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SHANGHAI (Kyodo) Two Japanese nationals in their 50s received heart transplants between 2001 and 2004 at a Shanghai hospital whose organs mainly come from death-row inmates, sources at a Taiwanese company that arranged the procedures said Thursday.

Japan was seemingly unaware of the cases, as a survey released March 9 by the Health, Labor and Welfare Ministry said there were no cases of Japanese receiving heart transplants in Asia outside of Japan.

Ethical and medical concerns have often been raised regarding organ transplants in China over issues that include the use of organs of prisoners on death row and uncertain postsurgery health-care, experts said.

More than 100 Japanese nationals have to date received heart transplants abroad. The number is considered high, and is attributed to the scarcity of donors available in Japan due to strict requirements that donors, who must be declared brain-dead, be age 15 or above and that consent be given by both the donor and the next of kin.

Only 160 cases of organ transplants, including 31 heart transplants, have taken place in Japan over the span of eight years and five months since legislation for organ transplants took effect in October 1997.

However, over 12,000 patients are registered on the Japan Organ Transplant Network waiting for matching donors.

While a heart transplant in advanced nations, including the United States, is estimated to cost some $860,000 (about 100 million yen), including travel expenses, the sources of the Taipei-headquartered Yeson Healthcare Service Network said it only costs about 13 million yen to 14 million yen at the Zhongshan Hospital in Shanghai.

The sources said a man who lives in Japan received a heart transplant at the hospital, which is affiliated with Fudan University, in 2001 and a Japanese woman who resides in the Netherlands underwent the surgery in 2004. Both are now healthy, they added.

Most organs used in transplants at the hospital come from death-row prisoners in China, the sources said. The patients get their blood tested at the hospital and it usually takes about two to three weeks to locate a suitable prisoner as the “donor.”