From Cure to Governance: The Biopolitical Scene After the Brain Death Controversy in Japan

Abstract

This article follows the transformation of discourses and practices concerning organ transplantation in Japan, as well as considers the effect of comparison in dealing with the recent transformations of this medicine. Since the first enactment of the Japanese Organ Transplantation Law in 1997, public interest has shifted from cultural meanings of medicine to governance by numbers. When the Organ Transplantation Law was revised in June 2009, people seemed to be concerned about the number of donations more than ever and tended to pay less attention to the scientific controversy that had surrounded the redefinition of death in Japan since the 1960s. It is fair to say that the discourse about the shortage of organs occupies an increasingly important place in recent debates and serves as a mode of justifying brain death and organ transplantation. There is therefore an urgent need to analyze how the controversy between science and culture has been overcome during these twelve years. What kinds of criteria have been newly employed to justify brain death and promotion of donation? It is now impossible to ignore new kinds of biopolitics if one wants to understand how the human condition has been reconceptualized in recent medical and legal practice. By focusing on the social meaning of the shortage of organs and on the changing arguments justifying organ transplantation, I discuss the biopolitical conjuncture between economies and bodies and argue that, on the emerging biopolitical scene, organ donation and brain death are interpreted through economic practices.

Keywords:

• Bioeconomy
• justification
• organ transplantation
• brain death controversy

Acknowledgments

A previous version of this article was presented at a session of the thirty-fifth annual meeting of the Society for Social Studies of Science (4S) in August 2010. I would like to thank the organizers, Gergely Mohácsi and Atsuro Morita, and the other members for having productive discussions. I also acknowledge Liv Nyland Krauss for reading and commenting on an early draft of the article.

Notes

 1 A historical review of this term is given in Passet 2008 and Helmreich 2008.

 2 To understand broader aspects of bioeconomy, it is also important to refer to the recent science studies literature, which describes the ways that life sciences and biomedical research create new industry for economic growth (e.g., Cooper 2008; Kent 2008; Sunder Rajan 2006; Waldby and Mitchell 2006).

 3 For an analysis of the 2006 case of organ trafficking, see Yamazaki 2009.

 4 Preconditions for determining brain death in Japan consist of five items: (1) profound coma; (2) dilation of both pupils of 4 mm or more, with pupils fixed; (3) loss of brainstem reflexes; (4) isoelectric electroencephalogram; and (5) cessation of natural breathing (arrested respiration test). The former law defined a brain-dead person as one from whom organs could be removed for transplantation and whose whole brain function, including brainstem, could be certified to be irreversibly arrested. The current law, in contrast, defines a brain-dead person simply as a person whose whole brain function, including brainstem, can be certified to be irreversibly arrested. This implies that the brain-dead person is defined regardless of organ donation. See also Natori 2011 and Aita 2011 for an overview of the revised law.

 5 Two well-known journalists criticized the concept of brain death in different ways during this time (see Morioka 2001). Michi Nakajima (1985) introduced voices of ordinary people. They could not accept brain death as death because the brain-dead patient's body was still warm and mismatched to the usual experience of death. Takashi Tachibana (1986), on the other hand, criticized the Japanese criteria for brain death from a scientific standpoint, because it could test only the cessation of the brain's observable functions, not the actual death of all brain cells. See also Ishii and Hamamoto 2009, Kimura 1998, Morioka 1995 and Morioka 1989 for the historical understandings of organ transplantation in Japan.

 6 According to data gathered by the National Institute of Public Health (Kokuritsu Hoken Iryo Kagakuin), 29 percent of people asked had no considerable knowledge of brain death, compared with 11 percent in the United States, 6 percent in Germany, 8 percent in France, and 6 percent in the United Kingdom (Minemura, Yamaoka and Yoshino 2010). On the subject of the donor family's understanding of brain death, see Yamazaki 2008.

 7 Many social actors are against this revision and claim the need for further discussion, such as the Japanese Association of Religious Organizations (Nihon Syukyo Renmei) and some religious foundations (Jodo Shinshu, Oomoto, Nichiren, etc.) that made proclamations against the revision of the law. In addition, an academic group of bioethicists (Seimei Rinri Kaigi) opposed the law because of its premature conclusions without public discussion, but it has not yet been able to provoke any productive controversy.

 8 The discrepancy between recipients and donors contributes to the practice of overseas transplantation. The fact that there is a shortage encourages some Japanese patients to go abroad where more organ transplant surgery is done (Yamazaki 2007).

 9 I use the term translation following Bruno Latour (1999: 88): “The operation of translation consists of combining two hitherto different interests…to form a single composite goal.”

10 For kidney transplantations, 186 operations were performed in 2010, while the number of those on the waiting list was 11,910 as of 21 July 2011.

11 “Kaigai de zouki isyoku 522 nin…Kouseisyou haaku bun” (“522 People Having Transplants Abroad:Analyzing the Ministry of Health, Labor and Welfare”), Yomiuri Shinbun (22 April 2006) reports on the first research by the Ministry of Health, Labor and Welfare. The article also states that the numbers included most of the heart transplants, but the status of liver and kidney transplantation is difficult to determine because most of those patients go abroad on their own, without a doctor's advice. The destinations vary with the type of organ.

12 For an ethnographic description of overseas transplants, see Yamazaki 2007, in which I introduce and analyze six cases.

13 The chouki-noushi lasted up to a maximum of eleven years (Yomiuri newspaper, 18 December 2007).

14 There is a problem of legal interpretation here. People who promoted the revised law alleged that the revised law did not define brain death as death in general. But, on the other hand, there are some who insist critically that the law actually considers brain death to be human death. See also note 4.

15 In this interview, Foucault said, “What I'm trying to pick out with this term is, firstly, a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral and philanthropic propositions—in short, the said as much as the unsaid. Such are the elements of the apparatus. The apparatus itself is the system of relations that can be established between these elements” (298).