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Play Provides Commentary on Brain-Death Dispute

July 3, 1991

TOKYO (AP) _ A young fisherman washes ashore unconscious and is taken for dead, but his heart still beats feebly.

A surgeon removes it for a transplant.

Years later, the fisherman’s ghost returns and agonizes: ″I screamed when doctors opened my chest and took my beating heart out. ... My voice didn’t come out, but I was still hanging onto my life. Am I alive, or am I dead?″

The scenes from ″The Well of Ignorance,″ a play performed this year in the centuries-old form of noh drama, reflect a pressing issue in modern Japanese medicine.

In the United States, it has been accepted since the 1980s that a person is legally dead when all vital brain functions irreversibly cease. Not in Japan.

Doctors in the West frequently remove still-functioning vital organs for transplant once a donor’s brain is dead. Japanese doctors are extremely reluctant to do so.

″Medically speaking, judging brain death can be done without difficulty, but I don’t think many Japanese can easily accept the concept of brain death,″ said Tomio Tada, an immunology professor at the Tokyo University medical school and author of the noh play.

″Unlike Westerners, Japanese do not make a clear distinction between body and soul,″ Tada said. ″Because Japanese have a strong respect for the flesh, it is hard to accept the idea of brain death while the rest of the body seems to remain alive.″

Japan’s only heart transplant occurred 23 years ago. The donor was a brain- dead boy who drowned; the recipient of his heart lived 80 days.

Other physicians accused the doctor of murdering the donor. Prosecutors spent years trying to build a case against him, but eventually gave up.

This year, the debate resumed when Osaka University doctors considered attempting Japan’s first liver transplant from a brain-dead donor.

Police demanded the doctors wait until the man’s heart stopped beating, too late for the liver to be of use. The doctors eventually dropped the project, citing medical reasons.

An advisory panel to Prime Minister Toshiki Kaifu issued an interim report in mid-June suggesting organ transplants from brain-dead donors be allowed in some cases. A final report is expected in January.

There is no Japanese law defining death.

″Unless brain death is legally justified, there is always a possibility for doctors to be charged with murder,″ said Dr. Satoru Hattori of the Health and Welfare Ministry.

Prosecutors are investigating four cases for possible criminal charges against doctors who removed organs from the brain-dead.

Because doctors believe the law gives them more leeway to do kidney and corneal transplants, about 80 kidney transplants conducted last year, or 10 percent of the total, used organs from brain-dead donors, according to ministry statistics.

About 60 patients went abroad last year to receive livers or hearts. Another 60,000 Japanese desperately need kidney, heart, pancreas or liver transplants, many of which require brain-dead donors.

The heart can beat for days after brain death, and artificial respirators can maintain vital organs for weeks until appropriate recipients are found.

Opponents of recognizing brain death, such as Buddhist monks, argue that such manipulation is unethical.

Toshiro Murase, vice chairman of the Japan Medical Association, said a wariness about doctors, who often are criticized for not being forthcoming about the health of patients, is another obstacle.

″Unlike the United States, where brain death gained public support after doctors determined the technical arguments of the issue, the discussion in Japan is going nowhere because of the public distrust of doctors,″ he said.

Tada, author of the noh play, believes the definition of what constitutes death must be reached by ″social agreement″ in this consensus-oriented nation.

Cumaz Hashioka, 69, an admired noh performer who played the brain-dead fisherman, said: ″Everybody from philosopher to artists should join the discussion ... because death comes to everyone sooner or later.″

He believes noh is well-suited to the debate, because the form always has dealt with souls and spirits, blurring the border between life and death.

Tada’s play never resolves the questions it raises about death.

″The decision is up to the audience,″ Hashioka said. ″In the same sense, it is each individual who should decide whether to support brain death, because there is no definite answer to life and death.″

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