Organ transplantation is probably an issue which preoccupy people’s minds the most about religious points of view on the subject of diseases and cure.
Organ transplantation is probably an issue which preoccupy people’s minds the most about religious points of view on the subject of diseases and cure. Since organ transplantation is a treatment method, to which there are no alternatives today, it is an important part of science of medicine and it is a subject of close interest for religion, law and ethics because both the donor and the receiver are human beings and the material which is transplanted is a human organ. This article is going to include the subject’s aspects which are interest of religious teachings and views only.
As for a brief history of organ transplantation, organ transplantation which began in the sixteenth century has developed in the course of time and transplantation of organ from a human being to another began in the nineteenth century. This method of treatment, which firstly began as transplantation of skin, vein and muscle, has developed through time to the level of transplanting vital organs such as heart, liver, kidney, bone marrow and cornea. Since the second half of twentieth century, these transplantations have begun to yield successful results. Now, organ transplantation is a source of light and hope for life for many patients suffering from vital diseases in our country, like in other countries as well. However, although organ transplantation between human beings is such an important treatment method, it has brought about some religious and legal problems and this issue has begun to be discussed by various groups from different points of view.
The relationship between organ transplantation and Islamic principles and aims can be evaluated from two aspects. Firstly, the evaluation of organ transplantation in terms of its results related to essentials of faith and to otherworldly life. Secondly, carrying out a research on the issue in order to determine whether organ plantation is permissible according to Islamic law’s principles and aims.
1. In terms of essentials of faith and otherworldly life
The evaluation of organ transplantation in terms of essentials of faith and otherworldly life requires discussing whether it complies with the belief of resurrection, the responsibility and testimony of organs on the Day of Judgment and general religious responsibilities, and reaching a precise conclusion on the subject.
Resurrection and sins committed with that organ
The majority of ahl as-sunnah scholars and Islamic theologians think that resurrection is going to be physical in the hereafter and human beings are going to be resurrected with their souls and bodies, called to account and be rewarded or punished. The Quranic verses seem to support this view (see Ta Ha 20:55, al-Hajj 22:5, 7; al-Nur 24:20, Ya Sin 36:78-79, al-Qiyamah 75:34). The fact that resurrection is going to be physical (with body) plays a role – partly though – on people’s hesitation about organ transplantation. However, when the issue is examined deeply, it is seen that organ transplantation is not directly related to resurrection; or more properly that organ transplantation has got nothing to harm the belief of resurrection because the transplanted organ is going to be returned to its real owner. Actually, it does not prevent organs to be resurrected with their real owners even though they decayed under soil, burnt to ashes, or eaten by animals. As a matter of fact, the Quran states that one’s organs are going to be gathered together with the slightest details in the hereafter (al-Qiyamah 75:34). Islamic scholars, judging from this proof and the likes, have concluded that everyone is going to be resurrected with their own organs.
The responsibility of sins committed with the transplanted organ
If one commits a sin or performs a meritorious action with his transplanted organ, this punishment or reward belongs to the organ’s new owner, not its real owner because what matters in the first place is self-control and the one who uses that organ is the responsible one. As a matter of fact, if one harms someone else with something entrusted to him, the one who harms is responsible for it, not the real owner.
Testimony of organs on the Day of Judgment
As for the testimony of organs on the Day of Judgment, The Quranic verses and hadiths on this subject can be interpreted as either ‘organs will speak with their behaviors on the Day of Judgment’ or ‘people will not be able to make any excuses or tell lies and everything will be so clear in the presence of Allah.’ Even if the Quranic verses on this subject (an-Nur 24:24, Fussilat 41:19, 21, 22) are accepted to have concrete meaning, it does not provide any evidence against organ transplantation. Actually, Allah knows everything and organs can testify everything performed with them during the time they are with the body.
Religious responsibilities and whether the donor or the receiver is Muslim or non-Muslim
When the issue is evaluated in terms of religious responsibilities, it is essential to stress, in the first place, that one’s personality does not change with organ transplantation, because metaphysical characteristics and inner world do not depend on the biological structure of the organs.
