Author: Mr. Obadah Ghannam

Editor: Dr. Saad Ismail

Checked & Approved By: Mufti Muhammad ibn Adam al-Kawthari, Ms. Natalie Akenzua, Shaykh Ruzwan Muhammad, Ms. Arzoo Ahmed, Dr. Raeesa Nurani

Organ DonationAnd Islam

Glossary i i

Introduction 1 4

A Contemporary Issue 4

The Ethics of Organ Donation In Islam 4

The Ethical Basis Against Organ Donation 5

The Ethical Basis For Organ Donation 5

General Requirements For Organ Donation In Islam 1 6

The Legal Position On Recieving Organs In Islam 7

The Legal Position On Donating Organs In Islam 7

Is Living Autograft Donation Permissible? 7

Is Living Allograft Donation Permissible? 8

Is Living Xenograft Donation Permissible? 9

Is It Permissible To Donate Organs When You Die? 9

Organ Transfer Between A Muslim And A Non-Muslim 1 10

Conclusion 10

© MHSN – The Muslim Healthcare Students Network. All rights reserved. Aside from

fair use (a few pages or less for non-profit educational purposes, review, or scholarly

citation) no part of this publication may be reproduced, stored in a retrieval system,

or transmitted in any form or by any means, electronic, mechanical, photocopying,

recording or otherwise, without the prior permission of the copyright owner. The

medical information in this article is presented to help educate readers on the Islamic

laws concerning medicine and healthcare. The author, editors, reviewers and MHSN

are not responsible for any medical decisions or actions taken based on the

information in this article. Furthermore, the guidance given in this publication is

general guidance. All individual cases must be dealt with on an individual basis, with

the advice of qualified medical experts and qualified Muslim scholars.

Contents

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Allograft

Asystole

Autograft

Basic function

Cadaver

Donation after brainstem death (DBD)

Donation after circulatory death (DCD)

Fatwa

Fiqh

Halal

Haram

Organ

Organ donation

Organ transplant

Shariah

Tissue

Vital function

Vital organ

Xenograft

An organ taken from one member of a species and received by a member of that same species, e.g. from one human being to another.

Irreversible cessation of the heart.

An organ or a tissue obtained from the same individual to which it is being transplanted, such as a piece of skin.

A physiological process within the body that does not directly sustain life. Termination of this function does not lead to death.

Latin for a dead human body.

The retrieval of an organ after the irreversible death of the brain-stem, which controls breathing. The death is confirmed through neurological criteria.

The retrieval of a cadaveric organ after the patient’s heart irrevers-ibly stops beating.

The legal opinion of a Muslim scholar.

Islamic law.

Permissible according to Islamic law.

Impermissible according to Islamic law.

A mass of specialized cells and tissues that work together to per-form a function in the body.

The process of giving an organ to someone in need of it, or making a pledge to do so.

GLOSSARY

A surgical operation where the function of a failing or damaged organ in the human body is restored with a new organ.

Islamic law.

A group of cells in the human body performing a common function.

A physiological function without which one would die.

A life-sustaining organ whose removal leads to death.

An organ or tissue obtained from a different species, such as por-cine valves.

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Organ transplantation is an effective therapy for the treatment of irreversible organ damage. The first successful transplant took place in the 1950s¹, and it has since advanced to become an effec-tive and safe cure for many illnesses. It is considerably limited by the number of organs available and has thus been the subject of many national campaigns to increase the number of donors. Be-tween 2010 and 2011, 7,797 people were on the transplant waiting list, whilst only 3,740 trans-plants occurred². Three people died every day as a consequence of this shortage³.

Organ donation is subject to a great deal of controversy amongst Muslims, and challenges several fundamental beliefs held by the faithful about the human body, including its inviolability and sacred nature⁴. This article reviews the diverse opinions Muslim scholars have expressed about organ donation, and allows lay Muslims to make a more informed choice on the matter.

The transplantation of human organs, with its complex operations, impressive therapeutic benefits and ability to take organs from the dead to save the living, is a recent phenomenon that could hardly have been predicted or discussed in traditional Islamic legal literature. As a conse-quence, modern scholars have had to apply the classical Islamic framework of deriving legal rulings from source texts to a new context. Their approach has been to split the topic into two broad strands – cadaveric and living donation, with the latter being further split into auto-graft, allograft, and xenograft donation.

INTRODUCTION

A CONTEMPORARY ISSUE

The majority of Muslim scholars agree that organ donation is permissible⁵, though some do reject the practice outright⁶ ⁷, particularly those from the Indian subcontinent. Both groups of scholars draw their opinions from valid sources and respect one another’s views, recognising that there is no sin in following either of the two rulings.

THE ETHICS OF ORGAN DONATION IN ISLAM

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Scholars who argue against organ donation raise four main objections to the practice;

• The human body has been honoured and made sacred by God, irrespective of whether it is dead or alive. It is unlawful to deform it in any way, regardless of how extreme the need may be. Cutting the human body to retrieve organs amounts to mutilation and deformation, and is therefore prohibited in Islamic sources⁸.

