Organ Donation in Islam

Abstract

Nowadays, the increasing scientific and practical advances in the field of organ donation have caused many discussions in the world. One of these topics is religious beliefs in divine religions, which has always been one of the most important challenges in the field of organ donation. Although there are differences in the views of different religions regarding organ donation, many of these views are close to each other. Often, different sects and religions have accepted organ transplantation with their own conditions. Based on Islamic jurisprudence and Shariah principles, organ donation is permissible under certain conditions; most religious scholars have also accepted this opinion. The Muslim holy book (Qur’an 5:32) has mentioned, “if anyone saved a life, it would be as if he saved the life of the whole people.”

1. Introduction

From a long time ago, the connection of ethics and science in different fields of knowledge has always been an important and obvious principle for the material and spiritual advancement of mankind. In the realm of experimental sciences, especially medicine, ethics is considered an inseparable part. The principles of medical ethics have four principles, which Islam has also accepted. These four principles are as follows:

1. Autonomy: It means that the patient has the right to choose or refuse his treatment method.

2. Beneficence: It means that the person working in this field should act for the benefit of the patient and his benefit.

3. Non-maleficence: It means not harming a person.

4. Justice: It means issues related to the distribution of scarce health care resources and decisions about who receives what treatment, justice, fairness, and equality should be observed [1].

The emergence of Islam and its emphasis on scientific education and attention on medical science have had a great impact on the progress of science in Islamic countries. Almost all great Muslim doctors had full knowledge of theology and their works were both in the field of medicine and in the field of jurisprudence and ethics. Islamic medical ethics are based on the principles of respecting human life and preserving its values. From the point of view of Islam, besides being a social necessity, and human and moral mission, medicine is also a Shariah responsibility, because it is obligatory for a man to reach the highest levels of human perfection. Considering that medical science deals with the treatment of disease and maintaining human health, the doctor should study the features and subtleties of the creation system in the body. Therefore, during the training period and even during the treatment, he is constantly dealing with the complexities of the existential system. For these reasons, the medical profession connects man with God more than other professions.

In the medical profession, it is necessary to keep in mind the following four general principles that Islam has in mind about a man and his life in all medical matters, so that we can make the right decision more easily when making a decision for each person.

1. Belief in the purposeful life of all human beings.

2. Belief in the value of every person’s life.

3. Belief in the existence of individual differences.

4. Belief in the ability and readiness of each person to do things according to their abilities.

In addition to paying attention to medical issues, medical scientists have also given ethical recommendations. The teachings of Islam have advised Muslim scientists to have commitment and responsibility in medicine, to acquire expertise, be careful in their work, avoid any negligence in the matter of medicine, and pay attention to the mental and physical health of patients as the most important points of medical ethics in prophetic medicine. All the scientists of the world believe in the Hippocratic Oath in medicine. With a little possession, this oath is known as the “Oath of a Muslim Doctor” in the view of Islamic doctors. This oath, which is a mixture of the moral teachings of Hippocrates and Islamic culture, contains the following points:

• Paying full attention to performing sensitive medical duties;

• Effort in treating and guiding patients;

• Considering the sanctity and spirituality of medicine in strengthening the morale and maintaining the health of patients;

• Avoiding contaminating the sanctity of medicine with unstable material symptoms and sensual moods and satanic temptations;

• Respect for divine decrees and limits;

• Serious avoidance of betrayal and violation of patients’ rights; keeping patients’ secrets except in cases of necessity;

• Knowing that God is present and watching in all situations.

2. Islam view about scientific progress in the organ donation field

In Islam, science and practice are tied together with religious and moral values. Islam has welcomed science and scientific research, and has always encouraged Muslims to strive for scientific progress and excellence.

Organ transplantation is one of the new issues of medical science and one of its important achievements. The brain death phenomenon and the possibility of using it in organ transplantation, although it has brought new hopes in saving the lives of a number of patients, it has also brought many moral, cultural, and legal issues. In Islamic sources, human life is sacred, and preserving his life is a divine duty [2, 3]. Islam’s attention on new scientific research and findings in meeting the religious and worldly needs of man gives legitimacy to medical advances in saving human lives.

