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 )