Kidney transplants: Editorial

April 5, 2007

Four medical societies, among them the Japan Society for Transplantation, have expressed clear disapproval of a controversial procedure advocated by Makoto Mannami, head of urology at Uwajima Tokushukai Hospital, Ehime Prefecture. The issue is transplants of diseased kidneys.

In a statement issued Saturday, the four societies said transplanting kidneys affected by cancer and other diseases is unacceptable from the medical viewpoint at the present time since the practice poses many problems. The stance is based on plain logic. Kidneys that still perform their function should not be removed, and diseased ones that must be removed should not be implanted in another person's body. We support this common-sense argument.

In championing his unique method of transplantation, Mannami has argued that using organs that otherwise would be disposed of offers surgeons an alternative to removing organs from dead or living donors. He says it helps ease an acute organ shortage. But if the Ministry of Health, Labor and Welfare decides to ban the procedure based on opinions expressed by relevant academic societies, Mannami said he will comply.

So the verdict announced by the four academic societies will put a halt to transplants of unhealthy kidneys, at least for the time being.

Many patients and their families pinned their hopes on this method and urged the health ministry to approve it. They must be disappointed at the news. But they have no choice but to accept the conclusion of experts who criticize this approach for being riddled with serious flaws concerning both the removal and implantation parts of the process.

A joint investigation by the four academic societies uncovered numerous cases in which kidneys that should have been medically treated were removed for transplants. It also turned up cases in which kidneys were removed in ways that posed a danger to the donors. Efforts to obtain consent for transplant and treatment options from patients were insufficient, according to the findings. Transplanting kidneys that must be removed due to disease risks transferring the problem to recipients.

Based on these findings, the four organizations denounced the practice, saying, "Experimental medical procedures were conducted in a closed environment without due consideration to the medical and ethical issues they raised."

While the practice was started by doctors driven by a professional desire to save patients, there is no denying that the donors of the organs were not treated with the respect they deserved. The doctors' failure to follow the necessary procedures in what can only be described as a self-righteous attitude has aroused public distrust of medical transplantation itself.

The four medical societies, however, do not rule out the possibility that transplants of diseased kidneys could become an acceptable option in future. Progress in medical science could lead to the development of completely new methods of organ transplants. The scope of organs that could be transplanted may become much wider than now. However, scientific or technological progress should not be allowed to obviate the need for open and serious debate within academic circles or society on the necessary conditions for approving organ transplants.

For the sake of such debate, the 42 cases of transplants of unhealthy kidneys that have been disclosed should be scrutinized carefully. There are a number of questions that must be answered. Did the transplanted diseased kidneys function properly in the bodies of the recipients? How many of the patients who underwent the operations have survived?

A dearth of organ donations promoted Mannami to act. At this moment, some 12,000 people are waiting for kidney transplants. The figure will likely keep growing.

Unlike hearts or livers, kidneys can be transplanted from a brain-dead donor and also a donor whose heart has stopped beating. Are there effective ways to raise the number of kidney donors? This is a challenge that demands intellectual contributions from many people.

Copyright © 2007 The Asahi Shimbun.

This article posted April 22, 2007.