Efforts to remove obstacles and problems in organ transplantation, in addition to reducing the costs of maintaining brain-dead patients and giving hope to patients in need of organ transplantation, prevent profit-seeking, and unethical and illegal actions in this field. Since the culture that governs the Islamic society is an authentic Islamic culture, medical innovations and procedures, including organ transplantation, must be in accordance with Islamic standards and pay special attention to moral issues and problems in the Islamic society, otherwise failure in experience. Because even if this issue is legal, people will withdraw as the main provider and will not accept organ transplants due to moral problems.

3. Religious beliefs related to organ donation in Islam

Today, the increasing scientific and practical advances in the field of organ donation have caused many discussions in the world. One of these topics is religious beliefs in divine religions, which has always been one of the most important challenges in the field of organ donation. Although there are differences in the views of different religions regarding organ donation, many of these views are close to each other. Often, different sects and religions have accepted organ transplantation with their own conditions [4].

Given that the issue of organ donation and organ transplantation close communication with humans and their life and also religions, moral philosophies and different social traditions have different views about man, body, and soul. So, the issue of organ transplantation has been the source of many ethical, philosophical, and legal debates in the world. The views of religions on this issue are often related to the place of man in their value system. Because organ transplantation is closely related to the human body and decisions related to it. For example, in Islam, any action that is considered to treat and save human life is accepted. As in the Muslim holy book (Qur’an 5:32) is clearly mentioned, “if anyone saved a life, it would be as if he saved the life of the whole people” [4].

Religion and religious beliefs are one of the important and effective aspects of organ donation, because religion and religious beliefs are very influential in the cultural structure of societies, people’s thinking, and performance in various fields [4]. In the term, religion is a worldview and a set of beliefs that try to provide an explanation for a series of questions that are created for humans throughout their life [5].

Paying attention to religious beliefs is one of the main matters that make people consider organ donation as a pious and good act that brings them closer to God. Because every brain death victim can save several patients who need organs from inevitable death. It must be acknowledged that accepting organ donation is a moral, godly, and altruistic act, and all societies should try to spread this beautiful act [6].

Evidence shows that the relationship between Islamic teachings and organ donation is very complex. Religious beliefs, especially Islamic beliefs, may be considered as both barriers and facilitators of organ donation. On the one hand, Islam attaches great importance to preserving human life, so that by supporting organ donation, it has been able to provide an opportunity to create a positive public atmosphere to promote the culture of organ donation in Islamic countries (Qur’an 5:32). On the other hand, some Muslims based on views, such as that God is the protector of human life and the process of life preservation and treatment is in his hands, do not believe in organ donation for the treatment of diseases that require organ donation or do not accept organ donation because they believe that removing body parts is a kind of respect for the dead body.

Positive religious beliefs regarding organ donation can have a profound effect on improving public attitudes and lead to an increase in organ donation in society, although most people do not have sufficient knowledge regarding religious issues in the field of organ donation. It seems that in intervention studies related to increasing organ donation, special attention should be paid to increasing people’s awareness of correct religious beliefs and correcting incorrect religious beliefs. In a recent intervention study in Iran, it was tried not only to increase people’s awareness about correct religious beliefs, but also to correct wrong religious beliefs. For example, some people think that it was God’s will that a person needs a transplant, so there is no need for doctors to do anything to save him, or they think that God’s will is that the body is buried healthy after death. Therefore, it is important to correct such false religious beliefs [7].

The presence of religious beliefs, such as the inevitability of death, being alive after death, and the continued existence after death in Muslims, encourages them to donate organs. For example, based on the religious teachings of Islam, Muslims do not emphasize on maintaining the integrity of the body, because Muslims believe that after death, the human body will be rebuilt in the resurrection.

In Islam, man is the best of creation and the God’s Caliph on earth (Qur’an 1:30). Man has been given reason and free will, and man is not only responsible for his health, but he must also strive to preserve his life. God has respected human life in the Qur’an (5:32), so that this verse clearly legitimizes medical advances in saving human lives and prohibits suicide and euthanasia. Muslims due to Islamic teachings, emphasizing the importance of saving a human life, are encouraged to save a human life. Islamic teachings have a key role in persuading Muslims to save human life and this view can influence the positive public attitudes toward organ donation [8].

4. The jurisprudential ruling of donating organs in the Islamic perspective

The jurisprudential ruling of transplanting/donating organs is one of the major concerns of Islamic societies, and contemporary jurists have presented different interpretations according to the verses, hadiths, and examination of jurisprudential texts and rules. Some believe that it is not permissible to transplant organs, and others consider it permissible with some restrictions and conditions.

Therefore, it is natural to answer the following questions:

• What is Islam’s opinion on organ donation?

