A Change of Heart

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TIM LARIMER TokyoHelicopters raced through the night sky trailing police motorcades rushing from hospital to hospital. Television networks interrupted soap operas with news bulletins. It was, by all accounts, one of the more frantic newsgathering spectacles ever in a country where media mobs are the norm. The object of all this attention: a heart transplant operation. Wait a minute. This is 1999. Surgeons around the world have been transplanting hearts for more than three decades now, and while the operation is not quite routine, it is no longer whiz-bang science. Yet up until last week, no doctor in Japan could perform the surgery. This is a country where technology moves with a flash, but attitudes change at a glacial pace. Indeed it was only last week that a government panel indicated it will finally approve the birth-control pill later this year.

The transplant policy dates back to 1968, when Dr. Juro Wada performed one of the earliest heart transplants--only to be investigated for murder. Critics alleged that the person who donated the heart was not yet dead because the brain was still functioning. It didn't help Wada's case that the recipient died after 83 days. Ultimately the accusation against Dr. Wada was dropped, but his reputation--as well as that of the procedure itself--were tarnished. We had medical doctors accusing other doctors, says Dr. Wada, now 77. It completely demolished the spirit of medical pioneers.

Not to mention the hopes of thousands of patients, who over the past three decades could not get the transplants they needed to live. Everyone was afraid, says Dr. Shinichi Nunoda, a cardiologist at Tokyo Women's Medical University. Surgeons feared they would be accused of murder. And if a surgeon was accused, his department and hospital would have been left with a bad reputation. In 1991 Nunoda risked his career by helping cardiac patients travel overseas for transplants. In the past 15 years, 44 Japanese have received new hearts in other countries. I thought about it over and over again, he says. If these patients could not get a transplant because I would not help them, then they would die. I would regret that forever.

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Last week's milestone operation was made possible when Japan's Diet finally decided in 1997 to allow doctors to declare patients brain-dead, that is, dead even though the heart is still functioning. This change in law was critical because most organs, including the heart and liver, begin to deteriorate rapidly after the heart stops pumping, and that makes the organs less likely to survive a transplant.

Getting the law changed required overcoming public skepticism of transplants. The fear appears to have been that reckless or over-eager doctors would prematurely declare people dead simply to harvest their organs. And so when the Diet finally revised the law, it included strict regulations on transplants.

That's why nearly two years passed between the legal change and the first successful transplant. Donors must fill out cards giving permission for their organs to be used, and surviving family members must approve the donation. The few donor cards carried by Japanese are closely scrutinized by authorities. When one donor died last year, his organs were not allowed to be transplanted because his card was improperly filled out. The donor had ticked off the organs he would donate and signed the card but failed to circle a number located next to the donor option. It was ridiculous, says Dr. Kazuo Ota, a Tokyo kidney specialist. We wait 30 or 31 years. Now we keep waiting.

And the wait is not likely to get much shorter. Doctors fear that the intense media coverage will discourage people from signing up as donors. Though the names of the patients involved were never published, radio and TV stations rather morbidly reported the stages of the donor's decline while she lay dying, leading her family to threaten stopping the operation. The medical teams have only themselves to blame. So concerned that nothing taint the operations, surgeons let reporters watch the heart transplant, live, on video screens at the hospital.

Tragically, one group of Japanese still has no hope of receiving life-saving transplants. The 1997 law does not allow anyone younger than 16 to donate organs, which means, practically speaking, that children will not be able receive organs either--adult organs are no good for them. That's why Hiroshi Suzuki, 25, of Niigata, is carrying out the kind of desperate fund-raising campaign that Japanese have frequently witnessed in the past. His 2-year-old daughter, Reina, needs a liver transplant. So far, the family has collected half of the $500,000 needed to make a trip to Detroit for the operation. Even Suzuki is conflicted about letting children donate organs. It is complex because it is very difficult to judge brain death for small children, he said. Still, says Dr. Ota, It is very embarrassing. We depend on other countries to save our children's lives.

With reporting by Hiroko Tashiro/Tokyo

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