The White Peril 白禍

Japan has its own brewing debate over organ transplantation and how donors and recipients are permitted to find each other. The irritant was this story, which broke a week ago:

Police are seeking to establish a criminal case against an organ donor believed to have collaborated in an illegal kidney transplant for cash.

The 59-year-old female donor posed as a concerned relative of the recipient, Suzuo Yamashita, 59, a fisheries company executive who underwent the transplant at Uwajima Tokushukai Hospital in September 2005, police said.

A third person in the case, Tomoko Matsushita, Yamashita's 59-year-old common-law wife, is believed to have acted as a mediator in the illegal transplant.

Yamashita and Matsushita were arrested Sunday on suspicion of paying money for the donor's kidney. Matsushita is also suspected of brokering the transaction.

Unsurprisingly, that case appears to be part of a pattern:

A number of cases have been discovered in which patients in need of kidney transplants have falsified their relationship with donors to meet the ethical guidelines of the Japan Society for Transplantation, which approves organ transplants between patients and their relatives.

...

As the case followed on the heels of another in which a patient married a donor to meet the society's guidelines for transplant, a number of hospitals have set stricter regulations than those of the society to prevent similar incidents.

One of the Nikkei's editorials this morning blames hospitals for not running thorough enough checks:

The hospital and doctors have explained that, once they learned that the sale of an organ [was being conducted], they did not perform the surgery. But doubts remain whether they really had no sense whatever that money was changing hands. Doctors state that their hospital has performed 82 transplants of kidneys from live donors--and this was the single case in which the sale of an organ was involved? Because this case came about through slipshod verification of the donor's identity, it will be necessary to investigate whether the sale of organs took place in other cases.

Organ transplantation is, fundamentally, performed with organs from cadavers; live donorship is considered a last resort. This is because extracting an organ from a healthy person is invasive and therefore not considered optimal. However, in cases of liver or kidney transplants, transplant surgeons rely mostly on live donors. This is because even since the Organ Transplantation Law, which went into effect in 1997, permitted the use of organs from brain-dead donors, there has been a chronic shortage of donated organs. It is clear that this new emphasis on live donorship has been an invitation to the sale of organs.

Well, if you think the brokering of organs isn't happening in Japan, you're probably in need of a brain transplant from a live donor. Back-room dealing is the rule here in plenty of sectors, but health care, with its weird bottlenecks and thickets of rules, is practically begging for it. The Japanese system is great at maintaining a high average life expectancy; but individual experiences with major problems are notoriously uneven, and plain white envelopes full of money are frequently used to smooth the way by those who can afford it. (They often go to the doctors themselves.)

Note, too, that any organs donated by live friends are considered suspect and must be approved by a board; it's not just strangers, but any non-relatives, who should raise the legal alarm. Virginia Postrel has been blogging about the ethics of selling organs for a few months, since she donated a kidney to psychiatrist and journalist Sally Satel. Her latest post on the subject mentions that hospitals in the States are now being less skittish about donors and recipients who hook up on the Internet; but IIRC, an organ donation from a compatible friend has never been a real problem in most cases.