On the other hand, another issue which should not be missed is that Islam considers a human being only a human being and gives equal right of living to everyone, without making discrimination according to gender, nationality, race, skin color, socio-economic situation and the likes. In this sense, it would be pointless to claim that the donor or the receiver is religiously responsible because the receiver or the donor is unbeliever or non-Muslim. Islam has always deemed treatment important, given equal right of treatment to everyone and considered saving one person’s life equal to saving the whole humankind (al-Maidah 5:3). According to this, it is inappropriate to make discrimination among people such as Muslim and non-Muslim or believer and unbeliever in terms of organ transplantation. Besides, it is Allah who guides one to the right way and determines one’s death. Everyone has got their own free-will in responsibility. For this reason, considering organ donation to a non-Muslim or an unbeliever helping them to commit sins or extending their lifetime does not comply with Islam’s general principles on this subject.
2. In terms of Islamic Law Principles
As for whether organ transplantation is permissible or not according to Islamic law, it is obvious that there cannot be any clear statement on this issue, which has emerged recently, in general principles and Islamic jurisprudence books. Although the Quran and sunnah pass detailed judgment on some issues which are considered necessary, they generally find it adequate to state some principles and criteria valid for problems which can emerge in every century and every age, instead of detailing each issue related to law. This is the natural result of the fact that the Quran and sunnah are resources and criteria for Muslims until the Doomsday. Classical Islamic jurisprudence (fiqh) books solved the problems of their time, guided Muslims in their daily lives and helped them under the light of the Quran and sunnah. According to this, it is possible to comprehend the judgment of organ transplantation in our time by considering how Islamic jurisprudents and axioms react to similar events.
Obligations make harams halal
It is stated in the Quran (al-Baqara 2:173, al-Maidah 5:3, al-An’am 6:119, 145) and hadiths (Musned, V, 96, 218; Abu Dawud, “At’ima”, 36) that in case of starvation and obligation which threatens human life, harams become permissible and not sinful. Although Islam cares for the dead, it cares more for human beings and life, and includes protecting life in five basic aims of religion.
Islamic jurisprudents have stated that in case of suffering from starvation which threatens one’s life, it is permissible for him to eat dead person’s meat, to utilize haram and unclean things for treatment and medication including parts of human body such as bones, teeth and blood, to cut off dead mother’s womb in order to save baby and cut off a dead person’s stomach in order to take a precious material such as jewelry, which was swollen. This fatwa of Islamic jurisprudents and the likes shed light upon organ transplantation in our day. However, there are also jurisprudents who do not agree with such solutions in such situations.
This issue is compatible with the general rules of “Obligations make objectionable things halal” and “What is severely harmful is overcome by what is lightly harmful.” Moreover, it is also compatible with the view “the less bad one of two bad things is preferred” because it is a matter of life and death.
Organ transplantation from a dead body
Contemporary Islamic scholars and fatwa institutions have found taking an organ from a dead body and transplanting it on a patient permissible depending on various reasons. Similarly, in our country, Presidency of Religious Affairs, Religious Affairs High Commission declared fatwa giving permission to organ transplantation from a dead body to a living person under some conditions, with their ordinance dated 03.03.1980 and numbered 396/13, in addition to their previous ordinances. Moreover, Kuwait’s Fatwa Commission of the Presidency of Charity Foundations and Religious Affairs (ordinance dated 24. 12. 1979, numbered 132/79 and ordinance dated 14.09.1981, numbered 87/81), Islamic Jurisprudence (Fiqh) Academy of Saudi Arabia which operates under World Union of Islam, al-Azhar Fatwa Commission and Islamic Jurisprudence Academy associated with The Organization of Islamic Conference in Egypt (ordinance dated 11.02.1988 and numbered 4/1) have adopted the same view and permitted organ transplantation from a dead body to a living person under some specific conditions. The majority of contemporary Islamic scholars have personally declared fatwa in the same way.
The commissions and individuals mentioned above state that the following conditions are necessary for organ transplantation from a dead body to a living person to be permissible:
1. Organ transplantation must be vitally necessary.
2. Experts on the field must have a strong belief that the patient will recover with this treatment.
3. The dead person must have permitted organ donation before he died or if not, his inheritors must permit organ donation.
