Masato Goto

Masato Goto’s 2001 liver transplant at UCLA turned a powerful underworld figure into the center of a cross-border investigation. The questions surrounding his treatment were not limited to how he obtained a scarce organ: they also concerned how he entered the United States despite being blacklisted, whether he exchanged intelligence with the FBI for a visa, and whether money connected to criminal activity paid for care. The account does not resolve every question, but it shows how Goto’s reach crossed the boundaries between organized crime, government intelligence, and medical institutions.

Identity and Position in the Underworld

Goto was the boss of the Goto-gumi, a subgroup of the Yamaguchi-gumi, which the account describes as Japan’s largest organized crime group. The Goto-gumi had more than nine hundred members and a reputation for severe violence. A man speaking to the narrator on the group’s behalf framed the proposed article as a danger to Goto’s life: he regarded Goto as his oyabun, a surrogate father, and believed the investigation could ultimately kill him. That relationship helps explain why a report about Goto’s medical history could provoke a death threat even before the narrator had assembled all the facts.

Goto’s importance also lay in the scale and reach of the network around him. The narrator’s investigation linked his case to money sent from Japan to the United States through a Las Vegas casino’s Tokyo branch, while accounts of other criminal enterprises in the book show how organized crime could operate through businesses and financial arrangements as well as direct intimidation. Those broader examples do not establish that Goto controlled every such operation; they locate his case in an underworld whose dealings could intersect with ordinary commercial structures.

Illness and the Transplant

In January or February 2001, doctors at Showa University told Goto that he would die without a liver transplant soon. He had hepatitis C and a heart condition, and he was considered a very unlikely transplant candidate in Japan. The narrator’s earlier understanding was that Goto received the transplant in the summer of 2001 at the Dumont-UCLA Liver Cancer Center. The later account dates the surgery to July 5.

The transplant raised questions beyond Goto’s individual medical need. Japan had a stringent transplant system and few donors; many Japanese patients who needed organs either went abroad or died waiting. From the narrator’s perspective, the case also prompted a question about fairness to American patients: whether a Japanese criminal with the means and connections to obtain treatment abroad could receive an organ while law-abiding U.S. patients waited. The account presents this as an ethical concern, not as proof that Goto displaced a particular patient or violated transplant rules.

The FBI Arrangement and Its Uncertain Record

In April 2001, Goto approached the FBI through Hoshi Hitoshi, a former political fixer with connections to the Liberal Democratic Party. Hoshi relayed Goto’s offer. The FBI wanted information about prominent yakuza because the National Police Agency had refused to share such information, citing privacy issues. Goto offered a comprehensive list of Yamaguchi-gumi members, related front companies and financial institutions, and information about North Korean activities.

In exchange, Goto sought a U.S. visa so he could receive a liver transplant at UCLA. The narrator concluded that Goto arranged the UCLA treatment himself and that the FBI pressured U.S. Immigration and Customs to grant the visa, which the agency reluctantly did. The FBI’s role, as described, was to help open the door to the United States; UCLA provided the medical treatment. The possible intelligence value included information about North Korea, which was then of particular interest to U.S. authorities because of allegations involving counterfeit currency. Goto was also said to have close North Korean connections, though claims about the nature of those ties remained allegations.

After the July 5 operation, Goto provided only a fraction of the information he had promised, then flew back to Japan and never spoke to the FBI again. The account notes that there were no records of his return to Japan. It also reports conflicting estimates of the cost: Goto reportedly told an associate he paid $3 million, while police reports gave a figure of $1 million and speculated that his doctor received $100,000 for each visit to Japan, usually at the Imperial Hotel. The narrator had earlier encountered estimates ranging from close to $1 million to $3 million. The varying amounts were part of the investigation’s uncertainty, not a settled accounting.

Public Questions and Unresolved Responsibility

The account says that only Goto’s inner circle knew about his FBI arrangement. It further reports the narrator’s suspicion, formed while reviewing other Yamaguchi-gumi materials, that Goto might not have been the only Japanese patient with yakuza ties to receive a UCLA liver transplant; there may have been three others. The evidence does not establish that UCLA or Dr. Busuttil knew of any patient’s criminal connections at the time of treatment.

UCLA and Dr. Busuttil said they did not make moral judgments about patients and treated them according to medical need. They did not explicitly deny knowing that some patients had yakuza ties, but declined to address what they knew and when. An investigation by the U.S. Centers for Medicare and Medicaid Services and UCLA found no evidence of improper conduct. That finding addressed whether the medical center or its staff had acted improperly; it did not settle the broader moral dispute over allocating scarce organs to foreign patients with criminal records.

A separate question concerned the source of payment. Federal law-enforcement sources told the narrator that, in an international context, money laundering can involve transferring criminal proceeds from overseas into the United States. Since yakuza commonly obtained money through criminal activity, agents considered it possible that some payments to UCLA by at least one of the four Japanese patients with yakuza ties came from illegal activity in Japan. The account states that, to the narrator’s knowledge, none of the men had been investigated for money laundering, and that any investigation would require Japanese authorities’ assistance. It leaves unresolved both whether UCLA knew of the patients’ ties and whether it knew that any payment or donation might have come from criminal proceeds. Goto’s case thus remains consequential not as a fully proven account of institutional wrongdoing, but as a documented intelligence bargain surrounded by unanswered questions about medical fairness, disclosure, and the movement of money.