Page - 7 - in Critical Issues in Science, Technology and Society Studies - Conference Proceedings of the 17th STS Conference Graz 2018

1. Transplantations in Japan In Japan, there has until recently been a very strict law dating from 1997 concerning the donation of organs. Not only was it an opt-out1 instead of an opt-in systemi but there was also a restriction with regard to age (15 years old), and family consent was necessary. This changed with the law of 2010: there is now an opt-out system but there continues to be a considerable shortage of organ donors. (Egawa et al. 2012) Scholars usually agree on four main causes for the fact that organ transplantations are not particularly popular among the Japanese: The first possible reason is the first Japanese heart transplantation, which was performed on Hokkaido in 1968 (only one year after the first semi- successful human heart transplantation in the world). It is known as the ‘Wada case’ and it provoked a scandal because the patient died not long after the operation and the surgeon was later accused of murdering both the donor (it was later revealed that the declaration of the donor's death before removing the heart might have not been entirely justifiable) and the patient (whose own heart may not have been in such a bad state). Thus the public has often perceived organ transplantations as a mere means of career advancement for doctors instead of the regular treatment for the patient's sake. (Lock 1999) The second problem is that of gift exchange. The infinite gratitude saved people feel towards the dead donors is always psychologically problematic (Varela 2001) but the sophisticated system of gift exchange in Japan and the impossibility of the enormous gift of a vital organ to fit into it makes this problem almost unsolvable. (Ohnuki-Tierney 1994) The two last usually discussed factors are differing approaches to bodily integrity and brain death. These are interconnected and I will focus on them more. In Japan, the identity of a person is usually understood as a complete body ( – gotai – five body parts) compared to the Western concept where identity is situated in the head, that is in rationality. So for some people, the organ transplant is an unnatural rationalization which comes from the West. The emphasis on bodily integrity can be also supported by anthropological evidence like the lack of interest in ear-piercing, never adopting foot binding from China, etc. Even though the fact of having someone else's organ in one's own body is surely an unusual experience for most people regardless of the culture he or she feels to be part of (Nancy 2008), the Japanese seem to see it as especially problematic. (Lock 1999; Ohnuki-Tierney 1994) The notion of brain death is related to this. If personhood is distributed in the whole body, why should a person be dead if it is ‘only’ his or her brain that does not work? Brain-dead people still have a lot of traits which are associated with life: a brain-dead person usually has a normal skin color, is warm, their heart is beating, their digestion works, they can even deliver a child (e.g. Kinoshita et al. 2015). Personhood is not necessarily located in the brain exclusively, so the fact that the brain itself is dead does not have to indicate the death of the person. All this is again set to be connected to Western rationalization: when it comes to stating brain death, relatives have to rely on proclamations of experts educated in Western science. To continue with life support thus does not have to mean only the unnecessary expenses spent on already dead people. Instead, it is the prolongation of life or the natural way of dying slowly rather than one moment of 1 This means that people are not considered to be potential organ donors automatically and they have to explicitly state their consent. A similar situation can for example be found in the United States or Germany. In the Czech Republic and in Austria (among others), there is by contrast the opt-out system. 7