• Where does this opinion come from?

• Does Islam have obstacles or conditions for this matter and if it has obstacles or conditions, in which case?

First of all, the general framework of the cognition of humans from the Islamic viewpoint on organ donation should be defined, because when God sent his prophets to convey the divine message to the people, they all had a basic concern. Their only concern has been to solve the spiritual, physical, moral, psychological, and livelihood problems of man and lead him to progress and excellence.

Within the scope of the human-to-human relationship, the special concern of Islam has been to bring man out of the cocoon of his individuality toward philanthropy, forgiveness, and self-sacrifice in order to obtain the mercy and grace of God. Regarding the Islamic society, the Holy Prophet of Islam says: “The example of the believers in terms of compassion and kindness among themselves is like the members of a body, if one part of it hurts, the rest of the members sympathize with him by waking up at night.”

In the religion of Islam, the highest form of forgiveness is to prefer others over oneself, so that the benefit of others is preferred over one’s benefit and their comfort is preferred over one’s comfort. So, self-sacrifice is the best form of worship and the highest degree of faith.

Therefore, due to the fact that forgiveness and self-sacrifice are at the heart of Islam religion, we can understand that organ donation in Islam has a special sanctity and encourages Muslims to donate organs. According to Islamic jurisprudence and Shariah principles, organ donation is permissible under certain conditions. Most religious scholars and jurisprudential communities have also accepted this opinion. The most obvious of these conditions are stated below:

-In organ donation from a living person to a living person, the donor must be aware of what he is doing and do it voluntarily. Organ donation should not cause the death of the donor or failure of his vital and necessary organs, such as eyes, heart, or other vital organs. Because the rule of jurisprudence says: a loss cannot be removed by a similar loss [9].

• Religious affiliations of the donor, his kinship ties, and gender should not be considered.

• If organ donation occurs after the death of the donor, organ donation should be done with the consent of the patient’s family.

• Respecting a dead person is like a living person. Therefore, it is necessary to take all necessary precautions to preserve the respect of the dead body after taking the required organ and then burying the dead body according to Sharia standards [10].

5. Some reasons for agreeing to organ donation

In the following, some of the most important reasons for those who agree with removing organs from people with brain death in Islamic society are stated:

5.1 The vital role of transplant in preserving human life

From the verses of the Holy Qur’an and many hadiths, as well as the words of religious scholars, this point is well used that saving a life is especially important.

However, many haram actions are considered permissible in case of conflict with the preservation of one’s own or another’s life. Therefore, in the confrontation between saving the life of a Muslim and the prohibition of dissection, the saving of a Muslim’s life can be prioritized over the prohibition of dissection. In the case of organ transplantation, saving the life of a Muslim takes precedence over the dissection of another Muslim’s body, and its haram status is removed.

5.2 Relieving the hardships of patients who need organ transplants

The lack of transplanted organs and ethically acceptable ways to provide the needed organs to patients who need organ transplants are among the most important issues in this field. As we know, many patients who need a transplant die while waiting for a transplant, and they had a hard life before they died. Now, if it is possible to transplant these patients, they can return to normal life and be rescued from suffering and hardship [11].

6. Some reasons for disagreeing to organ donation

Although the religion of Islam agrees with the issue of organ donation, still some people in Islamic societies are against organ donation. Below are some of them.

6.1 Insulting the dead

The main reason for the opponents of organ harvesting from people with brain death and transplanting it to needy patients is that dismembering the dead body and cutting his organs is an insult to the dignity of the dead. In fact, the opponents believe that the practice of organ transplantation actually calls into question the respect we give to the dead bodies [11].

Burial ceremonies are a common custom in all human societies, and forbidding people from such ceremonies is considered as a great insult to human identity. Particularly if the deceased is a Muslim, which according to some hadiths, the obligation to respect a Muslim is not limited to his lifetime, and respect for him is also necessary while he is dying and he should not be insulted. In response to this argument, it should be said that these hadiths are used as long as the necessity does not require it, and there is nothing more important than respecting Muslims. If the harvesting of the body parts of Muslim preserves the respect of the Muslim, and the saving of the life of the Muslim or Muslims depends on the removing of the organ from the dead Muslim and transplanting it to the patients, then it is permissible.

6.2 Not accepting brain death as absolute death

A brain death person has life and is not yet completely dead, so organ transplantation is unallowable.

