Japan’s long kidney waits fuel overseas demand amid Cambodia brokerage case
Japan’s organ shortage drives patients overseas as a kidney transplant at a Cambodian military hospital comes under scrutiny over alleged illegal brokerage
- Japan faces a severe shortage of donor kidneys, with an average wait time of approximately 14 years and 9 months, which drives patients to seek transplants abroad.
- The demand for overseas procedures has led to illegal brokerage, exemplified by a case where a Japanese man was indicted for arranging a kidney transplant in Cambodia.
- In the case, a Japanese patient paid a coordinator approximately US$157,500 for the procedure at a Cambodian hospital previously linked to organ-trafficking allegations.
- Japan's low rate of deceased organ donors (1.13 per million people) is a key factor, starkly contrasting with countries like the US (49.7) and Spain (53.93).
Long waits for donated kidneys in Japan are pushing some patients to seek transplants abroad, with a Tokyo man’s operation in Cambodia now at the centre of an alleged illegal brokerage case.
The man, in his 70s, had lived with kidney disease for more than a decade and could not obtain a kidney from a relative. He contacted a consultation centre advertising transplant services, travelled to Cambodia and paid a local coordinator US$157,500, approximately 5 million baht, for the procedure, according to Nikkei Asia.
Japanese authorities believe Hiromichi Kikuchi, 66, who effectively ran the centre, received more than 9 million yen, approximately 2 million baht, from the patient and used some of it to repay personal debts. He has been indicted on charges of violating Japan’s organ transplant law.
The Yomiuri Shimbun reported on July 8 that the operation linked to the arrests of Kikuchi and two others the previous day was believed to have taken place at Preah Ket Mealea Hospital in central Phnom Penh.
Cambodian hospital faces questions
Affiliated with Cambodia’s defence ministry, Preah Ket Mealea is one of the country’s largest hospitals, with more than 1,000 beds and over 20 departments. Founded in the late 19th century during French colonial rule, it remains a major medical institution serving the community.
A 73-year-old woman who attends monthly for heart treatment told The Yomiuri Shimbun that the hospital was upgraded every year and described its doctors as kind and trustworthy.
The facility has also featured in earlier organ-trafficking allegations.
In 2023, Indonesian police arrested middlemen and others accused of sending more than 100 Indonesians to Cambodia to sell their kidneys.
The Associated Press and other outlets reported that the operations were believed to have taken place at Preah Ket Mealea.
There is no confirmed evidence that the donor in the Japanese patient’s case was a victim of that trafficking network.
The hospital had also been the subject of a separate organ-trafficking investigation reported in 2014.
Cambodia enacted legislation in 2016 prohibiting commercial organ transplants, with violations punishable by up to 20 years in prison. A representative of a non-governmental organisation working on human trafficking told The Yomiuri Shimbun that foreign groups involved in organ trafficking continued to operate in the country.
The newspaper wrote to the hospital in late May seeking information, including transplant statistics covering Japanese patients. It had received no response by July 7.
A shortage measured in years
Japan Organ Transplant Network (JOT) figures show approximately 17,000 people registered for organ transplants at the end of July 2026. Its records list 636 deceased-donor transplant procedures in 2025, excluding transplants from living donors.
That annual total is equivalent to roughly 4% of the subsequent waiting-list figure, illustrating the disparity in scale rather than an individual patient’s annual chance of receiving an organ.
For kidneys, JOT gives an average waiting time of approximately 14 years and nine months among recipients transplanted between January 2002 and December 2023. The figure describes the historical experience of those who received deceased-donor kidneys, rather than a guaranteed wait for someone registering now.
The donor shortage is pronounced in international comparisons. Figures cited for 2024 put deceased organ donors per million people at:
- Japan: 1.13
- Spain: 53.93
- United States: 49.7
Donation systems differ. In Japan, donation after brain death can proceed on the basis of a person’s expressed wishes or family consent where the person has not refused donation. Spain operates a system of presumed consent unless a person has opted out.
Japanese residents can record their wishes on My Number cards, driving licences, donor cards or JOT’s website. Nevertheless, a government survey in 2025 found that only about 20% had clearly expressed their position on organ donation.
Hospital readiness is another constraint. A health ministry survey found that only 465 of 922 institutions providing advanced emergency medical care had the necessary arrangements to support the organ donation and transplant process.
Treatment abroad creates follow-up difficulties
By the end of March 2023, 543 patients who had undergone organ transplants overseas were receiving follow-up treatment in Japan. The main destinations were:
- United States: 227 patients
- China: 175 patients
- Australia: 41 patients
Those figures cover overseas transplants generally and do not establish that the procedures were illegal.
The Japanese government has warned that organ trading and unauthorised brokerage remain unlawful even when surgery takes place outside Japan. It has also raised concerns about continuity of care when doctors at home receive insufficient records of an overseas operation and the treatment provided.
Takashi Kenmochi, president of the Japanese Society for Clinical Renal Transplantation, expects demand for overseas procedures to persist while Japan lacks sufficient hospitals, doctors and authorised organisations to coordinate transplants.
