She knew that only a liver transplant could save her life, but Wakana Kume was still undecided about going ahead with it.

Kume, a round-faced, short-haired teenager, shared the profound unease of many Japanese with the idea of taking organs from people at death. Because certain transplants are virtually impossible to obtain in Japan, Kume reluctantly flew to Australia. She finally became comfortable with the idea there, as she awaited a donor.A nurse spoke of a donated organ as a "special gift," and Kume was moved by the idea.

"Suddenly I realized that these organs were presents," said Kume, 16, who received the transplant two years ago and is now back in Japan, in good health. "When I was younger, I couldn't fully accept the idea that brain-dead meant death. I just didn't understand."

Japan is locked in a furious and agonized debate over whether to legally define the boundaries of death and explicitly allow organ transplants. The issue is now before the parliament, but it is so sensitive that lawmakers have decided - for the first time in many years - to vote their consciences and not to issue any party positions.

In Japan, death is regarded in the traditional way, as occurring when the heart stops beating. But in much of the developed world, a person is considered dead if the brain stops functioning - even if the heart still beats. American laws vary by state, but all recognize that death can be determined by the complete and irreversible cessation of brain function.

This makes it possible to remove vital organs, like heart, lungs and liver, for transplanting from a brain-dead patient. Only if such a patient is still breathing with the help of a respirator, the heart still pumping blood through the body, are these organs healthy enough to be used in transplants.

But because Japan does not recognize brain death as death, this process is far more difficult to accomplish. Transplants are not banned outright, and those made from living donors, involving kidneys and parts of the liver, are performed frequently. But without any law that pinpoints the actual moment of death, there are no clear guidelines when it comes to other vital organs, and this has caused both confusion and fear.

Police officers handling traffic accidents have at times stopped doctors from asking relatives whether they can take organs from brain-dead victims. More important, the threat of lawsuits and the social taboo against taking an organ from a person who, in the traditional view, may not be dead are so widespread that few doctors perform the operations.

A result is that hundreds of patients, perhaps thousands, are dying every year because they cannot receive organ transplants in Japan. Even in the United States, where an acceptance of brain death makes many more organs available, there are about 52,000 people on waiting lists, according to the United Network for Organ Sharing in Richmond, Va. Last year, it said, about 19,410 people received transplants.

Some Japanese patients are so desperate that they are accepting kidneys and other organs that were not used on American patients because the donors were too old or sick.

Many other patients go overseas. But travel is costly and sometimes happens too late.

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Miyuki Monobe, an 8-year-old girl whose family relied on donations from across Japan to travel to Los Angeles in April for her operation, died before a heart transplant came through.

"When a doctor tells a patient that he needs a transplant, it's like a sentence of death," said Kazuo Ota, a prominent doctor who has performed many kidney transplants from living donors. "The patient knows it is impossible to receive a transplant in Japan."

There are two proposals to legalize organ transplants; one recognizes brain death as death and the other does not. The bill to legalize brain death won passage in the lower house on April 24. But it faces a stiff upper-house battle and possibly months of debate, with some politicians saying they will try to block it.

Still, the Japan Society for Transplants, a medical industry association, is beginning preparations for such operations, and it will soon distribute two million donor cards asking people to mark down whether they want to donate their organs at death.

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