Organ Transplantation

 

(This article is based on a paper presented by the author at the Parliament of World Religions in Capetown, South Africa, December 1-8, 1999.  The views expressed in this article are those of the author and do not represent the Islamic Research Foundation International, Inc, its Board of Trustees, Executive Committee, employees or volunteers)

 

"And whoever saves a life it would be

As if he had saved the life of all the people."

                                                                    …..Qur'an, 5: 32

 

Every 27 minutes someone in the world receives an organ transplant, but nonetheless every 2 hours 24 minutes someone dies waiting for an organ to become available. Hundred of thousands more are on waiting lists around the world.

Every year millions of people die of various causes, but only about two percent of these people are potential organ donors. Of these potential donors, less than thirty percent will have any of their organs or tissues donated. Those who do will save an average of five lives and improve the quality of life of up to fifty more people.

 

Artificial Organs
Artificial organs are devices which are designed to replace the body's normal functions that have been lost due to disease or injury. Artificial organs may be implanted or used outside of the body. They may permanently replace the body's function, or they may just be temporary until the affected organ can be transplanted.

When irreversible organ damage occurs, the best long-term solution is usually transplantation. However, the number of donors is far lower than the number of people waiting for a transplant. Thus many patients must wait long periods of time until an organ becomes available for them. Artificial organs provide an alternative to simply waiting for an organ to become available. Some artificial organs, such as the artificial kidney  (hemodialysis) can be a temporary measure to maintain as normal a life possible, while others, such as Bioartificial Organs. Research into bioartificial organs is currently underway. Bioartificial organs have a synthetic membrane, which encloses functioning cells, while still permitting a naturally functioning organ to perform its job. This would help protect the organ from rejection.. Experiments are mainly focusing on the liver, pancreas, nerves, and adrenal cells.
 

Blood Substitutes
Researchers are currently developing substitutes for human blood. Blood substitutes would avoid potential problems with blood transfusions, such as allergic reactions, mismatches, and the transmission of diseases. Synthetic plasma substitutes such as dextran have been developed to increase blood volume, but so far they have had no ability to carry oxygen.  Perfluorocarbon solutions can carry dissolved oxygen but have proved to be less than successful. 

The majority of the Muslim scholars belonging to various schools of Islamic law have invoked the principle of priority of saving human life based on the Qur'anic verse quoted above (5:32) and have permitted the organ transplant as a necessity to procure that noble end."  

In Islam Organ Transplantation is governed by two Judicial Rules:

1.      Necessities overrule prohibition

2.      Choice of the lesser of the two Evils if both cannot be avoided.

An organ is defined as any part of human body, tissue, cells, or blood.  Organs of a deceased person, most of them, are useless. Certain organs continue to function even after the death of a donor.  For majority of the organs a donor should be alive to donate the organs. An example is a person who is clinically dead, that is the physical body is living but the brain stem is dead.. In order to donate a donor should meet certain conditions listed below. 

Transplants are classified as follows:

1.      Transplant of an organ  from a living person

2.      Transplant of an organ from a dead person.

3.      Transplant of an organ from an Embryo.

 

Transplant from embryos 

1.      When embryos are aborted  due to miscarriage

2.      When embryos are aborted for medical, or criminal reasons

3.      When embryo is externally developed for example -test-tube babies 

THE SHARI'AH RULES AND LEGISLATION

1.      Organ transplant within the same person: Examples are plastic surgery performed to restore function or shape, such as skin, cartilage, bones, veins, etc.  Plastic surgery performed to change the person to elude the law is not permitted. Majority opinion is that it would not be allowed for cosmetic purposes. 

2.      The donor should meet the following conditions: -
First: The donor must be able to exercise free will, is in control of all his/her faculties. Donor gives permission without coercion if alive.

Second:  The organ donated should not affect his/her own life, which is the property of God alone. No one has the right to donate his or her life to someone else. Nor does he/she has the right to donate an irreplaceable part of his/her body, such as heart or brain.

     Third:  The donor should not sell his/her organs for cash nor in exchange for other organs of the body, since life and the human body in all its totality is the property of God. 

Organ transplant from one living person to another person is permissible in organs involving: Liver, kidney, lung, blood, skin if donor is in legal capacity. Donated organ must not disfigure the donor.

If donor is not of sound mind or dead, then the parents, spouse, guardian or ruler must decide. If the donor is under-age, in which case the donor's guardian has no right to donate parts of his/her body, since the guardian is appointed to protect and preserve the body of the ward. 

4.      Part of an organ such as cornea of the eye can be donated 

5.      Life-depending organ is prohibited. E.g. heart or brain from one living person to another. Donated organ should not risk the life of the donor. 

6.      Organ transplant is prohibited if a basic function of the body is damaged. 

7.       Organs from dead to the living person with prior permission of deceased or heirs. 

8.      Transplanted organ should not be sold. Or no material gain for the donor. 

9.       Transplantation is permissible from one Muslim to another and from a non-Muslim to a Muslim.  Transplanting Muslim organs into those under Muslim protection is a matter of some disagreement, while the transplant of Muslim organs into non-Muslims is not permitted. (Reference No. 5). 

The late Pakistani President, Zia-ul-Haq bequeathed his eyes for the blind. However Maulana Maududi declared it invalid.  Later on Maulana Maududi changed his views.

