FINAL REPORT CONCERNING BRAIN DEATH AND ORGAN TRANSPLANTATION

Japan Medical Association

1988

Traditional religious and cultural values surrounding death and dying inform the Japanese public's reluctance to accept brain-based criteria for determining death and the subsequent harvesting of organs for transplantation. Generally, the medical profession has been more amenable to the use of brain criteria for determining death. In 1988, the Bioethics Council of the Japan Medical Association issued its Final Report Concerning Brain Death and Organ Transplantation. The report recognizes the legitimacy of brain criteria for determining death, in addition to the traditional cardiac criteria. However, it also includes a clause that emphasizes the need to consider the wishes of the patient and/or the patient's family and to obtain their consent when using brain criteria to determine death. This compromise position permits the introduction of brain criteria for death while not offending those individuals who oppose it.

1. Definition of Death
   In addition to cardiac death heretofore, death of the brain (irreversible loss of brain function) can be considered as the state of death of the individual human being.
2. Brain Death Determination Criteria
   With the criteria of the Research Group of the Ministry of Health (Kazuo Takeuchi, Group Leader) as minimum required criteria, fundamental particulars should be determined by the ethics committees of university hospitals, etc., and determination should be carried out with certainty and circumspection according to these criteria in such a manner that no doubt remains.
3. Respecting the Wishes of the Patient Himself and His Family
   It is considered appropriate under present circumstances to carry out the determination of death resulting from brain death upon giving serious consideration to the wishes of the patient himself and his family and obtaining their consent.
4. Justifiability of the Determination of Death Resulting from Brain Death
   Together with being generally recognized by the Japan Medical Association and others, it is considered that the determination of death as a result of brain death is socially and legally justifiable when the consent on the part of the patient has been obtained and determination has been carried out by physicians in a reliable manner according to appropriate methods.
5. Time of Death as a Result of the Determination of Brain Death
   In regard to the time of a death as a result of a determination of brain death, it can be considered to be (1) the time when determination of brain death was first made or (2) the time of confirmation of brain death six or more hours subsequent to that. The time of death indicated on the death certificate can be either (1) or (2) above; however, as a precaution in case of disputes over inheritance after death, the other of the two should be recorded in the records of the patient's treatment.
6. Organ Transplantation
   The transplantation of organs is to be carried out in accordance with the guidelines established by the Japan Transplantation Association once the organ donor, organ recipient and the families involved have received thorough explanations and their consent given through their own free will has been obtained.