Saudi Journal of Kidney Diseases and Transplantation

EDITORIAL
Year
: 2004  |  Volume : 15  |  Issue : 4  |  Page : 429--432

Ethics of Organ Transplantation: An Islamic Perspective


Khaja H. Mujtaba Quadri 
 Assistant Dean, Curricular Development, Associate Professor and Consultant Nephrologist, Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan

Correspondence Address:
Khaja H. Mujtaba Quadri
Asso. Prof. of Medicine & Cons. Nephrologist, Shifa International Hospital, Islamabad
Pakistan




How to cite this article:
Quadri K. Ethics of Organ Transplantation: An Islamic Perspective.Saudi J Kidney Dis Transpl 2004;15:429-432


How to cite this URL:
Quadri K. Ethics of Organ Transplantation: An Islamic Perspective. Saudi J Kidney Dis Transpl [serial online] 2004 [cited 2019 Nov 13 ];15:429-432
Available from: http://www.sjkdt.org/text.asp?2004/15/4/429/32873


Full Text

This article is dedicated to my friend the Late Prof. Sameer Bin Huraib of the King Fahad National Guard Hospital Riyadh. He and the author were both invited as a pair to contribute to a conference on Ethics in Transplantation. But Alas! He has joined his Maker; may his soul rest in peace and tranquility. Amen.

I begin my discussion with a few real life scenarios.

a). A 30-year-old male from a neighboring country approached me a few years back asking me how he could "donate his kidney" to his employers friend who wanted to "buy" it. This was during my sojourns in a friendly country. I took him aside and strongly coun­seled him against the act, but still asked him how much money he was offered. As I walked off he called out again and asked me "How about if I sell one kidney and buy another cheaper one elsewhere?" b). My present nephrology colleague tells me of his experience with a patient transplanted ten years back who came to him with a normal serum creatinine and some urologic complaints. During the course of investigations, a renal scan revealed normally functioning native kidneys and a poorly functioning transplanted kidney; a case of transplantation, in retrospect, for acute renal failure! c). A PhD student of Islamic Studies developed renal failure a few years back, met me in consultation and, as per my advise, got trans­planted with one of his sister's kidneys, which unfortunately failed for technical reasons. He got re-transplanted in a European country with a kidney from another sister which got 'mismanaged' and in desperation wanted to go to a famous city in Pakistan to buy a kidney. Fortunately, he consulted a well known scholar who told him to avoid this if he could because this was not acceptable on religious grounds and now another family member has come forward to donate. d). A 15-year-old patient of mine developed renal failure four years back. Both parents wanted to donate "pre-emptively". The patient's solitary brother also developed renal failure six months later. I recently received an email from the parents stating that since both parents have "donated" to their two sons, their family is unique in that all four of them have one functional kidney each!

We have all been approached in our practices all over the world by patients who have been transplanted "elsewhere", with related or unre­lated donor organs. We have often obliged in terms of some form of follow-up. However, what is the ethical course related to this, from a physician/surgeon's point of view? Should we attempt to learn and understand or should we push the issue under the rug?

To Understand This, We Need to Define "Ethics"

The Oxford English Dictionary defines Ethics as "the science of morals; the depart­ment of study concerned with the principles of human duty. [1]

Ethics systematically examines what is right, good or just, in human conduct. Morality is the social, religious or professional tradition of values about what is right, good or just in human conduct. [2]

Ethical Questions in Transplantation

The ethical questions in transplantation relate to the source of donor organs e.g. anencephalic donors, cadaveric donation which is still con­troversial in some countries, paid living donors, donation under coercion or by minors, executed prisoners and by patients in a persistent vegetative state as well as organs from animals (xenotransplantation). The other major ethical issue has to do with equitable distribution of organs. [3]

Islamic Ethics of Organ Transplantation:

This question is no longer an issue in the West and several Muslim countries. Well documented consensus opinions from Islamic Fiqh Academy, Muslim World League, Makkah, 1985, Eighth Working session states that it is permissible in the Shariah (Islamic Law) to remove the organ from one person's body and transplant it into another person's body in order to save the life of that person or to assist in stabilizing the normal functioning of the basic organs of that person.

Conditions to be Met; (Islamic Fiqh Academy) for Permissibility of Organ Transplant from an Islamic Point of View:

a). Donor's life is not harmed in any way.

b). Donor voluntarily donates without any form of coercion.

c). The procedure is the only medical means available to alleviate the plight of the patient. d). The success rate of the procedure of removing and transplanting the organ is relatively high.

