Shintoism

Shinto is the indigenous spirituality of Japan. There is some debate as to whether Shinto can be classed as a religion. Shinto is very much concerned with the idea of purity and believes that people are born pure while that living creates impurities. The body after death is thus impure, dangerous and powerful.[48 49] Interfering with a corpse brings bad luck. There is also the concern that interfering with the corpse might injure the relationship between the dead person and the bereaved (known as the itai). It is therefore obvious that the Western medical concept of brain death must be at odds with the Shintoist view of death.

Not surprisingly, an early heart transplant in Sapporo in 1968 drew harsh criticism and triggered a long period of public scepticism. Until recently, legislation reflected this and forbid deceased donation so that patients in need often went abroad.[50] The law changed in 1997 to allow formally transplantation from deceased donors. However, even today, transplantation from deceased donors is not often carried out in Japan, and 90% of all renal transplants performed are from live donors.[51] The percentage of Japanese who carry an organ donor card is among the lowest in the world, as is the deceased donation rate (Table 1). During the first 6 months of 2010, only 95 transplants from 46 deceased donors were carried out in the country [52]. The rarity of deceased donation may also explain why Japan saw, out of necessity, the development of one of the first ABO-incompatible transplant schemes.[53]