We got in touch with medical centers and hospitals in the whole Europe, starting from Italy and France, then focusing our interest on the Transplant Centers. We found out that nowadays waitlisting for transplants is reserved mainly to citizens, to resident foreigners or to non resident foreigners on special conditions which did not apply to Taro.

This is the answer we received when we asked to the Customer Service Centre at the UK Department of Health.
"There are very clear Directions in the UK, issued by the Secretary of State for Health, on the allocation of organs from deceased donors, which place patients into two categories – Group 1 and Group 2.  Group 1 includes persons ordinarily resident in the UK, persons entitled under reciprocal health agreements such as European Union (EU) nationals, and certain people entitled under bilateral reciprocal health agreements. The Directions make it clear that a person in Group 2, that is, someone from elsewhere who does not meet these criteria, cannot receive an organ if there is a clinically suitable person in Group 1.  Current arrangements in the UK for the allocation of organs from deceased donors make it highly unlikely that an organ from a deceased UK donor would be allocated to a non-UK national who is resident outside the EU.  One might also wish to note that there is no provision through which visitors to the UK can automatically be entitled to free NHS hospital treatment.  Anyone who is not ordinarily resident is subject to the National Health Service (Charges to Overseas Visitors) Regulations 1989.  The regulations place a legal duty on NHS hospitals to establish whether a person is ordinarily resident, exempt from charges or liable to be charged.  Where it is established that charges apply, they cannot be waived for any reason.”

Certainly.  He has been very kind. We had an interesting meeting with him, showing him Taro's medical reports.  Taro could not be included in their waiting list because the Transplant National Center, being addressed a few days before by Prof. Salizzoni and regional director Dott. Amoroso, had given a negative reply for the reasons written in the previous question.

Yes. In India transplants on foreigners are done entirely with living donors, relatives to the  patient.  That kind of transplant is quite common in Japan too, of course, and it is the first  possibility we considered, but unfortunately the organs of Taro's relatives, for medical reasons were not suited for a transplant. Foreigners could legally be put on a waiting list but always in second priority, that is they can receive a transplant only if there are no compatible Indians. We have observed a similar procedure in many countries, among which Switzerland.

Yes.  They have been very kind and they have explained us that in France the enrolment of non resident  foreigners can be authrized in exeptional cases only if the Ministry of Health of the  patient's country makes a specific request, explaining why that operation cannot be done in their country. That condition cannot be applied to Japan, where that operation can be done, if only there were donors. However the sole operation would have costed 180.000 € to be borne by the patient or by his home country.

Yes, undoubtedly, but while we were getting organized to face that opportunity Taro got worse all at once and he could not stand a long distance journey and a long stay abroad (usually six months) in order to meet the necessary criteria  for the enrolment in the waiting list.

The medical staff at the University of Nagoya, specialist in living donor transplant, decided not to follow that way for two reasons:

1. verified unsuitability of the relatives' livers;
2. his body mass (he was tall and stout), together with the worsening of his physical conditions were serious drawbacks for the success of a partial transplant.

That opinion had been confirmed on principle by Prof. Salizzoni (Torino), according to the medical reports we have shown him.

Their savings summed up to about 150,000 $ and were available to support part of the costs for a possible transplant. Given the emergency situation, in addition to the donations they were relying on loans to be repaid later with the sale of their homes.

It is an Association that leads a role of garantee and control about the use of donations, above the direct interest of the people involved. It is based in Japan. None of the direct nor indirect relatives can be member of the association. You can find information about it here (President, address, contacts).

Of course Taro had a Japanese health insurance, that was covering his medical expenses. His health insurance was effective only for what concerned medical services within the National Health Service. It could have covered expenses for operations to be done abroad if not possible in Japan, but liver transplant is contemplated by the Japanese Health Service. Unfortunately the number of organs available for transplant is very low compared to the needs and therefore the waiting time is extremely long. Those elements are not taken into consideration by the National Health Service as possible reasons to cover transplant costs received abroad by Japanese patients.

From left to right

First row
Kyoko Sakamoto (Japan / Neighbor)
Mamiko Nagamatsu (France / Taro's sister)
Maya Nagamatsu Beccari (France / niece)
Daniele Beccari (France / brother-in-law)
Elena Ponzetti Beccari (Italy / brother-in-law's sister)
Claudio Beccari (Italy / brother-in-law's father)
Fumiko Nagamatsu (Japan / Taro's mother)
Momokosan (Japan / aunt)

Second row
Oyabusan (Japan / uncle)
Miho (Japan / cousin)
Gabriella Ferrua (Italy / brother-in-law's mother)
Daniele Iurlo (Italy / Elena's husband)
Akira Nagamatsu (Japan / Taro's father)
Laura Beccari (Switzerland / bother-in-law's sister)
Stefano Ricca (Switzerland / Laura's husband)
Chiibachan (Japan / grandmother)   

In the middle        
Taro Nagamatsu (Japan)