Islamic bioethical perspective on organ transplantation

• 1. I slamicP erspective onO rganT ransplantation Dr. Azza Hamdy El-Elemi Dr. Ghaiath Hussein

2. Objectives

• Introduce the basic principles on which Islamic philosophy is based

• Discuss how these principles affect its approach to organ transplantation issue

• Case Study

3. Basic Resources of Islamic philosophy & legislation:

• The Koran: believed by Muslims to be the book whose chapters and verses (Ayat)are from God (Allah), through revelation on His prophet Mohammed

• The Sunna: term that comprises all the deeds, and sayings that the prophet said, did, or agreed upon

• Unanimity of scholarson whether the discussed issue is allowed (Halal), or forbidden (Haram)

4. Islamic Ethical values

• 1- Human Dignity:The human quality that encompasses the concept of the ideal ethical value summed up by the term (taqwa)

• 2- Economic and social life:distribution of wealth on: family, orphans, poor, the traveling homeless, the needy, freeing of the enslaved.

• 3- Responsibility to develop a social conscienceand to share individual and communal resources. the duty of(Zakat)

5. Islamic Ethical values

• 4- Social Value:Quran give concern to the family to ameliorate the status of the women through abolition of pre-Islamic practices (female infanticide)

• Giving women rightsto inherit, ownership of property, the right to contract marriage and initiate divorce and maintain ones own dowry.

• 5- A main Islamic ethical message is to command the right and prevent the wrong.

6. Basic principles of Islamic philosophy onLIFEand death

• Lives and bodies are ultimately owned by their Creator

• humans are only vicegerents so their possession of their bodies is not absolute

• human life is a gift of God that should be respected and preserved as long as possible

7. From Koran and Sunna

• he who saved one life should be regarded as though he had saved the lives of all mankind. TMQ [5:32]

• No harm to oneself, (And) make not your own hands contribute to (your) destruction TMQ [2:195]

• The Hadith: "There is no (harm) injury nor return of (harm) injury." [ Malik's Muwatta, Book 36: 1429 ]

8. Basic principles of Islamic philosophy on Life anddeath

• No clear cut religious definition of death

• Contemporary scholars came to adopt the following definition

• The death of that part of the brain responsible for the primary vital functions, which is called the brain stem, is a reliable indicator of the occurrence of death

• (Statement of The Islamic Organization for Medical Sciences About the Medical Definition of Death, 1996)

9. How do these concepts affect position on transplantation?

• The majority of contemporary Muslim scholars legalized organ donation, with clear conditions as means of preserving life

• However,other scholars refused even the concept of donation claiming that:

• • - bodies are ultimate possession of God

• • -no one has a right to donate what s/he does not possess

• • - donation of any human tissue is a violation for the rule of being vicegerents.

10. Major rules of transplantation

• the medical profession is the proper authority to define signs of death

• current medical knowledge considers brain stem death to be a proper definition of death

• brain stem death constitutes the end of life for the purpose of organ transplantation

• organ transplantation is a means of alleviating pain or saving life on the basis of the rules of the Shariah

• Muslims may carry donor cards

11. Major rules of transplantation cont.

• the next of kin of a dead person may give permission to obtain organs from the body

• organ donation must be given freely without reward

• trading in organs is prohibited.

12. Interfaith and Organ Transplantation

• CATHOLICISM

• Transplants are acceptable to the Vatican and donation is encouraged as an act of charity

• JEHOVAHS WITNESSES

• Donation is a matter of individual conscience with provision that all organs and tissues be completely drained of blood

13. Interfaith and Organ Transplantation contd

• JUDAISM

• Jews believe that if it is possible to donate an organ to save a life, it is obligatory to do so. Since restoring sight is considered life saving, this includes cornea organ transplantation

• BUDDHISM

• Donation is a matter of conscience

• HINDUISM

• Donation of organs is an individual decision

• Source: http://transplantforlife.org/miracles/religion.html

14. General Conditions to permit organ transplantation

• The benefit to recipient weighs the potential harm to the donor

• The life, or a basic life function of the donor doesnt depend on donated organ

• The donated organ is renewable or its function is naturally compensated

• Organ sale is NOT permissible

Islamic Jurisprudence Council Conference, 1987 15. Conditions associated with a living donor:

• capable person

• done on his/her own free will

• never be the outcome of compulsion, family embarrassment, or financial need

• The organ must not be a vital organ

• No transplantation of sexual organs is allowed.

16. Conditions associated with a dead donor:

• death have been accurately diagnosed

• Organ donation from a deceased person should only be permitted by the close family members (heirs), or by the authorities if the dead is unidentifiable homeless, or of absolutely no heirs

• It must be done after having ascertained the free consent of the donor prior to his /her death. It can be through a will to that effect, or signing the donor card, etc.

• In a case where organ donation consent was not given prior to a donors death, the consent may be granted by the deceaseds closest relatives who are in a position to make such decisions on his/her behalf.

17. Conditions associated with a dead donor cont.

• It must be an organ or tissue that is medically determined to be able to save the life or maintain the quality of life of another human being

• The organ must be removed only from the deceased person after the death has been ascertained through reliable medical procedures

• Organs can also be harvested from the deceased with unidentifiable identities, but it must be done only following the valid decree of the authorities

• (source:http://www.islamonline.net/)

18. what does The Islamic code of Medical Ethics say?

• The individual patient is the collective responsibility of society, that has to ensure his health needs by any means inflicting no harm on others

• This comprises the donation of body fluids or organs such as blood transfusion to the bleeding or a kidney transplant to the patient with bilateral irreparable renal damage

• Markets of human organs are proscribed by key Fatwas (legal rulings)

19. More liberal point of view 20. The principles affecting distribution

• Distributive justice (Equity)

• Duty

• Right

• Virtue

• justice

• In Islam: bioethical decision-making is carried out within a framework of values derived from revelation and tradition

21. Challenges facing transplantation

• Ethical and legal challenges for transplantation:

• Declaration of death (dead transplantation)

• Consent to donation

• Uncertainty in determination of death:

• When should a person be treated as dead?

• Who should decide what concept of death is to be used?

22. Challenges facing transplantation contd

• Teams specialized for recruitment of organs

• Organ preservation

• Organ allocation:

• • • No resources

• • • No clear law

• • • No organized program of dead transplantation

23. 24. Lets Practice

• An 18-year-old Muslim man sustains severe head injuries in a traffic accident while riding his motorcycle.

• He is declared brain dead

• The transplant coordinator approaches the grieving mother to obtain consent for organ donation

• At first the patients mother is shocked at this approach

• She then politely says that she would like to wait for her family to arrive before making a decision

25. Hints

• Mutilation, and thus cremation, is strictly prohibited in Islam.

• Cadaveric organ donation is permitted

• Death is considered to have occurred when the soul has left the body ( lay people )

• Responsibility of declaration of death ( physician )

• One of the Muslim requirement is to bury the body on the same day

26. References and suggested readings

• http://www.islamset.com/bioethics/death/index.html

• Bioethics for clinicians: 21. Islamic bioethics. Abdallah S. Daar and A. Khitamy ( http://www.cmaj.ca/cgi/content/full/164/1/60#T127 )

• ISLAMIC MEDICINE( http://www.islam-usa.com/im1.html )