Friday, March 07, 2008

The Dead Helping the Living

My friend Joseph over at "Tame Goes Wild" has been studying Japanese at university for the past several years. It's a staggering amount of work becoming fluent in Japanese and I really respect how hard he both tries to accomplish his goals and become a better person. He often uses his Japanese speech and presentation opportunities to discuss important social issues. He's a gentle, kind soul and I hope you'll all make his Daily Mumble a regular read. He'll inspire you to try to be a better person, too. Sometimes when things in life make me feel down and discouraged, reading about his efforts lift my spirits.

In today's post, Joseph mentioned some interesting facts about organ donation in Japan and I made a huge comment containing some information I was eventually going to get around to posting, but hadn't gotten there yet. Google sent up error messages each time I tried to send the comment (with an attractive hexadecimal code to send along so they'd know what went wrong). I figured I'd try and salvage the (potentially) lost comment and just make the post I was going to make anyway.

A very long time ago, there was a legal drama called "L.A. Law" by David E. Kelly. This is the same man who currently makes the television drama/comedy "Boston Legal" and previously made the (abysmal in my opinion) "Ally McBeal" and (brilliant, again in my opinion) "The Practice". One of the things Kelly does in a lot of his legal shows is use real life cases as fodder for the dramatic situations on his shows. One of the memorable cases on L.A. Law was about a friend of one of the attorney's on the show who needed an organ donation or she would die. She was on a waiting list, but a 50 something Japanese man was being given the next available donation because he had paid a lavish sum of money for the privilege. The attorney argued about the ethics (or lack thereof) of allowing financial capability to determine who gets organs rather than need and how this created a situation where the rich and privileged received disproportionately better care. The way this worked, by the way, was that the donor was bribed to offer their organs to the highest bidder. She lost the case and ended up paying a bribe to another donor in order to keep her friend alive despite her own disapproval of this practice and that of her colleagues.

The reason this little drama was written into the show is that this is exactly what happens when many Japanese people need organ donations. As Joseph's statistics show, a staggeringly low number of Japanese people are willing to donate organs despite the fact that a very high percentage claim to approve of them. It is clear that they approve of them as recipients, not as donors themselves and to this day it's common for Japanese people who need organs to go abroad and pay big money to get them.

If you think I'm wagging a finger or criticizing the Japanese, you'd be wrong. While the imbalance is obvious (they're receiving and not giving), there are cultural reasons for their reluctance to donate organs and, despite cases where people can pay for the organs they get abroad, I'm sure that there are far more cases where people die in need of organs. In the end, they only harm themselves, and it's not really about fault but about belief systems which they have grown up with and a medical system which gives power to the families rather than respecting the wishes of the deceased.

My husband and I have discussed the topic of organ donation many, many times with students as there's a lesson on it in one of the textbooks both of us use (Impact Issues) about the topic. There's a cultural reason for the Japanese not donating organs (likely based in Buddhism according to my students). They do not believe the body should be cut into after death and feel the removal of any parts inhibits their ability to reach heaven. As it was explained to me, they have to cross a river after death and not being intact makes it hard to do so. In fact, I recall a gruesome murder case awhile back where a little girl was murdered and her hands were cut off by the killer and the comment the mother made to the paper was something like 'how can my little girl get to heaven without her hands?'

While Japanese people are not religious, they can be superstitious and also become more spiritually minded as they get older (as do most people). They may not exactly believe in their faiths, but they figure it's better to be safe than sorry, especially about the afterlife. They're not the only ones who feel this way. Some people who are raised as Christians and abandon their faith will still baptize their children "just in case". The fears and ideas you are indoctrinated in can be very strong and it's something all cultures share, not just the Japanese.

The other problem is that organ donation doesn't only come down to what the person who died wanted. If an individual signs up for organ donation and his family decides they don't want him to donate his organs, they can cancel his request, so even open-minded, "fearless" people who go against the grain of their cultural beliefs can be trumped out of making donations after death by a family who is uncomfortable with the idea of organ donation. Given cultural notions about cutting up the body after death, I have to imagine that most families would opt not to allow for donations.


gaijinalways said...

I would agree, it's their loss when trying to get organs that peopl don't wish to donate (or their wishes to donate were overuled by their families' beliefs). The physical body in my mind has little or nothing to do with the spiritual one.

Joseph said...

Thanks for that Shari. It's important to put statistics in context, something I neglected to do.

It was really interesting to see the reactions of our Japanese audience yesterday. Many were staggered that one little girl could actually save so many lives.

As with our presentation last week on climate change, our goal was not simply to demonstrate our language ability, but to actually have a real impact upon their attitudes towards the topic under discussion. A couple of people left us looking a little stunned, saying how they had been moved by these stories which showed that when they die, they have the ability to do the most amazing thing for someone else - give them the gift of life.

They commented on how that knowledge could help to overcome the cultural / religious norms that you describe. If relatives chose to not focus upon the physicality of it all, and instead see organ donation as their departed loved ones performing what could almost be described as a 'miracle', they may be far more inclined to allow the procedure to go ahead.

Prior to our presentations, we were asked to watch a 20 minute interview that our teacher recorded last year in Japan with several university students. Their thoughts mirrored what you said pretty closely - comments such as not being able to move on without all of their body parts - but they also felt that a general lack of awareness of the need for donors led to apathy.

It's been an interesting topic to study, and certainly got me thinking.


Thank you for your kind comments about my blog. Genuinely very much appreciated!

EdieS said...

One of the wonderful things about current biochemical/genetic research is that for some or=gan donations or uses, we can stretch out available resources. For example, did you know that the liver can be divided up and will grow in a recepient? There has cases where a small portion of liver was given to a reciepnt, and it grew to help the reciepnt. Now, the cases I heard of were where it was relatives donating apart of themselves, but still, there would be a way to help with a limited and very precious resource.

ターナー said...

I did some research on this a while back as well - you might be interested in this:

Shari said...

gaijinalways: I agree with you about a body having nothing to do with spiritual life and am more than happy to donate my carcass to science or medicine when I shuffle off the mortal coil. However, I try to be respectful of others beliefs on these matters. This isn't because I believe (or fear) that they are right, but just that I think beliefs aren't the sort of thing logic can be applied to.

Joseph: You're welcome for the comments. It's all true and well-deserved in regards to you blog.

It would be good if people could overlook their spiritual beliefs in this regard, and I think some do, but it's tough, particularly when they haven't seen the information your audience did.

In the U.S., there was advertising encouraging organ donation at one point and the system is made easier by having the option to tag driver's licenses with "donor" stickers, but Japan has no such systems in place. I think that's part of the problem with overcoming apathy and creating awareness.

The statistics you found were frankly shopping. I had no idea so few people donated over such a long period of time.

Edies: I actually had heard that livers can be donated in relatively small pieces and grow in recipients, though I believe that they're the only organs that can manage this. Cloning of organs carries some promise as well, but also some controversy.

Turner: I read your article and found it quite interesting. It does a good job of relating some of the points that were made in the L.A. Law episode that I summarized. Oddly, I was also aware of the organs from executed prisoners information because I used a news story from Voice of America about 8-10 years ago to write a textbook for my former company and that was part of the news we used.

Unfortunately, you can't stop unscrupulous governments or people from doing such things. You can only hope those who need organs will consider the source. On death's doorstep though, most people turn a blind eye.

Many thanks to all for reading and commenting!