Liver

Hi Blog,

Okay tough guy. Here's the deal: You think that being a lowly Yakuza is easy? That even down in the lower-ranks of Chinpira-dom that all of that strong-arming, gani-mata de aruku, smoking, womanizing and boozing is easy? Sure, punch perms and sorikomi fads come and go, but the irezumi is for life. Right?

Well, it turns out that if you live life to the Über-Yakuza fullest-- and don't get off-ed in the process-- you'll start falling apart anyway. But if you've got enough money and are willing to shill some soft tips to the FBI you can stroll on into the US and get that much needed liver transplant to get you right back onto the road of drinkin' and hard livin'. (Diabetes, though is another story since they haven't figured out a surgery for that.)

Got 10 minutes? Read these articles on the UCLA liver transplant service for the needy and sick Yakuza. And for the record, just like Dr. Busuttil, I'm not passing judgement here. I don't do that. I just report what I see without prejudice.

Oh, and if you're still around then definitely read Jake Adelstein's opinion piece from the May 11th Washington Post (pasted at the bottom of this post) where he talks about being a beat journalist for the Yomiuri Shinbun who reported on the Yakuza and how his reporting about said UCLA liver transplants lead to death threats against he and his family.

Omoshiroi...

From the LA Times:

Four Japanese gang figures received livers at UCLA

The recipients included one of Japan's most powerful crime bosses. Some in the medical community worry the revelation will have a chilling effect on organ donations.

By John M. Glionna and Charles Ornstein
Los Angeles Times Staff Writers

May 30, 2008

UCLA Medical Center and its most accomplished liver surgeon provided a life-saving transplant to one of Japan's most powerful gang bosses, law enforcement sources told The Times.

In addition, the surgeon performed liver transplants at UCLA on three other men who are now barred from entering the United States because of their criminal records or suspected affiliation with Japanese organized crime groups, said a knowledgeable law enforcement official who spoke on condition of anonymity.

The four surgeries were done between 2000 and 2004 at a time of pronounced organ scarcity. In each of those years, more than 100 patients died awaiting liver transplants in the greater Los Angeles region.

The surgeon in each case was Dr. Ronald W. Busuttil, executive chairman of UCLA's surgery department, according to another person familiar with the matter who also spoke on condition of anonymity. Busuttil is a world-renowned liver surgeon who co-edited a leading text on liver transplantation and is one of the highest-paid employees in the University of California system.

There is no evidence that UCLA or Busuttil knew at the time of the transplants that any of the patients had ties to Japanese gangs, commonly called yakuza. Both said in statements that they do not make moral judgments about patients and treat them based on their medical need.

U.S. transplant rules do not prohibit hospitals from performing transplants on either foreign patients or those with criminal histories.

The most prominent transplant recipient, Tadamasa Goto, had been barred from entering the United States because of his criminal history, several current and former law enforcement officials said. Goto leads a gang called the Goto-gumi that experts describe as vindictive and at times brutal.

The FBI helped Goto obtain a visa to enter the United States in 2001 in exchange for leads on potentially illegal activity in this country by Japanese criminal gangs, said Jim Stern, retired chief of the FBI's Asian criminal enterprise unit in Washington.

Goto got his liver, Stern said, but provided the bureau with little useful information on Japanese gangs.

"I don't think Goto gave the bureau anything of significance," Stern said. Goto "came to the States and got a liver and was laughing back to where he came from. . . . It defies logic."

Although Stern was not involved with the deal, he said he learned the details when he became unit chief in 2004 and continues to be troubled by what happened.

After the transplant, Goto was again barred from reentering the United States, said the first law enforcement official who was not authorized to discuss the matter publicly and therefore requested anonymity.

But Goto continued to receive medical care from Busuttil in Japan. The doctor traveled there and examined Goto on more than one occasion, said Goto's Tokyo-based lawyer, Yoshiyuki Maki -- and evaluated Goto while he was in custody in 2006.

Busuttil's medical opinion was cited in a successful court petition to have Goto released for medical care at a Tokyo hospital, Maki said.

