Many Japanese must have been touched by the statement issued by the parents of a young boy who recently became an organ donor.
“Our son will live on as part of somebody else’s body. We are proud of him,” said the statement, released after the parents made the wrenching decision to donate organs of their son, who had been declared brain dead.
The Organ Transplant Law was revised two years ago to legalize organ transplants from children under 15 years old. It was the first case of an organ transplant from a child younger than 6 in Japan.
The boy’s heart and liver were transplanted to girls under 10.
The hospitals that conducted the operations should do their utmost to ensure that the parents’ wishes will be satisfied. The Japan Organ Transplant Network, which acted as an intermediary between the donor and the recipients, needs to secure solid long-term support for the bereaved family.
The boy was diagnosed as suffering from hypoxic ischemic encephalopathy, a condition in which the brain does not receive enough oxygen.
There are some questions that must be answered concerning the process leading to the transplants. How did his death actually occur? How was he diagnosed as brain dead under the criteria for children, which is stricter than those for adults? How was it confirmed that the boy had not been abused? What concrete steps were actually taken until and after the parents made the decision to donate his organs?
We urge the network to reveal as much relevant information as possible to ensure transparency of the process while protecting the privacy and respecting the intentions of the boy’s family. It is also important to scrutinize all aspects and stages of the process.
Such efforts are necessary for providing the public with vital facts and information on which to base judgments concerning organ transplants. That is crucial for transplantation medicine, an area of modern medicine that involves many serious ethical issues, to gain public trust and support. That is also helpful for understanding the feelings of the parents.
Pediatric organ transplantation has long been a subject of a bitter and divisive controversy in Japan.
The original Organ Transplant Law, which came into effect in 1997, required a written agreement by the donor as a condition for conducting an organ transplant from a brain dead patient. This rule made it impossible for children under 15 to donate organs.
But small children need small organs. The only option for Japanese children with serious heart diseases who need a heart transplant was to go to other countries like the United States. The families of such children usually had to take out loans or set up donation campaigns to cover the huge expenses involved.
In any country, however, the number of patients waiting for transplants is far larger than the number of organ donors.
Due to this situation, international criticism has been growing about the practice of going abroad to receive an organ transplant. In 2010, the World Health Organization set new guidelines that call on patients to wait for transplants in their own countries.
The 2010 revision to the Organ Transplant Law, followed by the latest transplants from the boy under the revised law, represents a step forward, but there are still many formidable challenges remaining to be tackled.
Particularly important is support for parents who suddenly face the painful reality of the brain death of their child and have to make an agonizing decision on an organ donation.
All efforts by medical experts to save the child’s life must be made to ensure that the parents and other members of the family can accept the organ donation without troubled feelings. Transplant coordinators have an important role to play here.
All this requires effective measures to expand the manpower at understaffed hospital departments involved in emergency medical care for children and to make proficient and well-equipped transplant support staffs available.
This can only be achieved through steady, long-term efforts.
--The Asahi Shimbun, June 17
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