Socio-cultural dimensions of renal transplants in Japan.
One of the most vigorous developments in the recent years in the social sciences is seen in the domain of illness, health and health care systems. It has provided a meaningful interface between the health sciences and the social sciences. While the field is represented by a variety of approaches epistemologically, methodologically and theoretically, we have become increasingly aware of the socio-cultural dimensions of our health-related concepts and behavior. We no longer assume that even biomedicine is an objective ‘science’. Not only is its theoretical foundations not free of the structure of consciousness of the Western intellectual tradition, in which it has been developed, but its delivery is strongly influenced by a culture in which it is practiced [l]. The paper by Ohi et al. [2], entitled “Why are cadaveric renal transplants so hard to find in Japan? An analysis of economic and attitudinal aspects” is one such attempt. The paper provides us with a dramatic example of how the rational economic model has little room in Japan. While the information presented in the paper is fascinating, the causal factors chosen by the authors the decision making pattern in Japanese society and a residual effect of a dubious heart transplantation case in 1%8 seem misdirected and overly simplified. I also find objectionable the value judgement about the Japanese attitude (“Cadaveric kidneys may not be available in substantial numbers until this negativistic hypersensitivity is brought under control”, p. 270). In this brief commentary, I first offer a critique of these two causal factors proposed by the authors, and then suggest alternative ways for understanding the phenomenon of the Japanese reluctance for cadaveric renal transplants. The authors point to the “custom of the Japanese making decisions by consensus” (p. 269), in contrast to the “ ‘divided’ majority” underlying the decision mak-