The Times is not naming the other three transplant recipients in this article because neither they nor their lawyers could be reached.

Several transplant experts and bioethicists contacted by The Times said they were troubled by the transplants, especially because organs are in such short supply in this country. In the year of Goto's surgery, 186 people in the Los Angeles region died waiting for a liver, U.S. transplant statistics show.

Some, but not all, of the experts said a transplant center has an obligation to determine whether a patient would be a worthy custodian of an organ and to protect potential donors' faith in the system.

"If you want to destroy public support for organ donation on the part of Americans, you'd be hard pressed to think of a practice that would be better suited," said Arthur Caplan, a bioethicist at the University of Pennsylvania.

In a statement, the UCLA Health System said it could not comment on specific cases because of federal patient privacy laws. Generally, it said it complies with all the rules and regulations of the United Network for Organ Sharing, the federal contractor charged with ensuring the safety and fairness of the U.S. transplant system. Last year, UCLA performed more liver transplants than any other U.S. hospital.

"UCLA's processes for evaluating a patient -- both for mental and physical suitability for organ transplants -- are the same regardless of whether the individual is a U.S. citizen or a foreign national," the statement said.

Hospitals and doctors in the United States have the final say on which patients get added to their waiting lists and have the discretion to refuse patients with unhealthy lifestyles that could compromise the transplant's success. Patients may be refused on other grounds as well, including an inability to pay.

At the time of Goto's transplant, liver allocations were made based on both a patient's medical status and waiting time. Since 2002, livers have been allocated to patients based almost entirely on how sick they are.

It is unclear when Goto joined UCLA's waiting list. He had been in the United States two months when he received a new liver. Overall, 34% of the patients added to UCLA's liver waiting list between January 1999 and December 2001 received a new liver within three years of being listed, national transplant statistics show.

Busuttil, a former president of the American Society of Transplant Surgeons who has testified before Congress on who should receive priority for transplants, released his own statement this week. He did not directly address the transplants of the Japanese patients but said in part:

"As a surgeon, it is not my role to pass moral judgment on the patients who seek my care . . . . If one of my patients, domestic or international, were in a situation that could be life-threatening, of course I would do everything in my power to assure that they would receive proper care.

"I consider that to be part of my responsibility and obligation as a physician."

'A serious player'

On May 18, 2001, Tadamasa Goto boarded Japan Airlines Flight 0062 at Narita International Airport, bound for Los Angeles with his son Masato.

Goto, now 65, had hepatitis C and was worried it would develop into cancer, Maki, Goto's lawyer, said in an interview last week in his Tokyo office. Because Japan has an extreme shortage of organ donors, many sick patients feel they need to go abroad to seek treatment.

The FBI did not help Goto arrange his surgery with UCLA but did help him gain entry to this country, Stern said. The agency had long been frustrated by the reluctance of Japanese law enforcement to share information on yakuza members in the United States.

"For American law enforcement, it's been like pulling teeth to get criminal intelligence from Japanese authorities," said David Kaplan, a journalist who co-wrote the book "Yakuza: Japan's Criminal Underworld," published in 2003 by University of California Press.

In his book, Kaplan describes Goto's gang, the Goto-gumi, as an offshoot of the largest Japanese organized crime group, the Yamaguchi-gumi. In an interview, Kaplan said Goto is "a serious player in the yakuza. His gang is known for being particularly ruthless and violent."

A senior member of the group and an affiliated gang member were sentenced to prison for the 1992 slashing of a Japanese director whose film portrayed the yakuza as violent thugs, according to a story in the Japan Times. Goto was not personally implicated in the case.

Goto underwent a successful transplant in July 2001. He received the liver of a young man who died in a traffic accident, Maki said. "Goto is over 60 now, but his liver is young," he said.

Several years after the transplant, in May 2006, Goto was arrested in Japan on suspicion of real estate fraud.

Maki said he and other lawyers worried their client was not well enough to be interrogated. In addition to his liver problem, Goto was suffering from heart disease, high blood pressure and diabetes.