4. Death must be confirmed to have occurred by both medical science and law.
5. The organ must not be given in return for a payment or personal interest.
6. The receiver must permit organ transplantation from a dead body.
The commissions and scholars in question usually put forward axioms (deduced from the Quran and hadiths), which permit to perform haram things and use unclean or haram things for treatment in case of obligation, and jurisprudential rules and opinions depending on them as evidence to their fatwa on organ transplantation from a dead body. Moreover, they put forward the permission of eating a dead person’s flesh, applying treatment with camel’s urine, using silk and gold, cutting off dead woman’s womb in order to save infant, attaching a dead person’s bone or teeth to a living person’s body, and cutting off a living woman’s womb to take out dead infant so that the woman could live as examples and they base their fatwa on reasons of those permissions.
However, some contemporary scholars who do not find organ transplantation from a dead body permissible base their opinions on the hadith “Breaking a dead person’s bone is like breaking his bone alive” (Abu Dawud, the Dead, 60; al-Muwatta, the Dead, 45) and the belief of organs’ testimony and physical resurrection and the principle which say it is impermissible to change naturalness of creation. However, it is obvious that those opinions and their reasons are weaker compared to Islam’s principles and aims mentioned above.
Organ transplantation from a living person to another living person
As for organ transplantation from a living person to another living person, some contemporary scholars and fatwa commissions found it permissible under some conditions. Kuwait’s Fatwa Commission of the Presidency of Charity Foundations and Religious Affairs (ordinance dated 24. 12. 1979, numbered 132/79 and ordinance dated 14.09.1981, numbered 87/81), Islamic Jurisprudence (Fiqh) Academy of Saudi Arabia which operates under World Union of Islam (ordinance dated January 1928 in Mecca), and Islamic Jurisprudence Academy associated with The Organization of Islamic Conference in Egypt (ordinance dated 11.02.1988 and numbered 4/1) have found organ transplantation from a living person to another living person permissible under some conditions. These conditions are listed as follows:
1. There must be an obligation.
2. The donor must permit it.
3. Organ donation must not harm the donor’s health and it must be proved by medical report.
4. Experts on the subject must have a strong belief that the operation and treatment will be successful.
5. Medical and technical conditions must be adequate.
6. Organ donation must not be priced and must not involve any personal interest.
This fatwa is religiously based on the proofs mentioned above, especially on the verse “if any one saved a life, it would be as if he saved the life of the whole people” (al-Maidah, 5:32) and the verse “Help ye one another in righteousness and piety” (al-Maidah, 5:2), and hadiths which encourage helping, charity, self-sacrifice, and preventing harmful things and paving the way to useful and beneficial things.
The number of the contemporary Islamic scholars who do not find organ transplantation from a living person to another living person permissible is a bit more than the ones who do not find organ transplantation from a dead body permissible. Those who adopt this view base their opinions on the fact that one is not the real owner of his organs and thus cannot use them as they wish, that human beings are respected and precious beings which should not be touched, that organ transplantation alters natural creation and that this means removing what is harmful via another harmful thing, which is dangerous for both parties.
However, it is obvious that not every organ and tissue taken from a living person yields the same results and does not result in the same vital danger, the same health problems or physical abnormalities. As long as it does not risk the donor or damages his appearance and as long as it is a method of treatment to which there is no alternatives, it is more appropriate for Islamic principles and religious judgments to base our attitude on medical data.
As for organ donation, it must be performed with the supervision and control of a doctor who has got a command in this field and who has got strong faith. Then, the Quranic verses “Nor kill (or destroy) yourselves” (an-Nisa, 4:29) and “make not your own hands contribute to (your) destruction” (al-Baqarah 2:195) must be taken into consideration. And it should be kept in mind that organ transplantation must not harm donor, donor must not be forced into it and must not be deceived for the operation.
These criteria are also valid for blood donation.
Organ transplantation within one’s own body
Organ or tissue transplantation within one’s own body has not caused significant hesitations. Islamic Jurisprudence Academy associated with The Organization of Islamic Conference stated in their ordinance dated 11.02.1988 and numbered 4/1 that this kind of medical operation is permissible on condition that its benefits will be more than its harms, and it should be done with the purpose of recovering a defect or illness which causes the patient any biological or psychological disturbances. Besides, in the same ordinance, it was stated that organ transplantation from a living person to another living person is not permissible if it ends one’s life or includes an organ or organs which will result in total loss of a body function.
