A Gift of Life

Article excerpt

Organ transplantation scandals never seem to die: organ harvesting and smuggling, not to mention the sale of donor organs, are in the headlines these days. In addition to the medical and technical aspects, organ transplantation involves legal, moral, ethical, economic, logistical, and humanitarian aspects.

Islam allows organ transplantation as an acceptable therapeutic when (a) no other equally effective, simpler, safer, and/or more cost effective therapeutic modality is available; (b) the donation does not harm the donor; (c) the donation is done with the donor's free will and full approval. In the case of an unconscious donor or an organ donation taken from a cadaver, the next of kin's or legal guardian's approval is required; (d) in the case of donating a single organ upon which the donor's life depends (e.g., the heart or liver), the organ may not be removed until the donor's brainstem death has been ascertained; and (e) the donated organ is not to be sold. The donor may accept it as a gift, however, if the recipient offers it.

The transplantation of active reproductive organs is categorically forbidden, because this would violate the basic Islamic rules governing marriage, reproduction, and inheritance.

The basic governing rule is that organ transplantation is considered a humanitarian act accomplished with the free will and approval of all parties involved without pressure, coercion, or injustice. Improved surgical techniques, advances in organ preservation, and the availability of better and safer drugs for preventing tissue rejection have raised horizons in transplantation with a rapidly improving success rate. As demand increases, the logistics become more complex.

As Islam obliges sick people to seek treatment, it becomes a collective duty to cooperate with each other and achieve this goal of treatment and/or healing. According to the hadith: "Whenever the messenger of God was given a choice between two matters, he always elected the simpler and/or easier one."

The severity of illnesses proves that modern medicine has not found a way to cure all chronic illnesses. By definition, a chronic illness has persisted for months or years and may never be cured - an "end-stage chronic illness." This condition often causes progressive organ failure to such an extent that the patient is seriously affected, perhaps to the point of death. Organ replacement is considered, either in the form of transplantation or a temporary or permanent mechanical artificial organ. For example, some patients who need a heart or a kidney transplantation may be in a stable and progressively improving condition for a while. While conventional modern western approaches may offer alternative options, if none of these options are available transplantation should be considered a "fulfillment of one's Islamic duty."

There are several other hurdles. First, the donated organ must not harm the donor. For a successful outcome, the transplanted organ has to be living or at least viable. This situation is very limited (e.g., a donor who is a member of the recipient's immediate family) and will seriously limit the availability of organs to be transplanted. Securing viable organs from dead donors could greatly improve the availability of single as well as double organs. A viable organ has to have active circulation and oxygenation. But if we wait for the traditional criteria for death (i.e., absence of pulse and respiration), the potential donor's organs will no longer be viable.

This dilemma has been overcome by accepting brainstem death as an adequate criterion for death, for at this time the heart is still beating and respiration is artificially maintained. The great majority of Muslim scholars who deal with transplantations, whether they are medical experts or jurists, have accepted this criterion. For instance, the Second Symposium on Islam and Current Medical Concerns: Human Life, Its Beginning and End from an Islamic Perspective, organized by the Islamic Organization for Medical Sciences, Kuwait ("Proceedings of the Symposium" [Kuwait: Center of Islamic Medicine, 1985]); and the Third Symposium on Islam and Current Medical Concerns: The Islamic Vision of Some Medical Practices, organized by the Islamic Organization for Medical Sciences, Kuwait ("Proceedings of the Symposium" [Kuwait: Center of Islamic Medicine, 1987]). …