Chapter 25 - Complications


tl by dan luffey

1: Now for the next case.
2: Kondou-sensei, please come up.
3: Thank you. I'll begin now.

1: The patient's name is Akagi Kaori.
2: The donor who wishes to donate his kidney through a live transplant is Satou Eijirou.

Chapter 25 - Complications

1: First, I'll begin with the history of Akagi Kaori-san's disease.
2: Akagi-san contracted Type I diabetes mellitus when she was 11. That's when her kidney began to cease functioning.
3: When she was 20, she received a kidney transplant from her father.
4: Two years later, the transplanted kidney failed and she began dialysis.
5: She continued going to dialysis for the next eight years.
6: As you know, Type I has an extremely poor recovery rate through dialysis,
7: and so she is seeking to do another transplant.

1: A second transplant?
2: We don't usually do those here.
3: So this is a transplant between two strangers?
4: That's true. That name, though...Akagi Kaori. Haven't I heard it somewhere before?
5: Huh?
6: Is that Akagi-san from surgery?
7: And the donor's Saitou Eijirou?
8: You mean Saitou-sensei, the guy sitting right over there?

1: As you may have already noticed,
2: The recipient, Akagi-san, has been working at our university hospital.
3: And the donor is Saitou-sensei, who's sitting over there.
4: They are both medical workers, so they are both educated on the medicine involved.
5: Both of them understand how the entire procedure works.
6: We have finished examinations, and the donor has passed a psychological exam as well.
7: Categorically, this is a transplant between strangers,
8: but there are no laws against such a thing.
9: Still, it is a special case.
10: We're currently preparing documents in order to receive approval from the ethics committee.

1: Are you sure it's OK to do something like this?
2: A transplant between two strangers from the same hospital?
3: I've never heard of such a thing.
4: This is ridiculous.
5: Just because the two of them want it doesn't mean it's OK to proceed.
6: What will happen if people find out about this?
7: It could potentially ruin our image.
8: They're reporting all this after the fact.
9: What do they mean they've done all the examinations?
10: What are they thinking?
11: Don't they have a more convincing reason to do something like this?

1-6: chatter
7: This is a transplant that should not be done.
8: You just said that there were no laws against such a thing, doctor,
9: but doesn't a transplant between strangers go against the Society for Transplantation's ethic guidelines?

1: It's true that the JST does not recommend transplants between strangers in their guidelines.
2: But it's also true that they have not prohibited it.
3: The JST guidelines say this:
4: "A preferable transplant is done from a corpse, and not a living body. If a transplant must be done from a living body, then it should be done only between family members."
5: However, the JST is merely a group of "transplant surgeons."
6: They have no legal authority.
7: The JST does currently express opinions about cases that differ from their ethic guidelines,
8: but ultimately, they leave the decisions up to each hospital.

1: The entity that makes the actual decision as to whether a transplant is ethically permissible or not
2: is the ethics committee of the hospital.
3: Can we keep this discussion to medical matters, please?
4: This is a staff conference.
5: Then I'll ask you from a medical standpoint.

1: You said that you did a psychological exam to confirm the donor's desire to donate a kidney.
2: What kind of an examination was it?
3: Can a person donate a kidney to someone else simply because they're co-workers?
4: I cannot believe that the donor was using proper judgment.
5: If you like, I can show you the records.
6: But the purpose of the psychological examination was merely to confirm why the donor wants to donate the kidney.
7: In other words, we only need to make sure the donor truly has a personal desire to donate the organ.
8: Wouldn't you agree that a discussion about the donor's mental state should take place within the ethics committee?
9: So you haven't yet had a discussion about the ethics of this yet?
10: You engaged in examinations without a firm conclusion?

1: That's enough.
2: I get the fact that you're against this transplant, Mutsumi-chan.
3: Why don't you just use force to stop it, then?
4: Saitou-kun asked for time off to be hospitalized and undergo the examinations, correct?
5: You're his supervisor. If you didn't want him to do it, you shouldn't have let him go.
6: This is something that should be discussed among the entire staff,
7: Professor.

1: Be frank with me here, Kondou-kun.
2: You really have no problems with doing a transplant like this?
3: In order to contribute to the development of kidney transplants over the next decade,
4: I believe that increasing the number of live donors is the only method we've got.
5: As you know, brain death transplants are not fully viable medical options.
6: Out of the 1,000 transplants that happen every year, 90% of them are from live donors.
7: Which means that in order to increase that to 2,000, or even 3,000 kidney transplants per year,
8: we cannot keep limiting the donors to blood relatives only.

