Revised Organ Transplant Law

Under the Revised Organ Transplant Law that came into force in July this year, organ donation is now possible even if people have not clearly stated in writing their intention to donate organs, as long as the surviving family agrees. In early September as I write this paper, the eighth such case is being reported.

My immediate reaction is not that this is only the eighth case, but that there have already been so many cases. In the future cases will continue to increase, until one day newspapers may cease to allocate the space such reports deserve. However, while I consider it a good thing that advances in medical technology have resulted in more widespread benefits, at the same time I harbor a certain sense of discomfort regarding the rapidity of these developments. I am probably not the only one who feels this way.

The history of Western medicine has been assailed with similar troubling questions with regards to dissection, and these must be instructive when considering the issue of organ transplant.

Kaitai Shinsho

It is well-known that dissection made a major contribution to modern medicine. In Japan too, in 1771 Genpaku Sugita and Ryotaku Maeno, et al. observed the dissection of a body at the Kozukappara execution ground in Senju (the person who actually performed the dissection was called the old butcher), and verified the accuracy of the body scheme in the Tafel Anatomie which was the Dutch translation of the anatomy book of the German medical scientist Kulmus. Later, they undertook the laborious task of translating the book, publishing it in 1774 as the Kaitai Shinsho. This is known by all as the dawn of modern medicine in Japan.

So, who was dissected on that occasion? We need to take as much interest in those who donated their bodies as in Sugita, Maeno, and other great figures in medical history. Genpaku Sugita's memoir Rangaku kotohajime (1815) states: "The person who was executed on that day was an old woman aged around 50 who had allegedly committed a serious crime. She was born in Kyoto, and was nicknamed Aochababa [Green Tea Hag]."

History of Western dissection

It was from the Renaissance that the scalpel came to be inserted into a cadaver for the purpose of medical research in the West, and even Leonardo da Vinci is known to have secretly performed a dissection. From the 18th century onward, the number of cases of dissection increased at a dramatic rate. By this time, Western Europe had finally been liberated from the plague and starvation which had until very recently posed a risk to people's lives, and society was on the wave of the commercial revolution, a period of great economic development that allowed ordinary people too to get a true taste of affluence. Paradoxical though it may seem, when people are liberated from the pressures of life in this way, the demand for medical services rises.

While doctors today are licensed by a public certification system, in the past medical practitioners of so-called folk medicine used to establish themselves in practice side-by-side with qualified doctors who had graduated from medical school. However, as times advanced, the former were weeded out as charlatans, and a proper medical education became an essential condition to becoming a doctor. The demand for medical services then rose, and the number of medical schools and medical students increased rapidly. Inevitably, this was accompanied by an increase in demand for cadavers for dissection.

So, how did they secure those specimens? If we consider 18th century Great Britain, it was the bodies of executed criminals such as Aochababa mentioned earlier that were officially approved as cadavers for dissection. Moreover, dissection was permitted only of the bodies of those condemned criminals who were considered to be totally evil, as an additional punishment.

Grave-robbing

This resulted in a dire lack of cadavers for dissection. The British Parliament held a select committee on the dissection issue in 1828 and the committee's report shows graphic testimony of the way in which medical schools secured cadavers for dissection. I would like to present some extracts from the testimony of the eminent medical scientist Granville Pattison.

I.was working as assistant to Alan Burns during the last four years of his life (1809-1813). At the time, we were obtaining cadavers by robbing graves. Students who were directly affiliated to the instructor always obtained their own specimens.
Each of the lecturers had what they called their own private army. Normally, these would comprise eight students, who would go out to exhume cadavers.
It was such a distasteful thing, as well as being life-threatening, since people were often shot while carrying out the exhumation work.
Large groups of people would inevitably appear and throw stones at the students as they carried a cadaver from the execution ground to the dissecting rooms.

From the final piece of testimony, we can see that those very same people who must have cheered at the execution reacted with great animosity to the performing of a dissection, no matter how utterly evil the criminal was.

While it seems that the medical schools sometimes robbed graves themselves, according to the same report, in London there were dozens of body-snatchers who used to sell the exhumed cadavers to the medical schools. However, as we see in Pattison's testimony, the family of the deceased took measures to thwart them, such as standing watch until the corpse underground decomposed. Even if they still managed to obtain the cadaver, often it was already too decomposed to be of any use.

Anatomy murders

The story of the toil involved in securing cadavers for dissection comes to a head. Murders took place in order to obtain fresh cadavers that could be sold at a high price. In Great Britain there were two renowned anatomy murder cases.

In English there is a verb "to burke." It means to suffocate, and the word originates from a real person. Between November 1827 and October 1828 a person called Burke killed 16 people in Edinburgh before the murders were discovered and sold their bodies to medical schools. Next, two men in London, Bishop and Williams, killed at least two people between October and November 1831, again selling the cadavers to medical schools.

Public criticism of medical schools was uproarious. One newspaper made the following ironic remark: they are supposed to be anatomists and yet do not seem to have been able to tell whether "the cadavers had been burked or whether they had simply died." Surely they did not purchase the bodies knowing them to have been murdered...?

In June 1832 the Anatomy Act was passed by parliament, abolishing the system of dissection as additional punishment for condemned criminals, and the dissection of cadavers was legalized except in the case when the person concerned clearly refused when they were alive to be dissected, or when their surviving family refused to allow dissection.

Those who opposed the legislation did so on the grounds that ultimately it prolonged the lives of the wealthy by dissecting the unclaimed bodies of poor people to advance medical science. In fact, until somewhere during the 20th century, the source of supply for the majority of cadavers for dissection in Great Britain was the poorhouses. It was not before World War II that dissections came to be carried out mainly on bodies donated voluntarily.

Aochababa and Genpaku Sugita

An even more compelling debate now developed. On December 6, 1832, the Times, which supported the Anatomy Act, reported in detail the execution on the previous day of Bishop and Williams (naturally, their cadavers were dissected), and in the same day's issue carried a letter from a person affiliated with the hospital describing an operation carried out by the eminent surgeon Henry Earle. It was an operation to remove a malignant tumor from the face. The contributor says:

It is during this period precisely that I want those people who oppose dissection to really understand this operation. . How did Dr. Earle come up with the method of squeezing the carotid artery so that loss of blood did not prove fatal? It is thanks to dissection.

Meanwhile, Michael Sadler, known for having uncovered the true condition of wretched child labor, criticized the Anatomy Act in parliament as follows:

Simple surgery such as treating broken arms and legs does not require advanced scientific knowledge. For the lower classes, this is the surgery that is needed most.
. Even if advances in anatomy result in prolonging human life by several hours, is it acceptable to ride roughshod over the natural feelings of human beings to achieve this?

While the level of medical technology is different, the problems of organ transplant today are the same in nature. The fact that both the arguments for and against are persuasive is also the same. Personally, I adhere to the very commonly-held view that we should be cautious concerning organ donation except for cases where the person's intention has been clearly stated. However, I never want to forget that we owe developments in medical science not only to eminent figures such as Genpaku Sugita, but to the existence of people such as Aochababa, who supported them behind the scenes.