Isn't donating organs also 'Sadaquatul-Jaariyah'- a lasting act of charity long after one's death (Hadith).  Another Hadith says

 "KULLU MA'ROOF  SADAQAATUN"- all Good deeds are charity. 

'AD-DAROORAAT RUBIHUL MAHZOORAT' (Qur'an  2: 173)

Necessity makes permissible what is forbidden. 

'AKHAFFAD-DARA-RAYN'

Tolerating the lesser harm to remove or prevent greater harm, or choosing the lesser of the two evils (Hadith). 

'AL-IBAHA ASLAN FIL-ASHYA'

Everything is presumed to be lawful (unless proven otherwise by a legal

Command). What Allah has not mentioned (as Haraam or unlawful) are things permitted for you as a favor. 

Donation should be an act of 'EETHAAR' (selflessness/altruism).  Organ selling for personal benefit is viewed by all jurists as strictly prohibited (Surah 90:13).

Currently organ donation does not offer any financial benefit to donors or their families, but there is still concern of a black market developing for organs. Should families receive financial aid if they decide to donate their loved one's organs? Can a black market develop if money becomes involved? Should people be able to buy another person's organ(s)? If a black market does result, will wealthy people have an advantage over the poor? 

COMPENSATION 

A sick baby needs a kidney to survive. The sick baby is kept on dialysis (kidney machine) until a suitable kidney can be found. Parents  of the baby cannot afford the cost, nor do their kidneys match the baby's. The parents are willing to offer one of their kidneys what will be a suitable match  for a rich patient who needs kidney transplant. In return the rich patient wants to compensate them with the full cost of their baby's transplant. 

Can the principle of 'Daroorah' (dire Necessity, to save life) be applied in this case? Haleemah, the revered wet nurse of the Noble Prophet Muhammad (S)  did not sell her breast-milk, so to speak, But she was compensated for it.

"Can there be a better reward for a good deed other than another good deed"  Surah 55:60

 

Life is not static. With enlightenment, things change for the better. What was

once labeled as  'Haraam'--- microphone, Camera, video, TV, blood transfusion,

Artificial insemination, IVF-- are now commonplace among many as necessities

of life. Nobody measures the shadows any longer to check prayer Times-now the watch is watched.

 

Ethics

There is continuing research into the use of animal organs to make up for the lack of human donors, as well as genetically engineering animals to produce human hormones, enzymes, and even whole organs. Should animal organs be transplanted into human beings? Should we be genetically altering animals' genetic codes to produce human hormones, enzymes, or organs? Will altering other creatures' genetic makeup have any long-term effects? Who decides what is acceptable and what is not when it comes to genetic manipulation?

With the successful cloning of Dolly, many people turned their attention to the possibility of cloning humans. Is it ethically acceptable to clone human beings? What about cloning human organs to make up for the lack of available donors?

 

Recently interest and research into gene therapy has exploded. Soon gene therapy may be capable of curing genetic disorders that were previously fatal or incurable. Do we have the right to introduce new  genes  into people? How do we know that it will help and not harm them? How do we know that altering someone's genetic code won't have compounding effects on mankind? Does man even have the right to alter a fellow person's genetic code?

Controversy over human stem cell and brain cell research has also surfaced. With the isolation of stem cells earlier this year, researchers now believe that they have the capability of "tissue farming": the growth of neural, organ, and other tissues within the laboratory since stem cells are the basis of every human cell. Scientists believe that not only will they soon be able to grow specific human tissues and organs, but also engineer them to optimum condition.

Often parents and siblings are the best matches for donation, so they often donate bone marrow, a kidney, or part of a lung or liver to their ill family member. Bone marrow regenerates, and a person can live with only one kidney, but what about donating part of an essential organ? Donating part of a lung or liver is a difficult dilemma since the donor needs these organs to survive. Yet if the donor's ill family member doesn't receive an organ or part of an organ, he or she will also die. Is the increased risk to the donor acceptable, or should organs only be obtained from those who have been declared brain dead? Does the fact that the recipient is family influence their decision to give up part of an essential organ?

 

CONCLUSION: 

1.      Seeking cure is an obligation..

2.      Saving of life or improving Quality of life is a must.

3.      Using the forbidden for Necessity is allowed..

4.      Choosing the lesser of the Two evils is preferred..

5.      Whatever is forbidden is  Specifically mentioned by Allah in the Qur'an.

6.      We are warned not to forbid the Things Allah has permitted.

7.      Haraam must be proven by an Authentic command.

8.      Almighty Allah has not directly or indirectly prohibited organ donation

or transplantation.  In fact, He has encouraged the saving of life at any cost.

 

REFERENCES:

1.      International Conference of  Islamic Jurists.

2.      Contemporary  Jurisprudence  Research Journal, (Mujalat  Al-Buhuth al-Fiqhiyyah al-Mu'asirah) P.O. Box 1918, Riyadh,  Saudi Arabia.

3.      Dar al-Ifta al-Misriyya 1973-1982.

4.      Majallat al-Majma', 1987, Vol.1, p.37.

5.  Sheik Muhammadal-Mokhtar al-Salami ( Muftiof the Republic of Tunisia)

"Transplantation of Nerve Cells with particular reference to Brain cells.", at  www.Islamset.com