UCLA

UCLA occupies a contested place in Jake Adelstein’s investigation of liver transplants received by four Japanese men with yakuza ties. The book does not establish that UCLA or its physicians knowingly favored criminals or violated rules; it instead sets out a documented transplant, an official review that found no improper conduct, and unresolved questions about what the institution knew and where some of the money may have come from. The institution becomes the point where medical need, scarce organs, international law enforcement, and the finances of organized crime meet without a conclusive answer about responsibility.

The transplant and its route

In early 2001, doctors at Showa University reportedly told Tadamasa Goto that he would die without a liver transplant soon. He had hepatitis C and a heart condition, and was considered a very unlikely candidate for transplantation in Japan. In April, Goto approached the FBI through Hoshi Hitoshi, a former political fixer with connections to Nobusuke Kishi. The FBI wanted information on Japanese organized crime that Japan’s National Police Agency had not shared with it, 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 U.S. visa so he could receive a transplant at UCLA. The FBI pressured U.S. immigration authorities to issue the visa, which they reluctantly did. Adelstein emphasizes the division of roles: the FBI did not provide a liver or arrange the surgery itself; UCLA performed the transplant after Goto reached the United States. The operation took place on July 5, 2001.

The intelligence bargain did not deliver what Goto had promised. According to Adelstein’s account, Goto supplied only a fraction of the promised information, returned to Japan after the surgery, and did not speak to the FBI again. A later account attributed to one of Goto’s associates put the cost of the liver at $3 million. Police reports gave a lower total of $1 million and speculated that Goto’s doctor had received $100,000 for each visit to Japan, usually at the Imperial Hotel. These figures are reported claims, not a settled accounting of payments to UCLA.

Four Japanese recipients and a scarce resource

While examining other Yamaguchi-gumi materials, Adelstein came to suspect that Goto was not the only Japanese yakuza figure to receive a liver transplant at UCLA. He ultimately identified three other men, making four recipients in all. The evidence he assembled connected them to organized crime, but did not establish that they had made the same kind of agreement with the FBI as Goto.

After Goto, the names included Yoshiro Ogino, a gang boss in the Matsuba-kai and Goto’s blood brother; Hisatoshi Mio, identified to Adelstein by Shibata; and Saburo Takeshita, a financial operator in the Goto-gumi who controlled many front companies. Ogino allegedly donated $100,000 to UCLA after his surgery. Adelstein later reported that, to his knowledge, Ogino and the other two men had not made FBI deals and had entered the process under false names or false pretenses. Goto may have helped them gain access, but how the three were placed on UCLA’s transplant waiting list remained unclear.

That uncertainty mattered because the book presents organ transplantation as a scarce resource on both sides of the Pacific. Japan’s transplant system was stringent, donors were few, and people needing organs often had to leave the country or die waiting. Adelstein therefore framed the cases not only as a question about whether Japanese criminals received access in the United States, but also as a challenge to the fairness and transparency of allocation: whether nationality, wealth, or criminal connections affected the opportunity to receive a scarce organ. The evidence raises those questions but does not establish how the four patients were ranked against other candidates or that any particular patient was displaced.

Institutional knowledge and review

The book carefully distinguishes suspicion from proof about UCLA’s conduct. It had never been proven that UCLA or Dr. Busuttil knew at the time of the operations that any of the four patients 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. They did not explicitly deny knowing about the patients’ yakuza ties, but declined to address what they knew or when they knew it.

The U.S. Centers for Medicare and Medicaid Services and UCLA conducted an investigation into whether the medical center or its staff had acted improperly in carrying out the four transplants. According to the Los Angeles Times, the investigation found no evidence of improper conduct. That finding did not settle the distinct questions Adelstein posed about institutional awareness, the fairness of transplant access, or the origins of the patients’ funds. He records that critics continued to question the morality of providing organs to foreign recipients with criminal records while Americans also needed transplants; the book does not present that controversy as proof of medical misconduct.

Publication, money, and what remained unresolved

Adelstein first prepared the story for a book planned with Kodansha International. A weekly magazine declined to publish it, and he waited. After beginning to work with reporters at the Los Angeles Times, he contributed to a report published on May 31. It drew attention to the case, although Japanese coverage often attributed the story to the American newspaper rather than independently verifying or extending the reporting. The resulting publicity made UCLA central to a public debate about the transplant cases, even as the evidence left important institutional questions unanswered.

A further concern involved possible money laundering. Federal law enforcement sources told Adelstein that international money laundering could consist of transferring criminal proceeds from Japan into the United States. Because yakuza organizations generally derived much of their income from criminal activity, agents considered it possible that some money paid to UCLA by at least one of the four recipients had originated in illegal activity in Japan. The book does not establish that UCLA knowingly received criminal proceeds, or that the patients’ payments were traced to particular crimes. Adelstein knew of no investigation of the men for money laundering, and any such inquiry would have required assistance from Japanese authorities. He also left unresolved whether UCLA knew of the men’s organized-crime ties or the possible sources of their payments and donations.

UCLA’s significance in the account lies in that boundary between a completed medical act and unsettled questions surrounding it. The transplant that saved Goto’s life is presented alongside a failed intelligence exchange, three further recipients whose access remained unexplained, an official review that found no improper conduct, and concerns about both allocation and money. The record supports neither a finding that UCLA knowingly participated in wrongdoing nor a definitive account of how all four men obtained transplants. The institution remains the setting in which those competing possibilities—and the limits of what Adelstein could prove—come into view.