The lawyers asked that Goto be released immediately, but authorities rejected the request, Maki said. He said the lawyers asked that Goto be given his medication at precise times, but that did not happen either.

"Goto lost his appetite, had a terrible headache, scratched his arm until it started to get infected, and he was throwing up," Maki said.

Maki used the interview to vent against Japanese prosecutors, saying he believes they were attempting to exploit his client's poor health to obtain a conviction on what Maki considered groundless charges.

He said Busuttil, along with doctors from Tokyo University Hospital and Showa University Hospital in Tokyo, examined Goto in jail and recommended that he be released for outside medical treatment.

On May 24, 2006, some 16 days after he was arrested, the court temporarily released Goto and he entered the hospital.

Goto was acquitted of the charges in March of this year.

"The UCLA doctor [Busuttil] examined Goto during his detention and again one week after he received his not-guilty ruling," Maki said.

The law enforcement official who spoke on condition of anonymity said Goto's criminal history includes prison time. But Maki said his client's last conviction was three decades ago, for assault, and that his previous convictions were as a youth.

Court records in Japan are kept by prosecutors who generally do not share them with anyone not party to a case.

Jake Adelstein, a former reporter at Japan's largest daily newspaper, Yomiuri Shimbun, said he received a tip about the circumstances surrounding Goto's liver transplant in 2005. Within days of making inquiries, however, Adelstein was visited by men who told him: "Erase the story or be erased," he said in an interview.

Adelstein did not pursue the story but mentioned the incident in a recent opinion piece in the Washington Post. He said he would elaborate on it in a forthcoming book.

Dealing with scandals

Word of the surgeries at UCLA comes as the U.S. transplant system is slowly recovering from scandals that forced the closure of three transplant programs in California. In one of those, St. Vincent Medical Center in Los Angeles moved a Saudi national up a liver waiting list, bypassing dozens of others, and then covered it up by falsifying paperwork, officials there have acknowledged.

Overseers of the U.S. transplant system say they are unaware of other cases in which hospitals have provided organs to foreign criminals. But some hospitals, including Stanford University Medical Center, have performed transplants on U.S. prisoners -- often controversial because taxpayers foot the bill.

According to the ethics committee of the United Network for Organ Sharing, "one's status as a prisoner should not preclude them from consideration for a transplant."

The United Network for Organ Sharing encourages transplant programs to give foreign recipients less than 5% of organs from deceased donors each year, but the figure is not a hard-and-fast rule. At one point, in the 1980s, the threshold was 10%, but it was lowered after Congress considered banning transplants for foreign nationals entirely.

Centers that exceed the 5% guideline are asked for an explanation in writing, but none has been sanctioned publicly. In 2001, the year Goto received his transplant, UCLA slightly exceeded the guideline.

Typically, transplant experts say, foreigners cannot receive transplants at U.S. centers unless they are willing to pay the full cost of the procedure out of pocket -- without the substantial discounts given to insurers. Charges for a liver transplant and immediate follow-up care generally exceed $523,000, according to an April report by Milliman Inc., an actuarial firm.

It could not be determined how much UCLA and Busuttil were paid for the Japanese transplants.

Tom Mone, chief executive of OneLegacy, the group responsible for procuring and distributing organs in much of Southern California, said transplants for foreign criminals are "an unfortunate result of a system that's magnanimous to the world."

Mone also said that hospitals do not have the resources to investigate their patients. "The enforcement should be at the borders, not at the hospital," he said.

In recent years, nonresident foreign nationals have accounted for less than 1% of all transplant recipients nationwide, transplant statistics show.

Dr. Mark Fox, associate director of the Oklahoma Bioethics Center, said the UCLA transplants may create pressure to eliminate transplants for foreign nationals entirely, which Fox said he does not support.

"For some people, there are misgivings for transplanting foreign nationals at all. For some people, there are misgivings about transplanting criminals at all," he said. "When you put those two together, it is certainly reasonable to expect that a certain portion of the population would say, 'This is not what I expected when I signed my donor card.' " (link.)