1: Unless we make this society of ours one in which one co-worker can easily donate an organ to another,
2: we will not be able to increase the number of renal failure patients who are saved.
3: I asked if you had any problems or not,
4: Kondou-kun.
5: How could there be a problem in wanting to donate a kidney
6: to an acquaintance suffering from renal failure?

1: You still haven't answered his question.
2: The idea that a transplant will solve everything is just a fantasy.
3: Even if the transplant was a success, she would still have to take immunosuppressants for the rest of her life.
4: She would also have to continually come back to the hospital for check-ups. It'd be hardly different from the dialysis she does now.

1: She will have to live the rest of her life being careful about the condition of her transplanted kidney.
2: She'll always have to think about it when she eats, too. She'll be far from free.
3: And if it turns out that the kidney fails, she won't be able to tell the donor.
4: I know may people who've hid and gone back to dialysis.
5: The survival rate through dialysis is low, but it doesn't mean that everyone dies quickly.
6: There are many patients who've gone to dialysis for ten or twenty years and are still in good shape.
7: It's simply about how well one takes care of oneself.

1: Doctor, that logic of yours does not apply to Akagi-san.
2: Her renal failure was a complication from Type I.
3: She's in critical need of a transplant.
4: Then why doesn't she try to get a pancreas transplant?
5: Pancreas transplants are necessary to heal diabetes.
6: Live pancreas transplants are very difficult. It's not a realistic option.
7: Is offering up impossible options truly the right way to go about this?
8: You just want to perform a kidney transplant, don't you?
9: Can you please keep this discussion strictly to medical issues?

1: Okay, that's enough.
2: What is it with you two? Having trouble between the sheets?
3: Whoops...I can't say that, can I? It's sexual harassment.
4: Saitou-kun,
5: I'm a bully, and I don't believe that "good will" exists.
6: When the eldest son of three brothers offers to donate his kidney to his ailing father,
7: it's usually because he's going to get all of good old dad's inheritance.

1: Or let's say it's the youngest son who decides to donate a kidney.
2: That's because he's a NEET who hasn't worked a day in his life, and only knows how to nibble at his parents' ankles.
3: Or if the donor's a Filipino woman who just married the patient two weeks ago.
4: Or it turns out the two involved are superior and subordinate in some yakuza gang.
5: How...
6: are you planning to prove you're simply doing this out of good will?

1: I just want Akagi-san to survive.
2: So it's heroism? You're sacrificing yourself for her?
3: Good will
4: is not pure...
5: I am taking action for myself.
6: Honestly, I don't even care
7: what Akagi-san thinks about it.

1: I think that the eldest son who donated his kidney
2: only did so because he wanted the inheritance.
3: The youngest son who isn't working
4: probably wanted to earn the right to nibble at his parents' ankles through donating his.
5: Obviously, the sale of organs is something that cannot be permitted.
6: The same goes for the strong bullying the weak into donating.
7: But all people who donate kidneys
8: "want" something.
9: And I
10: want Akagi-san to live.

1: Good will is greed.
2: Just as long as she's still alive,
3: I don't care if I never even see her again.

1: You're a funny kid, you know that,
2: Kondou-kun?
3: Will you let me be selfish just this once,
4: Professor?

1: You may have left the transplant world already,
2: but I'm...
3: Stop talking about the past.
4: I'm still here.
5: Professor...
6: This is MY request.

1: Cut it out, Kondou-sensei.
2: What are you trying to do, intimidate me?

1: I can't guarantee what kind of response the ethics committee will give you.
2: Please, let's stop this, Professor.
3: There aren't enough merits to take such a risk.
4: How about repealing this request of yours, Kondou-sensei?
5: Have you forgotten your debt to the professor who's been nice enough to keep you on staff?
6: I would now like to present the examination results,
7: Professor...

1: We aren't done discussing this yet,
2: Kondou-sensei!
3: Stop! Time out!
4: Let's all take a break and cool our heads!
5: I'll begin with the results from the cross-match examination.
6: Are you really going to go through all this again, Kondou-sensei?!
7: Think about how much trouble you're causing!
8: What's...
9: going on here?
10: A - 24 and 2, B - 52, C- 12, DRB1 - 9.
11: Medically, none of these pose any problems.
12: Don't pose any problems?!
13: It's the transplant itself that's the problem!!

1: This transplant will never happen.
2: Not even if it gets approved in this conference AND the ethics committee.
3: The transplant won't be able to happen if the donor decides not to donate his kidney.
4: And Saitou-sensei...
5: Eventually, you yourself will choose not to donate your kidney.
6: Why won't you stop him, Professor?!
7: This isn't a question of ethics or medical problems!!

1: There were no medical problems found with the examination results.
2: And on that day, the transplant between myself and Akagi-san was approved during the conference.