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Saturday, July 2, 2011

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Under a cloud: Dr. Toshinobu Horiuchi (left) is escorted by police as officers search his clinic in Edogawa Ward, Tokyo, on June 24. KYODO PHOTO

Dark world of illegal organ trade

Doctor's arrest raises questions over just how prevalent it is


Last month's arrest of a Tokyo man over an organ trading scam came as a shock not just because he was a doctor attempting to get a kidney for himself, but also because he was collaborating with the yakuza to fake an adoption to obtain the organ.

Toshinobu Horiuchi, 55, was arrested after allegedly paying ¥10 million between 2009 and 2010 to gangster Kazuhisa Takino, 50, who Tokyo police say acted as a broker in the bogus adoption.

The gangster, Horiuchi's wife and two other people were also arrested for their alleged involvement in the case.

Trading in organs is prohibited by law and doctors operate under an ethics guideline limiting live donor transplants to relatives to prevent such trade from happening.

Horiuchi and Takino had trouble over monetary payments before arranging the surgery, investigative sources said, and Horiuchi eventually received a kidney from a man arranged, and apparently adopted, through a different channel.

Kota Takahashi, a Niigata University professor who heads the Japan Society for Clinical Renal Transplantation, condemned the case as "outrageous" and "unpardonable."

Others, meanwhile, point out that the case took place against the backdrop of a dearth of available organs for transplant.

Horiuchi inherited his father's clinic in Edogawa Ward and provided health care to the local community for more than two decades. Suffering from chronic kidney disease, his condition worsened in 2005. After starting dialysis, he sought a transplant and registered with the Japan Organ Transplant Network, the only organization in the nation authorized to broker transplants except for corneas.

Serious kidney illness requires the patient to undergo dialysis. According to the Japanese Society for Dialysis Therapy, it is currently being administered to around 297,000 people, more than half of them for at least the last five years.

These patients face various restrictions in work and life and are often troubled by fever or feel listless. Typical long-term patients also have numerous swollen needle scars and pain.

Getting a new kidney is the only radical treatment that can replace dialysis. The organ transplant network says 12,140 patients are currently on its waiting list.

Since its enforcement last July, the revised Organ Transplant Law has enabled harvesting of organs from brain-dead donors if consent is given by their families, but this change has not led to a drastic increase in supply.

Last year alone, only 209 kidney transplants were performed from donors who were pronounced brain dead or in cardiac arrest. Kidney transplants from live donors have been totaling around 1,000 a year over the past several years.

There are several organizations on the Internet that claim to broker transplants abroad. Unable to wait in Japan, many patients end up taking this approach.

Some head to destinations such as China, where relative costs for transplants are lower than other places, despite alleged eye-rasing practices such as organ trades or organs harvested from people who were executed.

According to the investigative sources, Horiuchi went to the Philippines in 2008 in hopes of getting a kidney but eventually gave up as a ban was coming into force against allowing transplants for foreign nationals.

In Japan, rumors have been circulating that providing organs is a way of earning money, but not enough light has been shed on whether there is a black market for organs or what exactly is taking place behind the scenes.

"The latest case as well as Uwajima Tokushukai Hospital's sick kidney transplants came to light because of trouble between the donors and the recipients," said Jiro Nudeshima, a researcher at the Tokyo Foundation who is versed in live donor transplants. "They would not have surfaced if surgeries had been completed without any trouble."

Doctors at Uwajima Tokushukai Hospital in Ehime Prefecture drew public attention for performing transplants after harvesting kidneys from patients with cancer or other maladies. After the practice came to light, the health ministry banned such transplants in principle in 2007.

On the latest case, a ministry official said: "The government guidelines explicitly state public documents must be provided to confirm family relations (between the donor and the recipient). Dubious adoption cases should be uncovered immediately."

But different hospitals apparently take different approaches in confirming kinship, ranging from requiring an official copy of the family register to examining a health care card.

"Any suspicious points will also be discussed at the center's ethics committee," said Shinichiro Tanaka, an official at Okayama Medical Center, which requires only health cards. "I can't believe there is a hospital accommodating a patient for a transplant like the latest case."

Tokyo Foundation's Nudeshima said: "A hospital's ethics panel can't fully serve the required role. A public committee mandated by law should be established to check if kinship is legitimate or if there have been any monetary transactions."

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