The reason they don't add them is because it would take two hits to kill people.
Then they would have to implement the extra hearts system, and there's two options that happen there:
1) You have something like UN, where you have to find every freaking heart all across the map, and you have massive lag spikes due to people crowding the quests for the first month.
2) They charge you for extra hearts. Probably something around the price of 10,000 gralats per heart.
Just a wild guess here. Not saying I know for sure this sort of thing would happen, but I'd assume so.