Japan’s organ network voided donor intentions of mentally disabled

From Kyodo

May 29 2024

TOKYO – Japan’s key organ transplant network has invalidated the organ donation wishes of all individuals officially recognized as being intellectually disabled, the health ministry said Wednesday.

The Ministry of Health, Labor and Welfare, which learned about the practice last month, issued a notice on Monday directing the Japan Organ Transplant Network to ensure invalidations are made only after confirming an individual’s mental capacity with their attending physician, rather than solely based on the possession of a so-called rehabilitation handbook — a document certifying intellectual disability.

The network said Wednesday that health minister Keizo Takemi had instructed it to use a third-party organization to investigate its stance of forgoing organ removal for those aged 15 and older and certified as mentally disabled, which was communicated to medical institutions in March.

“We take this matter very seriously,” the network’s president, Hiroyuki Yokota, said in a statement on its website. “We will continue to strive to respect the intentions regarding organ donation and contribute to the development of transplant medicine in Japan.”

According to the operational guidelines of Japan’s organ transplant law, if a mentally disabled individual aged 15 or older lacks the capacity to express valid intent, organ removal should not be carried out.

However, the guidelines also state that an individual’s attending physician should assess whether their disability prevents them from expressing meaningful intent.

If their doctor determines that there are no issues hindering their ability to express intent, then legal determination of brain death and donation of the brain-dead patient’s organs are possible, according to the health ministry.

Its 2010 guidelines also state that “careful judgment should be made based on individual circumstances, not solely on the possession of a (disability) handbook.”

The ministry said the network’s practice pertaining to those with intellectual disabilities came to light after it received a consultation from a medical institution in April regarding the matter.

The network responded that it had been routinely invalidating the wishes of such individuals, it said, adding the ministry does not have data on the number of invalidated cases.

Rehabilitation handbooks are issued to individuals with intellectual disabilities to facilitate access to support services. They include information such as the individual’s name, address, and the severity of their disability.