• The human body is a trust from God and not something we can claim ownership of. It is therefore inappropriate for one to decide to donate their body parts.

• Donating one’s organs harms the donor, contradicting a key principle in Islamic law which states that it is unlawful for individuals to inflict harm upon themselves or others.

• When the evidence prohibiting a practice conflicts with evidence supporting its permissibil-ity, caution entails that preference should be given to the ruling of prohibition.

In contrast to this, scholars supporting organ donation cite four main reasons for doing so;

• An important maxim in Muslim legal theory states that ‘necessity makes prohibitions lawful’. The necessity for organ donation is demonstrated by the number of lives it saves every year. Therefore the prohibition on organ donation is lifted.

• When confronted by two evils, the lesser of the two takes preference. Prospective death is clearly worse than the problems of organ donation, and thus is a sufficient reason to allow it.

THE ETHICAL BASIS AGAINST ORGAN DONATION

THE ETHICAL BASIS FOR ORGAN DONATION

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• Modern operating techniques to retrieve and implant organs take care to respect the human body and do not violate its sanctity.

• In certain situations, Muslims are permitted to utilise their God-given gifts to help others in lawful ways, even if doing so risks their own lives. It is permissible for example to put oneself in danger to save a person in a burning house. Organ donation is another such example.

Muslim scholarship has always stressed that individuals be consistent in the legal positions they adopt⁹. If an individual takes the view of impermissibility, they are required to hold both donating and receiving organs as impermissible. Being selective has been deemed a preference of one’s own desires over the conclusions of authentic scholarship, and is therefore reprehensible from a moral and ethical viewpoint.

The remainder of this article will focus on the conditions placed on organ donation by scholars who agree with the practice.

When an organ is donated or received, the following requirements must be satisfied.

1. The highest level of respect must be given to the bodies of the donor and the recipient. Is-lam sanctifies and affords immense dignity to human beings, as is clearly mentioned in the Quran¹⁰. Current practice in the UK would fulfil this requirement¹¹.

2. Consent must be given explicitly from a competent donor¹². If the donor is unable to give a decision due to their lack of capacity as defined by the Mental Capacity Act of 2005¹³, then Muslim scholars mention that the permission of the donor’s legal heirs must be sought upon their death¹⁴. If this cannot be obtained, consent may be given by a body responsible for Muslims’ affairs, such as a Muslim chaplain. There must be no compulsion at any stage. This sentiment is echoed in British law through the Human Tissue Act of 2004¹⁵; it is a legal offence to retrieve and use human tissue or organs without appropriate consent.

GENERAL REQUIREMENTS FOR ORGAN DONATION IN ISLAM

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1. 2. 3. There is a general consensus in Islamic literature that the relatives of the deceased have the

permission to allow an organ to be taken from the body even if there is no will or donor instruction to that effect¹⁶. They are also afforded the right of objecting to the retrieval of their relative’s organ, even if the deceased had left specific instructions consenting to such a procedure. The Human Tissue Act does not give the next of kin such rights, though standard practice dictates that the procedure would not go ahead if the family veto it.

4. There must be no buying and selling of organs¹⁷. It carries the risk of coercion, exploita-tion of the poor, and potentially deprives the donor and recipient of proper aftercare¹⁸. Human organs are not a commodity for profit and sale.

5. Reproductive glands must not be transplanted because of their ability to pass on the ge-netic characteristics of the donor,. The ruling on transplanting sexual organs that do not pass on genetic characteristics, for example the uterus, is still under research.

It is permissible in Islam to receive an organ transplant on the following conditions: that the pa-tient has an organ which has stopped functioning normally; that there is a strong danger that they will lose their life or develop a serious illness if the organ is not replaced through transplantation; and that there is no viable alternative¹⁹. Furthermore, medical experts should hold the opinion that there is a strong likelihood of a successful transplantation, and that the required organ is avail-able.

THE LEGAL POSITION ONRECEIVING ORGANS IN ISLAM

THE LEGAL POSITION ONDONATING ORGANS IN ISLAM

Autograft donation is widely permitted. The Islamic Fiqh Academy of India concluded in 1989 that ‘it is valid to replace a part of a person’s body with another part of the same person if necessity

IS LIVING AUTOGRAFT DONATION PERMISSIBLE?

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so demands.’ It must be established that the benefits of the operation outweigh its harmful effects and that the purpose is to replace a lost organ, reshape it, restore its function, correct a defect, or remove a malformation which is the source of mental anguish or physical pain.

Allograft donation can be split into three subtypes: the donation of a renewable organ, the dona-tion of a vital organ that performs a vital function, and the donation of an organ that performs a basic function.

Generally, scholars say that it is permissible in Islam for one to donate organs that can be automati-cally renewed, such as blood and skin. The Islamic Fiqh Academy of Jeddah and the European Council for Fatwa and Research said that an organ ‘may be transplanted from the body of one person to the body of another person, if such an organ is automatically regenerated’,. In light of this ruling, bone marrow may be donated.

