or she does not 
want to donate their organs after death.  The other 
amendment will keep the current definition of brain death 
as is, but will lower the age of donors from 15 years of 
age to 12.  (Note: The current law does not define brain 
death as actual death.  It provides that organs can be 
taken from a dead body including from the a body of a 
brain-dead person for the purpose of transplants, but 
under very strict conditions.)  Because the Diet members 
drafting the changes could not reach an agreement on the 
definition of brain death, they submitted the two 
different amendments. 
 
DONOVAN