In response to this issue, it should be said that nowadays brain death is considered absolute death in medicine. Accepting this, especially for those who have an emotional connection with a person who has suffered brain death, while he has a pulse, is breathing, his complexion is normal, and he appears to have just fallen into a deep sleep, it is very difficult. It is obvious that if brain death is not considered a definite death, organ transplantation from brain-dead people, which is a great source of organ supply, will face a serious problem. By dividing the stages of life into the full life of the corpse, continuous vegetative life, life of organs and cell life, and dissection, we all come to the conclusion that human death occurs in three stages:

1. Stopping the activity of the heart and lungs.

2. Death of brain cells after a few minutes of deprivation of receiving oxygen-carrying blood.

3. The death of the cells of the body, which is different compared with the organs.

This arrangement exists in the state of natural death, but in the state of brain death, death from the second stage. That is, the death of brain cells starts and consequently leads to the cessation of the activity of the heart and lungs and finally the death of the cells [12].

6.3 Violation of the creation system rules

Extending human life through organ transplantation is a problem that may be considered in conflict with Godly views. With this approach, we finally understand that new technologies have forced us to sometimes reflect on this question. Can the laws of Islamic society contradict what we know as the laws of nature, including respect to customs, such as family ties and religious-cultural values?

Some Buddhist groups also believe that prolonging human life by accepting another person’s organ or body through organ transplantation is unnatural and immoral. Also, waiting for others to die in order to continue living is immoral in their view.

This argument is also not acceptable due to the fact that maintaining health, preventing disease, and treating disease are logical axioms, and Sharia has approved it, even considered it obligatory. Therefore, the use of treatment methods with respect to divine limits is desirable and necessary [11].

6.4 Misuse of the organs

Another reason for the opponents of organ donation is the possibility of possible misuse, such as the buying and selling of organs of brain-dead patients by some doctors, profiteers, and even the rich people. The opponents believe that the following may occur:

1. Doctors do not use sufficient accuracy in prioritizing between the organ recipient and the donor, they pay less attention to the medical issues and consequences of transplantation, and in fact, the first word in the prioritization is the trading of organs, the criterion of which will be the payment of more money.

2. By paying the fee on behalf of those who have more income, the price of the organs of brain death patients increases day by day, and as a result, it causes deprivation of poor families from transplanted organs.

3. Allowing the buying and selling of organs in a region can attract rich people to trade in transplanted organs and may have uncontrollable consequences.

In response, it should be said that the existing problems cannot be a valid reason for prohibiting the use of the organs of brain death patients. Rather, it requires control and consideration of logical solutions, because sometimes the treatment of some chronic diseases is only possible through organ transplantation [11].

6.5 Having negative social consequences

Accepting permission to remove organs for transplantation and recommending it causes negative social consequences, many of which will not be controllable. For example, it is possible that the removal of organs is not limited to the ones that exist now, and other organs that have other interests are removed and there is nothing left of the human being to be buried.

In response to this issue, it should be said that if we can prevent this problem by establishing the necessary regulations and precautions, this certainly cannot be a reason for prohibiting organ donation, as currently in various countries only organ donation is permitted. It is not enough, but special regulations have been considered for the organization of organ donation, removal, and transplantation [11].

Below are the details of organ donation law in Iran as one of the Islamic countries.

In Iran, the organ donation program was established after Imam Khomeini’s jurisprudence supported the use of organs from deceased donors in 2000.

In this year, the organ transplant law was approved by Islamic Consultative Assembly [13]. The text of this law is as follows:

Hospitals equipped for transplanting organs, after obtaining written permission from the Ministry of Health, Treatment and Medical Education, can use the healthy organs of deceased patients or patients whose brain death is certain according to the opinion of experts, on the condition of the patient’s will or the consent of the deceased’s guardian for transplantation for patients whose survival depends on transplanting the above-mentioned organs or organs.

Note 1: Diagnosis of brain death is done by experts in equipped hospitals of state universities. These experts are appointed by the decree of the Minister of Health, Treatment and Medical Education for four years.

Note 2: The members of brain death detection teams should not be members of transplant teams.

Note 3: The doctors who are members of the team will not be included in the payment of ransom due to the injuries inflicted on the deceased.

It should be noted that Sunni scholars also have an acceptable consensus in the field of organ donation. For example, in 1982, the Sunni Scholars Association issued a fatwa on the permissibility of organ transplantation. Other fatwas have been issued in this regard.

