Public Sphere for Brain Death and Transplantation in Japan

Asako Kokubo M.D;

Abstract

Brain death and organ transplantation” law was ratifed in Japan in 1997 after a long debate on “brain death”. On the one hand, it is difcult to make a political decision concerning the medical scientifc issues such as “brain death” and “private issues” such as transplants. On the other hand, it is said that the “public sphere”
in the context of Habermas would work to accumulate debates about even scientifc and private issues in the process of decision-making. I would like to show that there were three dimensions of public spheres for brain death and transplants in the Japanese transplant history. In 1968 the frst heart transplantation in Japan was performed. But this case was accused and since then heart surgeons became silent. Namely, even in medical journals heart surgeons had not talked about heart transplants. I would say surgeons left the “public sphere”. However, the public sphere for brain death (Dimension1) grew later, when criteria for diagnosing brain death were established in 1983 and it brought on a lot of debate, which involved the general public and experts in the relevant felds. Dimension2 was built by patients. Instead of heart surgeons, patients built the public sphere by going overseas for transplants since 1984. Transplant abroad had been featured in the mass media. Doctors tried to rescue patients by transferring them overseas to places like the U.S.A. for transplants, since patients had no chance to survive as long as they were in Japan. This dimension functioned  transforming the logic of dichotomy that a doctor was an evil. Dimension3 is “accusations.” Kidney transplant surgeons had been accused of kidney transplants from brain-dead donors during 1984- 1992 and this also stimulated discussions. Even accusations had grew a public sphere. In conclusion, while heart surgeons had still been keeping silent, other actors had been building the public sphere in three dimensions which worked to ratify the brain death law.