It is impermissible to donate vital organs that perform life-sustaining functions. The Islamic Fiqh Academy of Jeddah state that it is ‘forbidden to transplant from a living person to another, a vital organ, such as the heart, without which the donor cannot remain alive’. This practice is deemed to be suicide, a serious sin²⁰ for which there is no legal justification. In practice, this bears little signifi-cance in the UK where such operations are not carried out²¹.

Organs that perform a basic function, which would not normally kill the donor when removed, can be either permissible or impermissible to donate. If the organ is singular, one is not allowed to donate it in full because its removal would cause an essential function to cease, regardless of whether it be an organ that is congenitally unique (such as the tongue or the pancreas) or one that has become one of a kind (like a patient who has lost an eye) ²².

Donating a portion of a singular organ, like a lobe of the liver, is permissible on the condition that the donor’s health is not placed at risk and the likelihood of a successful transplant is high. If the organ forms one of a pair, such as a kidney, then it is permissible to donate should it save the life of the recipient and not result in permanent damage to the donor.

IS LIVING AUTOGRAFT DONATION PERMISSIBLE?

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Solid organ xenograft transplantation is currently not performed, though the use of specific ani-mal tissues to replace their malfunctioning human equivalent is common (e.g. using a pig’s heart valve to replace a damaged human heart valve)²³. Many Muslim scholars say that xenografts are permitted in Islam if they come from permissible animals and if the animal is slaughtered accord-ing to Islamic standards. Even if these two conditions are not fulfilled, the Islamic Fiqh Academy of India holds it permissible to retrieve and use xenografts if there is no alternative and if the per-son’s life is in danger or their organ is at risk of being completely damaged.

IS LIVING XENOGRAFT DONATION PERMISSIBLE?

In the UK, cadaveric organ donation takes two forms: donation after circulatory death (DCD) and donation after brainstem death (DBD). In DCDs, organs are retrieved follow-ing asystole²⁴. This is the traditional definition of death²⁵ which is accepted by all Muslim scholars. In DBDs, retrieval begins when the function of the donor’s brainstem is perma-nently lost, leaving him or her irreversibly unconsciousness and incapable of breathing inde-pendently²⁶.

British law accepts this as a definition of death and generally Muslim scholars have agreed. In both cases, organs are retrieved only after an independent clinical confirmation of death.

Many Muslim scholars agree with the permissibility of cadaveric organ donation, including the Islamic Fiqh Council of Jeddah, the European Council for Fatwa and Research, the UK Shariah Council²⁷ ²⁸, the National Fatwa Council of Malaysia²⁹, the Islamic Medical Associa-tion of North America³⁰, the Islamic Religious Council of Singapore³¹, and the Fatwa Com-mittee of Kuwait, and al-Azhar Academy of Egypt³².

The conditions for this permissibility are that the transplantation either keeps the benefi-ciary alive or restores a basic function, and that consent be given first.

Some scholars however deem cadaveric donation to be impermissible. The Islamic Fiqh Academy of India in 1988 said: ‘If someone expressed his wish that after his death, his organs may be used for transplantation purposes, [then] it cannot be considered as Wasiyah [a will]

IS IT PERMISSIBLE TO DONATE ORGANS WHEN YOU DIE?

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according to Shariah and is invalid...’. The Islamic Religious Council of Singapore in 1973 also held this view because one does not own one’s body. However, the fatwa was revised in 1986 to be in harmony with the position adopted by many other Fiqh councils. This was based on the legal maxim in Islamic jurisprudence that necessities change the forbidden into the permissible; in this case the dire need for organ donors and the paucity of available organs were sufficient reasons to allow cadaveric donation.

ORGAN TRANSFER BETWEEN AMUSLIM AND NON-MUSLIMThe allocation process for donated organs within Britain does not discriminate on the basis of religion. All donations need to be made unconditionally³³. Specific requests for organs to go to family members or close friends are facilitated as much as possible, though clinical need ulti-mately takes precedence.

Muslim scholars have in their discourse addressed the issue of organ transfer between Muslims and non-Muslims, and by extension, the use of organ banks. Some hold it to be permissible to donate and receive organs from non-Muslims³⁴ ³⁵, whilst other disagree. Both views are valid.

CONCLUSIONOrgan donation is a complex topic encompassing a variety of legal scenarios, and therefore is not subject to one blanket ruling within Islam. Every case must be considered individually, and a com-bination of medical and Islamic scholarship is required.

There are two broad scholarly views on the subject – those who hold it to be permissible, given the fulfilment of specific criteria, and those who deem it entirely impermissible in every circumstance. Both viewpoints are valid, backed by supporting evidence and may be followed without fear of sin. Muslims are obliged to both respect each view and be consistent in following the one they choose. The majority of modern day scholars support the view of permissibility.

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We ask Allah Almighty to bring greater understanding to us all. To Him we all belong and to Him we will all return.

And Allah knows best.

AREAS OF FURTHER RESEARCH• A ratification of the Human Tissue Act (2004) in light of Islamic law.

• Porcine valve transplantation.

• Reproductive organs transplantation.

• Voluntary compensation of organ donors.

A summary of the views of Muslim scholars towards organ donation:

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