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 U.S. because of his criminal history, several current and former law enforcement officials said. Goto leads a gang called the Goto-gumi, which 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 U.S., 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 U.S. 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 2001 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 the 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 that 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 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 that 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 network encourages transplant programs to give foreign recipients less than 5% of organs from deceased donors each year, but that 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 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.' "
The Times' Tokyo bureau and staff writer Teresa Watanabe in Los Angeles contributed to this report.
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