Abstract
In Japan futile debate concerning brain death and organ transplantion have been going on for years. I will offer a compromize proposal regarding these debates. It is based on the anaimous conclusion of the Provisional Commission on Brain Death and Organ Transplantation, as stated in its Final Report : "We find it hard to find a reason to object if persons who, while they are alive, strongly desired to donate their organs, do so after they fell into this type of irreversible state". My proposal is as follows : (1) To confirm the wish of donation, written documents are required. This condition may be too strict to promote transplantations, but it is necessary for the present in order to appease the people's distrust of physicians. (2) In the Organ Transplantation Act now being deliberated in the Diet, brain death should be defined as death of a person in order to avoid prosecution for murder. (3) The definition of death by brain death should be restricted to the Act. Otherwise, the concept of death will be confused in relation to many other existing laws with references to death. (4) Brain death should be diagnosed only when an organ transplantation is scheduled or medical treatments are discontinued according to the patient's advance directives. This condition should be written in the guidelines for physicians. Except for these two occasions, most cases where brain deaths are strongly doubted can be managed by gradually narrowing down the range oft reatment, keeping pace with the process of resignation and grieving of the relatives. Finally, we must eracidate brain deaths by preventing traffic accidents and cerebral vascular diseases. Oragan transplantations from brain-dead patients should be eventually replaced by ideal artificial organs.