From the Washington Post Opinion Page:

This Mob Is Big in Japan

By Jake Adelstein
Sunday, May 11, 2008; B02

I have spent most of the past 15 years in the dark side of the rising sun. Until three years ago, I was a crime reporter for the Yomiuri Shimbun, Japan's largest newspaper, and covered a roster of characters that included serial killers who doubled as pet breeders, child pornographers who abducted junior high-school girls, and the John Gotti of Japan.

I came to Japan in 1988 at age 19, spent most of college living in a Zen Buddhist temple, and then became the first U.S. citizen hired as a regular staff writer for a Japanese newspaper in Japanese. If you know anything about Japan, you'll realize how bizarre this is -- a gaijin, or foreigner, covering Japanese cops. When I started the beat in the early 1990s, I knew nothing about the yakuza, a.k.a. the Japanese mafia. But following their prostitution rings and extortion rackets became my life.

Most Americans think of Japan as a law-abiding and peaceful place, as well as our staunch ally, but reporting on the underworld gave me a different perspective. Mobs are legal entities here. Their fan magazines and comic books are sold in convenience stores, and bosses socialize with prime ministers and politicians. And as far as the United States is concerned, Japan may be refueling U.S. warships at sea, but it's not helping us fight our own battles against organized crime -- a realization that led to my biggest scoop.

I loved my job. The cops fighting organized crime are hard-drinking iconoclasts -- many look like their mobster foes, with their black suits and slicked-back hair. They're outsiders in Japanese society, and perhaps because I was an outsider too, we got along well. The yakuza's tribal features are also compelling, like those of an alien life form: the full-body tattoos, missing digits and pseudo-family structure. I became so fascinated that, like someone staring at a wild animal, I got too close and now am worried for my life. But more on that later.

The Japanese National Police Agency (NPA) estimates that the yakuza have almost 80,000 members. The most powerful faction, the Yamaguchi-gumi, is known as "the Wal-Mart of the yakuza" and reportedly has close to 40,000 members. In Tokyo alone, the police have identified more than 800 yakuza front companies: investment and auditing firms, construction companies and pastry shops. The mobsters even set up their own bank in California, according to underworld sources.

Over the last seven years, the yakuza have moved into finance. Japan's Securities and Exchange Surveillance Commission has an index of more than 50 listed companies with ties to organized crime. The market is so infested that Osaka Securities Exchange officials decided in March that they would review all listed companies and expel those found to have links with the yakuza. If you think this has nothing to do with the United States, think again. Americans have billions of dollars in the Japanese stock market. So U.S. investors could be funding the Japanese mob.

I once asked a detective from Osaka why, if Japanese law enforcement knows so much about the yakuza, the police don't just take them down. "We don't have a RICO Act," he explained. "We don't have plea-bargaining, a witness-protection program or witness-relocation program. So what we end up doing most of the time is just clipping the branches. . . . If the government would give us the tools, we'd shut them down, but we don't have 'em."

In the good old days, the yakuza made most of their money from sleaze: prostitution, drugs, protection money and child pornography. Kiddie porn is still part of their base income -- and another area where Japan isn't acting like America's friend.

In 1999, my editors assigned me to cover the Tokyo neighborhood that includes Kabukicho, Japan's largest red-light district. Japan had recently outlawed child pornography -- reluctantly, after international pressure left officials no choice. But the ban, which is still in effect, had a major flaw: It criminalized producing and selling child pornography, not owning it. So the big-money industry goes on, unabated. Last month's issue of a widely available porn magazine proclaimed, "Our Cover Girl Is Our Youngest Yet: 14!" Kabukicho remains loaded with the stuff, and teenage sex workers are readily available. I've even seen specialty stores that sell the underwear worn by teenage strippers.

The ban is so weak that investigating yakuza who peddle child pornography is practically impossible. "The United States has referred hundreds of . . . cases to Japanese law enforcement authorities," a U.S. embassy spokesman recently told me. "Without exception, U.S. officials have been told that the Japanese police cannot open an investigation because possession is legal." In 2007, the Internet Hotline Center in Japan identified more than 500 local sites displaying child pornography.