In a conference held in 1989, some Islamic scholars, while pointing to the respect for the human body and stressing on not harming the human body (dead or alive), have pointed out that it is permissible to use the human body in a way that pleases God.

7. Diversity of views in different religions about organ donation

As we said before, the role of religious beliefs in organ donation is undeniable. Although there are differences in specific views, it is obvious that most religions in the world permit and support transplantation and donation. In the following, some of these views are expressed.

• AME & AME Zion

Organ donation is a charity act and a way of helping others.

• Amish

They agree with transplantation if there is definite evidence that the recipient’s health will improve.

• Assembly of God

The church has no official policy about donation. The decision to donate is up to the individual.

• Baptist

Donation is supported as an act of charity and the church leaves the decision to donate up to the individual.

• Brethren

In the Brethren’s Annual Conference in 1993 about the support of organ donation has been mentioned that “We have the opportunity to help others out of love for Christ, through the donation of organs and tissues.”

• Buddhism

Buddhists believe that organ donation is an individual conscience act. They highlight the importance of letting family members inform one’s desires about organ donation.

• Catholicism

Organ donation is acceptable to the Vatican and this is supported as an act of charity and love.

• Christian church

The Christian Church persuades organ donation. Their belief is that humans were created for God’s glory and for sharing God’s love.

• Episcopal

A resolution has passed by the Episcopal Church about the benefits of organ, tissue, and blood donation in 1982. All Christians are encouraged to become organ and blood donors.

• Greek Orthodox

The Greek Orthodox Church has no opposition to organ donation as long as the organ donation is used to better the life of human.

• Gypsies

The Gypsies believe that for one year after death, the soul retraces its steps. So, the body must remain complete because the soul sustains its physical shape.

• Hinduism

Organ donation is an individual decision. It is not in contrast to the Hindu religion.

• Independent conservative evangelical

In general, Evangelicals have no objection to organ donation, and this is an individual decision.

• Islam

Although the generality of transplanting organs from the organs of brain death patients is accepted in both Shia and Sunni religions in Islam, still some authorities of these two religions do not agree with organ donation, and their most important problem is the lack of belief in brain death as definitive death.

• Jehovah’s witnesses

Organ donation is an individual conscience issue with the provision that all organs of the body be completely drained of blood.

• Judaism

Jews emphasize that if it is possible to donate an organ to save a life, it is mandatory to do.

• Lutheran

A resolution has passed by the Lutheran Church in America about the role of organ donation in the well-being of humanity in 1984. They invite “members to pay attention to organ donation and to make any necessary family and legal preparation, like the sign donor card.”

• Mennonite

Mammonites have no formal position on organ donation, but are not opposed to it. They emphasize the decision to donate is related to the individual and/or their family.

• Pentecostal

They believe that the decision to donate should be left up to the individual.

• Presbyterian

Presbyterians support organ donation. They respect an individual’s right to make decisions about their own body.

• Protestantism

The Protestantism supports and encourages organ donation.

• Seventh-Day Adventist

Organ donation/transplantation is strongly supported by Seventh-Day Adventists.

• Society of friends

The Society of Friends does not have an official position on donation. Donation is an individual decision.

• Unitarian Universalist

Organ donation is generally supported by Unitarian Universalists. They believe that an organ donation is an act of love and selfless giving.

• United Church of Christ

The United Church of Christ encourages donation.

• United Methodist

The United Methodist Church passed a policy statement about organ donation. The United Methodist Church emphasizes the benefits of organ donation and encourages all Christians to become organ donors [14].

Key points

• The role of religious beliefs in organ donation is undeniable. Although there are variations in specific views, it is obvious that most religions in the world permit and support transplantation and donation.

• Religion and religious beliefs are one of the important and effective aspects of organ donation. Because there are very influential in the cultural structure of societies, people’s thinking, and performance in various fields.

• Positive religious beliefs regarding organ donation can have a profound effect on improving public attitudes and lead to an increase in organ donation in society.

• In Islam, any action that is considered to treat and save human life is accepted. Based on the Muslim holy book (Qur’an 5:32), “if anyone saved a life, it would be as if he saved the life of the whole people.”

• According to Islamic jurisprudence and Shariah principles, organ donation is permissible under certain conditions. Most religious scholars have also accepted this opinion.

• Some reasons for disagreeing with organ donation are insulting the dead, not accepting brain death as absolute death, violation of the creation system rules, misuse of the organs, and having negative social consequences.