Staff writerDoctors may be committing unforgivable crimes by performing organ transplants from brain-dead donors, a neurology expert warns.Tetsuo Furukawa, a neurology professor in the Department of Allied Health Sciences and Neurology at Tokyo Medical and Dental University, says it still has not been scientifically proved that brain-dead people are completely unconscious when they are classified as brain dead."It means that brain-dead donors may be experiencing extreme pain when their organs are being removed by surgeons for use in others," he says. "People should be informed about that possibility. When well-informed donors hope to give their organs to others, they should be at least put under general anesthesia when their organs are taken out."Furukawa is urging the medical profession and public to carefully consider the matter as the Organ Transplants Law goes into effect. The new law authorizing organ transplants from brain-dead donors was enacted June 17, one day before the end of the last regular Diet session, and became effective Oct. 16.The sensitive nature of the issue led to a compromise in the Diet, resulting in the law which does not set a uniform definition for brain death. It instead states that brain death is human death only when a donor has been examined and confirmed to be brain dead by two or more doctors, and the patient has given prior written consent to become a donor. A set of guidelines related to the procedure, issued by the Health and Welfare Ministry, states that only people aged 15 and over can become organ donors.There has been no discussion by medical scientists, either domestically or internationally, to examine whether brain-dead patients feel pain, Furukawa says. Heart surgeons who promote the procedure assume, without scientific grounds, that a brain-dead person has totally lost consciousness because their cerebral cortex has ceased to function, he says."But it is a biologically established fact that when the higher level of a nerve center is impaired, its lower level will start working in order to replace its function," Furukawa says. "This indicates that when the cerebral cortex loses its functions, the lower level of the central nervous system, that is, the nerve center beneath the cortex, brain stem and the spinal cord, may partly replace the functions." He goes on to say that current methods to determine brain death are not scientific enough.Under internationally standardized methods of diagnosis, a person is declared to be brain dead when all the following states are confirmed: deep coma, dilated pupils, loss of brain stem response, flat brain waves and loss of spontaneous breathing. These conditions should be reconfirmed more than six hours after the first check. However, medical circles in Japan have agreed that such methods should not be applied to patients under 6 years old because "children often have the ability to recover from severe brain damage."People suffering from some types of chemical poisoning, those with a body temperature of less than 32 C and patients with metabolic disorders should also be excluded as candidates for such methods of brain-death diagnosis because their conditions are sometimes indistinguishable from those indicating brain death. "Such an ambiguity should not be accepted when deciding whether a patient is alive or dead," Furukawa says.Current methods of diagnosing brain death, he says, should be fully explored to determine whether further treatment for the patient is possible. "We should admit the fact that, with the current level of science, we have no way to determine without fail whether a person is in the condition of brain death and whether patients declared brain dead have totally lost consciousness," he says. "It is possible that they feel pain but cannot express it in a way that can be detected by others. It is not science but barbarism to say that something that cannot be detected by current technology does not exist."He stresses that doctors should be humble enough to acknowledge that science and technology in the 20th century are not almighty and there are numerous things they do not yet know.
