Organ Transplantation as a Family Issue: Living Liver Donors in Japan

Abstract

The global criticism of organ trafficking and transplant tourism requires many countries to pursue legal protection of living organ donors for organ transplantation. Japan is one of the criticized countries: more than 26 000 people have become living organ donors. This paper presents an exploration of living liver transplantation in Japan from legal, social and ethical perspectives. Since the first living liver transplantation in 1989, the cases have increased, with extremely high dependency in spite of a few deaths and cases of severe disability. Government and professional guidelines stipulate that living donors be “relatives” so that living organ transplantation can be privatized and regarded as a family issue, although it is strictly limited to altruistic cases in some countries. Based on results of the Living Liver Donor Survey conducted in 2004, Japanese liver donors have had various experiences. Most male donors were employed, felt some obligation and had concerns about financial effects or employment during decision‐making. In contrast, only a quarter of female donors were employed, felt guilty for their children, and did not have opportunities for regular health checkups after donation. Severe tensions and family break‐up were observed in adult‐to‐adult cases, although donors were satisfied with donation overall. The author suggests that we should rethink privatization of living organ donation and that independent advocates should support potential donors. Further research is necessary to explore the reasons why organ donation is privatized even in some forms of cadaver cases in Japan.

Effect of social support and donation-related concerns on ambivalence of living liver donor candidates

“…The ambivalence found in our study also was higher than that found by DiMartini et al This might have been due to the fact that 100% of our study participants planned to donate their liver to an adult relative, whereas in DiMartini's study it was 74%. This is noteworthy because other researchers have claimed that the decision making for adult‐to‐adult LDLT may be more complicated than that in pediatric LDLT, because the former may involve more concerns in the decision‐making process . Cultural and national differences also should be considered in terms of the stricter moral obligations that are associated with more pressure on the donor in traditional collectivistic societies …”

“…This is noteworthy because other researchers have claimed that the decision making for adultto-adult LDLT may be more complicated than that in pediatric LDLT, because the former may involve more concerns in the decision-making process. 11,20 Cultural and national differences also should be considered in terms of the stricter moral obligations that are associated with more pressure on the donor in traditional collectivistic societies. 11 More than 40% of this study's participants reported a moderate level of ambivalence.…”

Psychological profiles of excluded living liver donor candidates

“…[15,21,29] However, poor family relationships and a lack of emotional social support may lead candidates to decide to withdraw from the assessment process. [30] In an effort to reduce the psychological impacts of living organ donation, the transplantation team should respect the voluntary decision of candidates during the assessment process. [31] In the present study, the decision to withdraw from assessment was respected.…”

“…To save the recipient's life via liver transplantation, family members are often active and willing to participate in the selection process. [19,30] This may lead to a large number of candidates not being selected.…”

“…Good social support and family relationships may work as a buffer to mitigate psychological distress before the donation surgery. [13,30] Thus, providing social support and referrals for family counseling during the evaluation are important. Through a multidiscipline collaboration, the transplantation team can provide more intricate care for donor candidates.…”