By Thomas Fields-Meyer
December 09, 1996 12:00 PM

IT WAS THE SORT OF TUMBLE THAT happens in schoolyards every day. Three weeks shy of his sixth birthday, Alex Van Cleave hopped off the school bus on the morning of Sept. 9 and bounded toward his first-grade classmates at the U.S. naval base in Yokosuka, Japan. Then he fell. “He just kind of tripped over his own feet,” recalls Carol Cressy, the school’s principal. “There was nothing in his way.” Picking himself up off the pavement, he cried a bit, then collapsed. Four days later, Alex died in the base hospital from a freak brain injury. For his parents, the death was as bewildering as it was horrifying. “You are always saying, ‘Be careful, don’t climb the trees too high!’ ‘Wear your helmet when you ride your bike!’ ” says Ann Van Cleave, 37, whose husband, William, 41, is a Navy commander. “I never said, ‘Be careful walking!’ ”

It may be a consolation of sorts that the Van Cleaves’ tragedy turned into a cause for hope in Japan when the family offered their son’s kidneys for transplant. Organ donation, routine in America, almost never occurs in Japan. Unlike the U.S., where brain death is widely accepted, Japanese custom allows transplants only after a donor’s heart has stopped. That makes heart, liver and lung transplants virtually impossible, since such procedures require the removal of organs while the donor’s heart is still beating by artificial means. Even transplants of kidneys and corneas, which can be recovered shortly after cardiac arrest, are extremely rare because Japanese cultural and religious beliefs oppose the desecration of bodies.

After the transplant of Alex’s kidneys to two Japanese youths, a group of 4,000 Japanese doctors announced that, law or no law, they would start a campaign to encourage brain-dead patients’ families to donate organs. Doctors are also urging Japan’s parliament, the Diet, to introduce a law recognizing brain death next year. Thus, Alex’s case may supply the extra push that will save thousands of Japanese in critical need of transplants. “To think that from that loss can come hope, new life and understanding,” says Father Hank Burdick, the Van Cleaves’ Episcopal priest until they left Groton, Conn., last August. “It has a resurrection feel to it.”

Alex, an outgoing little boy who liked pizza and The Lion King, was a collector of rocks, bottle caps and gum wrappers. “If he had a stick of gum, he would give you half,” says Ann, whose husband was stationed in Washington, Guam, the Philippines and Connecticut before moving the family to Japan, where he oversees the awarding of ship and shore supply contracts. Alex—whose brother Van is 8—was enthralled with Japan. “He liked the trains, the people, the cars and stores,” says William. “His big thing was, he wanted to climb Mount Fuji.”

That dream, and all his others, ended that Monday morning outside the Sullivans School (named for five brothers who died on a U.S. ship during World War II). Alex was rushed to the hospital, where doctors determined that microscopic nerve fibers in his brain stem had been torn by the fall. “The breakage of the fibers is what causes a disruption of the messages to the brain stem,” says Navy surgeon Lydia Hernandez, the first doctor to treat Alex. Outwardly he had only a small chin scrape. “When I first got there, I thought he would just wake up,” says William.

But his condition deteriorated quickly. “We just saw him not improve, and actually you watched things shut down,” recalls Ann, a retired Navy captain’s daughter who married Van Cleave in 1983. On Wednesday, Sept. 11, realizing that her son would never recover, she raised the possibility of donating his organs. Within hours of his death that Friday, Alex’s kidneys were transplanted to two Japanese youths—one 10, the other 19—who beat exceedingly high odds: In the U.S., 30 percent of those registered for kidney transplants receive them; in Japan, the figure is about 1 percent.

A recent survey found that more than half of the Japanese polled are now in favor of transplants, says Dr. Satoshi Teraoka of the Japan Kidney Transplant Network. “If we have a [brain death] law, organ donation and transplantation can develop very smoothly,” says Kikuo Nomoto, a leading transplant advocate.

Still reeling from their own loss, the Van Cleaves are no crusaders. “We’re not Japanese, so I can’t say what’s right for them. But it was the right decision for us,” says William. Adds his wife: “If one person or one family decides to do what we did, then that’s good. That’s all we really hope for.”


ANDREA PAWLYNA in Yokosuka, ANNE LONGLEY in Groton and MARGIE SELLINGER in Washington