For a Few Yen More: UCLA, Liver Transplants, and the Yakuza

Sometimes, you just can't make this stuff up.... As reported last week in the Los Angeles Times, UCLA [University of California - Los Angeles] Medical Center performed liver transplants on four people with apparent ties to Japanese organized crime.

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 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.'

These transplants were done at a time when the supply of livers for transplantation was limited.

In the year of Goto's surgery, 186 people in the Los Angeles region died waiting for a liver, U.S. transplant statistics show.

One factor was apparently that the particularJapanese transplant recipients could pay cash.

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.

A subsequent article (May 31, 2008) in the LA Times further noted that two of the Japanese transplant recipients made substantial "donations" to the hospital after their procedures.

A powerful Japanese gang boss who received a liver transplant at UCLA Medical Center donated $100,000 to the Westwood hospital shortly after the surgery, The Times has learned.

A plaque dated November 2001 at the entryway to a seventh-floor surgery office reads, 'In grateful recognition of the Goto Research Fund established through the generosity of Mr. Tadamasa Goto.'

UCLA also acknowledged that it received a separate $100,000 donation from another man who figured in Thursday's story. He donated in 2002, the year of his transplant.

The man was identified by a law enforcement official as one of four Japanese men now barred from entering the United States because of their suspected gang affiliations, criminal records, or both.

Finally, one previous attempt to report this story was stopped by apparent intimidation, as reported in the May 30, LA Times article.

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.

The story aroused concern for the integrity of the US transplant system. From the May 31, article:

Sen. Charles Grassley (R-Iowa), who has considerable influence on federal health policy and an interest in transplant oversight going back several years, said he was "worried about the credibility of the transplant system" and would demand additional information from the university.

If the transplant system 'doesn't have credibility, we're not going to have people donate organs,' said Grassley, the senior Republican on the Senate Finance Committee, which oversees federal hospital funds. 'I think I have to get to the bottom of things.'

Arthur Caplan, a bioethicist at the University of Pennsylvania, said hospitals have a responsibility to inquire about the source of their gifts.

'It starts to defy credulity that you're not going to be curious about who these people are, if only to ask them for more money down the road,' he said. 'Any development officer who didn't follow up a $100,000 gift with a check of who this guy is and who his friends are would be an ex-development officer.'

Wealthy foreigners, he added, are attractive to transplant programs because not only do they pay the full cost for their procedures, but they often make gifts of gratitude later.

One L.A. doctor said he believes that UCLA's reputation as a first-class transplant center will suffer from the news of the four transplants.

'It's going to have a real negative effect,' said Dr. David Boska, an internist in Brentwood who says he has referred 10 patients to UCLA over the last decade. 'Their interest is to make sure people know they have a first-rate program. This isn't going to help.'

Boska, who said he is a friend of Busuttil, added: 'I have lost faith in the system, not the program,' he said.

'You have a brother who dies because he doesn't have $500,000 to spend on a liver. That's a terrible thing to think about. Then you learn that we have foreign criminals who come in and get livers. That's not good.'

This seems to be yet another flagrant example of what happens when academic medical institutions put making money ahead of their mission, and ahead of physicians' core values. Now we seem to have a formerly revered academic medical center putting gangsters at the head of the transplant queue, as long as they pay the list price in cash and add some "donations" afterwards. Presumably, four patients, who may have had some kind of health insurance, but who did not have enough cash to pay the "list price" and then make another $100,000 donation, did not get those livers. Physicians are sworn to put the interests of their patients first, but in this case, patients with more money, however it may have been acquired, were first of all.

This case makes a striking argument for the need to drastically reform the leadership and governance of health care organizations, and academic medical centers in particular.

Finally, note that the story was suppressed for years, apparently in part due to dire threats by shadowy figures to the reporter who first looked into the story. This add a new dimension to the anechoic effect.