Los Angeles is where the book’s account of Tadamasa Goto’s 2001 liver transplant converges with an FBI intelligence deal and a wider dispute over access to scarce organs. The city is not merely a destination on Goto’s journey: through UCLA, it becomes the setting in which an American university hospital, Japanese organized crime, federal law enforcement, and questions of medical fairness meet. The narrative distinguishes what its investigation establishes from what remains uncertain about the transplant’s financing and the hospital’s knowledge.

The transplant destination

In an exchange about an investigation into Susumu Kajiyama, the narrator learns that Goto, described as a leading figure in Japanese crime, received a liver transplant in the United States. Asked where, the answer is Los Angeles: a university hospital, specifically UCLA’s Dumont center. That identification gives the story a concrete geographic focus. A transplant that might otherwise remain an abstract piece of underworld intelligence is attached to a particular American city and medical institution.

The medical crisis preceded the journey. In January or February 2001, Goto’s doctors at Showa University told him that he would die without a transplant soon. He had hepatitis C and a heart condition, and the book describes him as a very unlikely candidate for a liver transplant in Japan. Los Angeles thus enters the account as the place where an urgent need that could not readily be met at home was pursued abroad. The contrast is sharpened by the book’s account of Japan’s stringent transplant system, where donors were few and operations rare; many people needing organs either left the country or died waiting.

An intelligence bargain across borders

In April 2001, Goto approached the FBI through an intermediary. The agency wanted information about important yakuza figures because the National Police Agency would not share such information, citing privacy concerns. Goto offered a comprehensive list of Yamaguchi-gumi members, associated front companies and financial institutions, along with information about North Korean activities. In exchange, he sought a visa that would let him travel to the United States for treatment at UCLA.

The book separates the visa arrangement from the medical work itself. Goto had arranged the UCLA treatment on his own; the FBI did not provide him with a liver or perform the transplant. Rather, the account says, the FBI pressured U.S. immigration authorities to grant a visa, reluctantly enabling him to reach the hospital. The operation took place on July 5. Goto then supplied only a fraction of the information he had promised, returned to Japan, and never spoke to the FBI again. The investigation therefore presents Los Angeles as the endpoint of a deal whose promised intelligence proved far less complete than the agency had hoped.

The account also records competing figures for the treatment’s cost. Goto reportedly told an associate that he had paid $3 million for the liver. Police reports gave a figure of $1 million and speculated that his doctor had received $100,000 for each visit to Japan, often made at the Imperial Hotel. These figures are reported claims, not a settled accounting. Their presence makes the route to Los Angeles a question not only of access and travel, but also of how the treatment was paid for.

Other patients and unanswered questions

The investigation widened beyond Goto. While reviewing Yamaguchi-gumi materials, the narrator concluded that Goto was probably not the only yakuza figure to receive a liver transplant at UCLA; there were probably three others. A later account says that the other men apparently entered under false names or false pretenses, and that Goto may have helped them reach the hospital, though how they were placed on its transplant waiting list remained unclear. The book does not present those possibilities as fully resolved facts.

That uncertainty matters against the stated scarcity of organs. The book asks why Japanese criminals might receive treatment in the United States while law-abiding American patients waited, but it does not claim that nationality or criminal history alone explains the allocation decisions. UCLA and Dr. Busuttil said that they treated patients according to medical need and did not make moral judgments. It had not been proven that either knew, at the time of the transplants, that any of the patients had ties to the Japanese mafia. They did not explicitly deny such knowledge, however, leaving open what they knew and when.

A joint investigation by the U.S. Centers for Medicare and Medicaid Services and UCLA found no evidence of improper conduct by the medical center or its staff. That finding did not settle the ethical debate described in the book: critics continued to question the allocation of organs to foreign patients with criminal records while Americans needed transplants. The distinction is important. The account reports an official review that found no misconduct, while preserving questions about fairness and transparency that the review did not erase.

Money, evidence, and the city’s significance

The book raises a further possibility: that UCLA may, without knowing it, have received money connected to criminal activity in Japan. Federal law-enforcement sources explained that international money laundering can involve transferring criminal proceeds from overseas to the United States. Because yakuza income generally came largely from criminal activity, they considered it possible that some payment made to UCLA by at least one of the four men had an illegal source. The narrator emphasizes that, to his knowledge, none of the men had been investigated for money laundering and that any such inquiry would require Japanese cooperation. The possibility is not presented as proof that UCLA knowingly accepted criminal proceeds.

Los Angeles therefore functions as both a physical destination and the point at which separate systems become difficult to disentangle: Japan’s limited transplant opportunities, an American visa process, FBI intelligence priorities, hospital treatment, and money moving across borders. The book’s emphasis is not that the city or hospital has been proved complicit, but that the transplant’s circumstances leave consequential questions unresolved. Its significance lies in this carefully maintained tension between a documented journey and a bargain only partly honored, between an official finding of no improper conduct and continuing uncertainty about knowledge, payment, and who had a fair chance at treatment.