Summary of the Quranic Concept of Death

"Allah takes the soul at the time of death (al-Zumar39;42)". They ask you (O, Muhammad, PBUH) concerning the Rooh (spirit or soul). Say: The spirit (or soul) is of the authority of my Lord, of knowledge it is only little that is communicated to you. (Bani:Israel,17:85). Hence, the lack of consensus among Muslim scholars as to the defining moment of death persists.

Opinions of Scholars

Muslim Jurist Qadi Mujahid Al Islam Qasimi states that once the brain stem dies the soul leaves the body. (Qasimi, Dimaghi Mawt, p14). Opposing views also exist including from Shiekh Mukhtar Salami, Mufti of Tunisia who states that "it would not be right to consider a brain-dead person to be 'dead' as long as the essential systems of such a person are alive". (Salami: When does life end? IOMS p 422-423).

The Majlis-e- Shura (consultative assembly) Al Islami, Gatesville, Cape Town, South Africa, May 5 1994, states that "when those qualified to make judgments on brain-death declare such a person brain-dead, then the Shariah (Islamic law) concurs with this judgment and also regards this patient dead".

It was resolved by the Council of Islamic Fiqh Academy of the OIC, in its 4th Session Jeddah, 1988 that "it is permissible to trans­plant the organ from the dead to the living on the condition that it has been authorized by the deceased or by his heirs after his death". "Death may take two forms: a). when all functions of the brain come to a complete stop, and no medical cure can reverse the situation. b). when the heart and respiration come to a stop and no medical cure can reverse the situation". [Resolution no (1) of OIC (Organization of Islamic Countries) Islamic Fiqh Academy, resolutions and recommendations 1985-89 p52]

Some other Ethical Questions:

Are we violating the sacredness and sanctity of human body as a result of organ donation? The human body is considered an "Amana" or Trust? Do we, therefore, even own it to make any decisions about it? Subjecting the human body to material ends is unacceptable in Islam. On the other hand, there is a role for public welfare or "Masliha" and Altruism or "E-thar"? Can one inherit an organ or declare in one's will, donation of one's organs?

The exchange of money for organs has been addressed by the council of Islamic ideology in Pakistan who clearly finds this issue "repugnant to Islamic" principle, yet this practice goes unabated in certain leading cities of Pakistan.

When two consenting adults buy and sell their organs respectively, this falls under the definition of a victimless crime. However, this is analogous to prostitution, particularly if the "seller" belongs to the lowest and thus, exploitable strata of society and as we all know, most societies look with repugnance at prostitution. This, I hope, will convince our transplant colleagues who advocate "organ sale" (modified from Issues in Criminology, Scarman Center, Univ. of Leicester, 1997, p 139-179)

These are some of the other contentious issues that need further research. Pending this, I believe that answers may well be encompassed in the four principles advocated by Beauchamp and Childress. [4]

a). Respect for peoples' autonomy, in effect deliberated self-rule or self-determination, making thought out choices for oneself

b). Non-maleficence or the obligation not to harm

c). Beneficence or the obligation to benefit d). Justice i.e. the obligation to treat con­flicting claims fairly or justly, especially for health care ethics, in the context of scarce resources, of respect for people's rights and of respect for morally acceptable laws.

Islamic principles clearly allow what is not forbidden and Prophet Muhammad (PBUH) recommended staying away from the doubt­ful. This, in my view, should guide Muslim nephrologists and transplant surgeons as well as the rest of the scientific community who should be cognizant of this guiding principle when dealing with Muslim patients.

 Summary



I hope I have conveyed the major issues upon which Islamic Ethics has evolved consensus regarding organ transplantation and some of the more contentious issues over which debate continues amongst Muslim physicians. My own bias in accepting these "Pro-Transplant" views needs to be placed in perspective too and certainly some Muslim scholars still consider organ donation "not permissible".

 Acknowledgement



Mr. Qaiser Shahzad, Dept of Islamic Medical Ethics, Shifa College of Medicine and Professor M. Amin, Dean Shifa college of Medicine who taught me how to ask an ethical question.

Dr. Khawaja Sayeed Ahmed, Dr. Nayer Mahmud, my Nephrology colleagues and Dr. Saeed Akhtar, our transplant Urologist, who had the courage to take on the "organ traders" and speak out against this evil.

References

1Oxford English Dictionary. "Oxford Uni­versity" Press 1993.
2Miller RB. In Caring for the renal patient, Levinedz ED, WB Saunders 1997, pp203-42.
3Cameron S, Hoffenberg R. Kidney Inter­national Vol 55(1999) pp724-32.
4Transplantation and Ethics Raanon Gillon in Birth to death; Science and bioethics, Ed Thomasma and Kushner1996,p106-18.