There's talk in Japan of criminalizing simple possession, but some political parties (and publishers, who are raking in millions) oppose the idea. U.S. law enforcement officers want to stop the flow of yakuza-produced child porn into the United States and would support such a law. But they can't even keep the yakuza themselves out of the country. Why? Because the national police refuse to share intelligence. Last year, a former FBI agent told me that, in a decade of conferences, the NPA had turned over the names and birthdates of about 50 yakuza members. "Fifty out of 80,000," he said.

This lack of cooperation was partly responsible for an astonishing deal made with the yakuza, and for the story that changed my life. On May 18, 2001, the FBI arranged for Tadamasa Goto -- a notorious Japanese gang boss, the one that some federal agents call the "John Gotti of Japan" -- to be flown to the United States for a liver transplant.

Goto is alive today because of that operation -- a source of resentment among Japanese law enforcement officials because the FBI organized it without consulting them. From the U.S. point of view, it was a necessary evil. The FBI had long suspected the yakuza of laundering money in the United States, and Japanese and U.S. law enforcement officials confirm that Goto offered to tip them off to Yamaguchi-gumi front companies and mobsters in exchange for the transplant. James Moynihan, then the FBI representative in Tokyo who brokered the deal, still defends the operation. "You can't monitor the activities of the yakuza in the United States if you don't know who they are," he said in 2007. "Goto only gave us a fraction of what he promised, but it was better than nothing."

The suspicions about the Yamaguchi-gumi were confirmed in the fall of 2003, when special agents from Immigration and Customs Enforcement (ICE), whom I've interviewed, tracked down several million dollars deposited in U.S. casino accounts and banks by Susumu Kajiyama, a boss known as "the Emperor of Loan Sharks." The agents said they had not received a lead from the Tokyo police; they got some of the information while looking back at the Goto case.

Unlike their Japanese counterparts, U.S. law enforcement officers are sharing tips with Japan. Officials from both countries confirm that, in November 2003, the Tokyo police used information from ICE and the Nevada Gaming Control Board to seize $2 million dollars in cash from a safe-deposit box in Japan, which was leased to Kajiyama by a firm affiliated with a major Las Vegas casino. According to ICE Special Agent Mike Cox, the Kajiyama saga was probably not an isolated incident. "If we had some more information from the Japan side," he told me last year, "I'm sure we'd find other cases like it."

I'm not entirely objective on the issue of the yakuza in my adopted homeland. Three years ago, Goto got word that I was reporting an article about his liver transplant. A few days later, his underlings obliquely threatened me. Then came a formal meeting. The offer was straightforward. "Erase the story or be erased," one of them said. "Your family too."

I knew enough to take the threat seriously. So I took some advice from a senior Japanese detective, abandoned the scoop and resigned from the Yomiuri Shimbun two months later. But I never forgot the story. I planned to write about it in a book, figuring that, with Goto's poor health, he'd be dead by the time it came out. Otherwise, I planned to clip out the business of his operation at the last minute.

I didn't bargain on the contents leaking out before my book was released, which is what happened last November. Now the FBI and local law enforcement are watching over my family in the States, while the Tokyo police and the NPA look out for me in Japan. I would like to go home, but Goto has a reputation for taking out his target and anyone else in the vicinity.

In early March, in my presence, an FBI agent asked the NPA to provide a list of all the members of Goto's organization so that they could stop them from coming into the country and killing my family. The NPA was reluctant at first, citing "privacy concerns," but after much soul-searching handed over about 50 names. But the Tokyo police file lists more than 900 members. I know this because someone posted the file online in the summer of 2007; a Japanese detective was fired because of the leak.

Of course, I'm a little biased. I don't think it's selfish of me to value the safety of my family more than the personal privacy of crooks. And as a crime reporter, I'm baffled that the Japanese don't share intelligence on the yakuza with the United States.

Then again, perhaps I'm being unreasonable. Maybe some powerful Japanese are simply ashamed of how strong the yakuza have become. And if they're not ashamed, they should be. (link.)