Japan's lower house voted to scrap a ban on child organ donations, paving the way for patients aged under 15 to receive life-saving transplants here for the first time.
Current law bans organ transplants by children, a situation which activists say has claimed thousands of lives and forced many families to send children in need of transplants on costly overseas trips for surgery.
Under Japanese law, transplants have been rare even for adults because tough rules require donors to give prior written consent to having their organs harvested when they are brain dead, while their families must also agree.
The amended bill would scrap the age limit and the need for prior consent, unless the person explicitly opposed having their organs used, but it would still require family members of the children to agree.
The bill was approved by 263 to 167 votes and sent to the opposition controlled upper house. If it is rejected in the upper chamber, a two thirds majority in the lower house could turn it into law anyway.
The major political parties had told their legislators to vote according to their conscience. Only the Japanese Communist Party abstained, claiming that deliberations had not been sufficient.
The bill would also recognise patients who are brain dead as legally dead, long a controversial topic in Japan where many religious groups say a person is only deceased once their heart and lungs have stopped.
Japan adopted an Organ Transplant Law in 1997, but since then only 81 transplants have been carried out, compared to several thousand each year in the United States and several hundred annually in Europe.
The long-debated reform plans were fast-tracked this year after the World Health Organization signalled it would ask signatory nations in early 2010 to limit organ transplants to within their national boundaries.
In the move against so-called transplant tourism, which seeks to limit abuses, Australia, Britain and Germany have already announced they will refuse Japanese patients seeking organ transplants.