JAPAN HAS AN ORGAN DONATION PROBLEM: AN INTERVIEW WITH CAMPAIGNER YOSHIKO KOBATA

Kobota at Deathfes

An ageing society like Japan faces many challenges, ranging from health care to dealing with senility and loneliness. But while age-related issues are increasingly being focused on, there is till a great reluctance to address the topic of death itself, which is exactly why Deathフェス “Deathfes” was set up. Namely this is as an attempt to “normalise” conversations about dying in a society where the topic remains taboo. But it’s not just the elderly that death effects, it is people of all ages, and one of the key aspects of this, is the problem of organ donation. 

This is an area where Japan sadly lags behind much of the developed World, according to Yoshiko Kobata, a former Fuji Television announcer who is now very much a campaigner for Japan to take a more enlightened attitude to organ donation. Tokyo Metropolis met up with Kobata at the most recent instalment of Deathfes held recently at Shibuya’s Hikarie Building, to hear her views. 

Kobata has had an interest in this topic going back several decades. How did it all begin?

"People are often surprised to know that I’m so committed to this issue, even though I don’t have any family members who can only be saved by a transplant, nor do I have any relatives who have received the organ," she says. "It all began when, as a reporter, I did a special report on the role of Transplant Coordinators—a profession which plays a key role in organ transplantation. I interviewed a woman who had just received a kidney transplant. Facing the camera, she said, ‘I don’t know who donated this kidney to me, but I would like to take this opportunity to express my heartfelt gratitude.’ Tears streamed down her face. At that moment, I felt that television should do more to highlight the benefits of organ transplantation. I also believed that if more people, like that woman, could be freed from painful illnesses, our society would be filled with more smiles."

But standing in the way such pragmatic and altruistic idealism, which could turn the tragedy of unexpected fatalities into a life-saving boon for others, is Japan’s antiquated attitudes to death and dealing with the dead. 

"In Japan, talking about or thinking about death is considered bad luck." Kobata explains. "There is a tendency to shy away from death. Older people, in particular, sometimes believe if they donate their organs after death, they won’t be able to live a healthy life in Heaven."

But there are also more mundane and structural reasons for Japan lagging in organ donations. One major reason is the poorly written law on organ donation. According to Kobata, that problem stems from the Japanese tendency to make messy and unworkable compromises whenever there are differing opinions.

"This law, known as the Organ Transplant Act, came into effect in October 1997—nearly 30 years ago. The politicians prioritised getting the bill passed so it was a compromise proposal to persuade the opposition."

The law stipulated that organ donation was permitted only when the donor’s will was documented in writing and the family did not object. Since written expressions of intent were deemed valid only for those aged 15 or older, organ donation by children became a virtual impossibility. 

In addition, the determination of brain death in Japan requires that the same procedures be performed again after an interval of at least six hours, following the completion of a set of specific tests. 

"In effect organ donation in Japan has the strictest conditions in the world," Kobata emphasises. "How long do you think it took for the first donor to come forward after the law went into effect? It was 1 year and 4 months later. Because the law was so strict, some people referred to it as the ‘Transplant Ban Act’."

So what exactly is Kobata doing to change this grim (reaper) situation? One vital tactic is to face these awkward and taboo issues head on, which is one of the broader goal of DeathFes.

Participants at DeathFes

"DeathFes is an event that began in 2024," Kobata recalls, "This is its third year. I attended as a visitor in 2024 and became interested in its unique approach of not treating death as a taboo, so I started exhibiting there last year. This time, I was at my booth every day for the entire six-day event, raising awareness of organ transplantation, which I have been covering for more than 35 years as a journalist. The venue was filled with people of all ages, from children to the elderly, including those involved in the end-of-life industry, medical professionals, artists, and media."

Despite the negatives, Kobata feels that there is a big change in attitudes on the horizon.

"Traditional views on death have had a significant influence. However, young people’s attitudes are changing dramatically," she explains. "Many young people think that since the body will be cremated anyway, it would be better to put it to good use. The thought that a part of that person lives on inside someone else’s body might help ease the grief."

So, which countries does Kobata think Japan should emulate in its approach to organ donation?

"As the survey results show, Japan’s number of organ donors is only one-fiftieth that of Spain or the United States. Notably, many European countries with high organ donation rates, such as Spain, have adopted an opt-out system. Under this system, donation is the default option, and individuals must opt out if they do not wish to donate. Japan currently uses an opt-in system, where individuals must explicitly state whether they wish to donate. However, I believe that switching to an opt-out system might encourage people to think more seriously about the issue and express their wishes."

WEBSITE OF THE JAPAN ORGAN TRANSPLANT NETWORK