Faced with a lengthening list of candidates for heart transplants and a tiny list of donors, Japanese patients are going overseas to the US, Canada and Germany. Some parliamentarians claim that their law on organ donation is too restrictive and are calling for changes in the consent law. At the moment, Japan does not allow organs to be harvested from brain-dead patients unless they have expressed their wishes in writing. Without this in hand, even their relatives are not allowed to authorise a transplant. As a result, since 1997, only 29 Japanese diagnosed as brain dead have become organ donors, even though 3,000 suffer brain death each year.

Good intentions are not the problem. Although more than a third of Japanese say that they would be willing to donate their organs, only about 5% have signed donor cards. However there is also a deep cultural bias against harvesting organs from the brain-dead. A lobbyist against liberalising the law, Eiji Tsunakawa, says that removing the decision from a patient’s hands would violate the most precious of human rights. “It’s partly emotional, partly common sense,” he says. “How can you say that somebody whose heart is beating and body is warm and sweats is really dead?”

The scandal of Japan’s first heart transplant in 1968 hasn’t helped the cause of reform. The surgeon was investigated for allegedly removing the heart of a patient who was not dead and transplanting it to a patient who did not need it. He was never charged, but heart transplants were banned until 1997.

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