America

America is the destination at the center of Jake Adelstein’s investigation into Tadamasa Goto’s 2001 liver transplant: a place where Goto obtained surgery after securing a visa through an intelligence bargain, and where the case raised unresolved questions about money, access to organs, and institutional knowledge. The operation turned a medical journey across borders into a story about law enforcement and unequal scarcity, without establishing that UCLA knowingly treated yakuza patients or handled criminal proceeds.

The Transplant and the Journey

In January or February 2001, doctors at Showa University told Goto that he would die unless he received a liver transplant soon. He had hepatitis C and a heart condition, and was considered a very unlikely transplant candidate in Japan. By summer, he had received a transplant at UCLA’s Dumont-UCLA Liver Cancer Center. The surgery took place on July 5, 2001.

At first, Adelstein knew that Goto had undergone the operation in America but did not know how a man reportedly blacklisted by U.S. Customs and Immigration, the FBI, and the DEA had entered the country. He suspected that something about Goto’s arrival was irregular, but did not yet have the facts to explain it. Sekiguchi warned him that Goto had powerful reasons to keep the transplant story from becoming public and advised him to retreat temporarily, not abandon the investigation.

A Visa in Exchange for Intelligence

In April 2001, Goto approached the FBI through Hoshi Hitoshi, a former political fixer with connections to the Liberal Democratic Party. The FBI wanted information on important yakuza figures because Japan’s National Police Agency would not share that information, citing privacy concerns. Goto offered a comprehensive list of Yamaguchi-gumi members, related front companies and financial institutions, as well as information on North Korean activities.

In return, Goto sought a U.S. visa so he could receive a transplant at UCLA. The FBI pressured U.S. Immigration and Customs to issue the visa, which it did reluctantly. The bargain opened the door to America; UCLA performed the operation. According to the account Adelstein pieced together from U.S. Justice Department, Japanese police, and underworld sources, Goto supplied only a fraction of the information he had promised. After the surgery, he returned to Japan and did not speak to the FBI again. The sources described in the book could find no records of his return to Japan.

Payment and Unanswered Questions

The cost of Goto’s transplant was reported differently. Early accounts put the amount near $1 million, while others placed it at $3 million. Goto reportedly told an associate that he had paid $3 million in total; police reports listed $1 million and speculated that his doctor had received $100,000 for each trip to Japan, usually involving a house call at the Imperial Hotel. Adelstein also knew that some hospital expenses had been sent from Japan to America through the Tokyo branch of a Las Vegas casino. These details sharpened the financial questions but did not, by themselves, establish the source or legality of every payment.

Adelstein later concluded that Goto might not have been the only Japanese patient with yakuza ties to receive a liver transplant at UCLA; he thought there might have been three others. Federal law enforcement sources told him that payments to UCLA by at least one of the four men could have come from illegal activity in Japan, a possibility that could amount to international money laundering. To his knowledge, none of the men had been investigated for money laundering, and any such inquiry would have required cooperation from Japanese authorities.

Organ Access and Institutional Responsibility

The case placed America’s transplant system beside Japan’s scarcity. Japan had few organ donors and performed transplants rarely; people who needed organs often left the country or died waiting. From Adelstein’s perspective, the possibility that Japanese criminals had obtained organs ahead of law-abiding Americans posed a question of fairness as well as national jurisdiction. The evidence presented does not establish that criminal status determined the allocation decisions, or that the patients’ ability to pay gave them priority.

UCLA’s conduct remained contested but unproven. It was never established that UCLA or Dr. Busuttil knew, at the time of the operations, that any of the patients had ties to the Japanese mafia. Both said that they treated patients according to medical needs rather than making moral judgments. They did not explicitly address what they knew about the four patients’ affiliations or when they knew it. An investigation by the U.S. Centers for Medicare and Medicaid Services and UCLA found no evidence of improper conduct, as reported by the Los Angeles Times. That finding addressed misconduct, but left open the questions of prior knowledge and whether any payments or donations derived from illegal activity.