All in the family: Kidney donation in aging Japan

This article examines the ethical and cultural logics shaping living donor kidney transplantation in Japan, where donation is restricted to kin and deceased donation remains rare. Drawing on ethnographic fieldwork in a Tokyo-area hospital, it analyzes how Japan's kin-based transplantation regime contrasts with the utilitarian model dominant in the United States, where donor pools are expanded through non-kin and anonymous exchange. I argue that Japan's restriction to family donors reflects an ethic of care rooted in family-based welfare and intergenerational reciprocity. At the same time, the desire to prevent the exploitation of non-kin transfers the burden of giving onto family, in particular aging parents, spouses, and women, stretching traditional kinship obligations. It also privileges "social matching" over biological compatibility.