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Dr Juroh Wada of Sapporo Medical College, Sapporo, Japan performed the first heart transplant in Japan in 1968. However, for a number of reasons the procedure has never been repeated in this country. First, the "Wada transplant" aroused considerable criticism. Dr Wada was accused of murder by a citizens' group on the grounds that the donor, a 20-year-old drowning victim, may have been alive rather than brain dead when the heart was removed; these charges were dropped after a 2-year criminal investigation. Dr Wada was also criticized for transplanting the heart to a recipient who may not have been a suitable candidate for transplantation-the patient had rheumatic valvular disease of the heart. These criticisms, coupled with a growing distrust of physicians among the Japanese population, have prevented the procedure from being repeated. However, encouraged by subsequent success with and growing use of heart transplantation in Europe and the USA, the Research Committee on Brain Death, Ministry of Health and Welfare, Japan (Chair: I. Takeuchi), in 1985 established criteria for diagnosing brain death. In 1988, the Committee on Bioethics of the Japan Medical Association published the "Final Report on Brain Death and Organ Transplantation," which endorsed the "Takeuchi criteria" as the minimum necessary for diagnosing brain death, and declared that in addition to the already recognized cardiac death, brain death (the irreversible loss of brain function) could be considered the death of an individual. However, the general public, religious organizations, philosophical groups, and particularly the bar association were strongly opposed to the recognition of brain death, arguing that

Why Is Heart Transplantation Not Performed in Japan? Refutation of Dr Yoshio Watanabe's Arguments Against Heart Transplantation.