The United States functions in the book not merely as a place beyond Japan, but as a point where criminal money, intelligence, medical treatment, journalism, and personal safety cross borders. Las Vegas and California appear in an investigation of loan-sharking proceeds; UCLA becomes the destination for a transplant secured through an FBI arrangement; and, later, the United States is both a refuge Adelstein returns to and a setting for renewed work on human trafficking. Each connection makes the country part of the story’s machinery, not a distant backdrop.

Financial and Journalistic Terrain

The United States first enters this strand of the narrative through the investigation of Susumu Kajiyama’s gambling and financial activity. Kajiyama had visited Las Vegas for more than ten years, maintained accounts with a casino and a bank in California, and withdrawn money in the United States. After a tip from U.S. authorities, the Tokyo Metropolitan Police Department had been sending officials to examine his Las Vegas transactions since the summer. The Department of Homeland Security, the Nevada Gaming Commission, and the FBI were also investigating him on suspicion of violating U.S. money-laundering laws. The MGM Grand was making what the account describes as a token effort to cooperate.

The inquiry linked activity in Nevada to money held in Japan. A trusted contact at the FBI confirmed that the Tokyo Metropolitan Police Department had already visited Las Vegas and seized $2 million in cash from the MGM Grand’s Tokyo office. Adelstein used that confirmation to advance a story, while withholding the fact that a Yamaguchi-gumi connection had also supplied information. He attributed the information to the FBI, a description he considered partly true and a way to protect both his source and himself.

The reporting arrangement itself crossed national boundaries. Adelstein made a deal with a local Las Vegas reporter: he would publish the story first in Japan, and the other reporter would then get the scoop in Las Vegas after doing reporting work for him. The time difference and the limited American readership for Japanese newspapers made the exchange workable. The proposed headline, centered on Kajiyama as a casino whale, framed the investigation through the language of conspicuous gambling. More substantially, a deal with a police division chief coordinated the order of publication and disclosure: first the Las Vegas story, then an announcement about the seizure of more than $2 million in Tokyo, followed by a planned rearrest over Japanese money-laundering violations and further reporting on the FBI investigation in the United States. The geography of the case was therefore also a sequence of negotiated disclosures between reporters and police.

A Transplant and an Intelligence Bargain

The United States becomes still more consequential in the account of Tadamasa Goto’s liver transplant. In November 2006, an organizational source told Adelstein that the FBI had allowed Goto to enter the country; the source identified Jim Moynihan, the legal attaché at the U.S. Embassy in Japan, as the person who arranged it. The alleged exchange was intelligence for access: Goto promised a comprehensive list of Yamaguchi-gumi members, related front companies and financial institutions, and information on North Korean activities, while seeking a U.S. visa so he could receive a transplant at UCLA.

The account distinguishes permission to enter the country from the provision of medical treatment. Goto had arranged the UCLA procedure himself; the FBI’s role was to pressure U.S. Immigration and Customs to grant the visa, which it reluctantly did. The surgery took place on July 5. Goto then supplied only a fraction of the information he had promised, returned to Japan, and did not speak to the FBI again. According to the book, there were no records of his return to Japan. The bargain thus produced an outcome in the United States, but not the full intelligence cooperation that had been promised.

The transplant also sets an individual case against a wider disparity in access to organs. Japan’s transplant system is described as stringent, with few donors and rare operations; many Japanese people who need an organ either leave the country or die waiting. From an American perspective, Adelstein questioned why Japanese criminals might receive precedence over law-abiding U.S. citizens. He later realized that Goto might not have been the only Japanese criminal with ties to a UCLA liver transplant, and that there might have been three others. The book presents this as a developing suspicion, not as a proven account of how each transplant was arranged.

The questions about UCLA remain carefully qualified. It had not been proven that UCLA or Dr. Busuttil knew at the time of the transplants that any patient had ties to the Japanese mafia. UCLA and the doctor said they did not make moral judgments about patients and treated them according to medical need, but had not explicitly addressed what they knew about the four patients’ connections. A review by the U.S. Centers for Medicare and Medicaid Services together with UCLA found no evidence of improper conduct, according to the Los Angeles Times. Separately, federal law-enforcement sources told Adelstein that payments to UCLA by at least one of the four men might have included proceeds from criminal activity in Japan. The account does not establish that any of the patients was investigated for money laundering; it explains that such an inquiry would require cooperation from Japanese authorities. The United States is therefore presented as a site of unresolved questions about medical access and financial scrutiny, rather than as the setting of a proven institutional crime.

Home, Protection, and Renewed Work

After resigning from the Yomiuri Shinbun, Adelstein returned to his home in the Midwest and began preparing for law school with an LSAT course. He tried to leave behind the routines and relationships of his former reporting life, including late nights and contact with yakuza, police, and people from the sex industry. The contrast is specific: the life he was trying to establish was quieter and, in his description, involved nothing more dangerous than a lawn mower. Yet his return did not close the connection to Japan or to the subject of trafficking.

A former CIA colleague later emailed to say that the U.S. Department of State was sponsoring a major study of human trafficking in Japan and had been urged to consider Adelstein for the job. The opportunity offered a chance to do public-interest work with proper funding, but taking it would also return him to the world he had left. The evidence records his hesitation, not the eventual outcome of that offer. The United States here provides a possible institutional base for renewed investigation while also representing the personal distance Adelstein had tried to create from his previous work.

That distance was not absolute. On March 5, 2008, after threats connected to his reporting on Goto, an FBI special agent accompanied Adelstein to the National Police Agency to discuss protection. The FBI contacted local U.S. law enforcement and arranged for a watch on his house in the United States. Adelstein refused to identify his source inside the Goto-gumi, despite being warned that this might make it harder for Japanese police to justify round-the-clock protection. The measures coordinated agencies on both sides of the Pacific, and extended the danger associated with reporting in Japan to Adelstein’s American home.

The Country’s Divided Role

Across these episodes, the United States occupies several roles that do not resolve neatly into one another. Its authorities investigate suspected money laundering and provide information that can move a Japanese police inquiry forward; the FBI also becomes a participant in the visa arrangement that enabled Goto’s transplant. U.S. institutions are scrutinized over the handling of foreign patients and possible criminal proceeds, but the book distinguishes unresolved questions from established wrongdoing. Meanwhile, U.S. officials help protect Adelstein, and a U.S.-sponsored study offers a route back into work on trafficking after he has attempted to leave that work behind.

The country’s significance lies in this overlap of access and accountability. Money traced from Japanese loan-sharking operations reaches casinos and accounts in the United States; intelligence is traded for a path to medical care; and the reporter’s American home becomes part of an international protection effort. These connections make the United States neither simply a safe haven nor merely an extension of the Japanese investigations. It is a place where the consequences of those investigations arrive, and where institutions and individuals must decide what they will disclose, facilitate, investigate, or protect.