Importance of human life in Islam
It is known that the religion of Islam, which considers life, death and after-death each a natural occurrence and stage, making them meaningful, attaches importance to healthy, peaceful and safe life for people both socially and individually, orders some precautions which enable this and leaves others to the initiative and efforts of people, suggesting them as principles only.
In this sense, it is reasonable that Muslim communities are hesitant about organ transplantation at the beginning, and even are against it with a social reflex and find some religious reasons for their attitude. This kind of resistance functions as a guarantee preventing traditional communities from dissolving when they encounter an innovation and as a protector of social structure.
However, now that it has been witnessed that organ transplantation is a method of treatment to which there are no alternatives yet and which brings people back to life, these hesitations should be broken, hesitant attitudes should be quit, serious steps should be taken towards it, people should be informed of the issue and institutions to enable it should be founded.
Muslims, who are followers of a religion which deems human life very important, are supposed to lead the world and set an example for this issue.
Allah the Glorious states that human beings are very honorable beings in the Quran: “We have honored the sons of Adam; provided them with transport on land and sea; given them for sustenance things good and pure; and conferred on them special favors, above a great part of our creation.” (al-Isra, 17:70).
The fact that humankind is honored by Allah can also be deduced from the fact that it is impermissible to enslave a free person and sell him as a slave (Ibn Mitfah, Sharhu’l-Azhar 3/30; Ibn Hazm, al-Muhalla 9/17; al-Huliyy, Sharaiul Islam 2/16).
Ibn Qudamah says the following on the issue: “We do not know that anyone opposed to this judgment.” (Ibn Qudamah, al-Mughni, IV, 302).
This judgment is also fixed by hadiths. In a hadith which Imam Bukhari and others narrated from Abu Huraira, the Messenger of Allah (pbuh) says:
“Allah the Glorious said: There are three people, to whom I will be enemy on the Doomsday: 1- One who swears for something on My name and then does not keep it. 2- One who sells a free person as a slave and then spends money earned from it. 3- One who hires someone and then does not pay him although he has completed the work.” (Ibn Hajar, Fathu’l Bari, IV, 417; al-Ayni, Umdatul-Qari, XII, IV).
Just like it is impermissible to sell a human being, it is also impermissible to sell a part of hi, that is, an organ of his, because this trade includes insult to human beings and their organs and degrading. Hanafi jurisprudents support this view. They say, basing their opinion on the hadith narrated from Abu Huraira written above, “If selling and buying a free person is impermissible, it is also impermissible to sell a part of his; because the judgment about his parts is the same as the judgment about him.” (Kamalu’d-Din, Muhammad bin Abdul-Wahid, Sharhu Fathu’l-Qadr, VI, 63). Judging by this, it is also considered haram to benefit from parts of a human being in other ways. Parts such as hair and nails cannot be benefited from and they are buried. (an-Nawawi, Sharhu Muslim, XIV, 103). This is because the Messenger of Allah (pbuh) said: “May Allah curse the ones who add (and have it added) hair to hair, who have themselves tattooed and those who tattoo.” (al-Tirmidhi, Clothing, 25).
However, if there is a vital danger for one if organ transplantation is not performed, it is permissible for the buyer to buy it. The sin of this trade is on the seller. (Muhammad Wafa, Bayul-Ayanil-Muharrama, p. 110-113).
We can list the opinions of scholars who find organ transplantation permissible in case of obligation as follows:
1- They found it permissible judging from the verse “if any one saved a life, it would be as if he saved the life of the whole people” (al-Maidah, 5:32).
2- They took into consideration the fact that Islam is a religion of easiness.
3- They concluded that it is permissible based on this reasoning: “If blood transfusion is considered permissible today, organ transplantation must also be permissible – on condition that it is performed in accordance with the human dignity.
4- If the donor cannot stay alive after the organ donation, it is definitely impermissible, because it is not permissible to end one’s life while trying to save that of another’s.
5- A living person’s one kidney and one eye, blood and teeth can be donated with the permission of the donor.
6- Before the organ transplantation is performed, experts on the subject must decide that the patient will recover with this treatment.
7- If the organ is to be taken from a dead person, the dead person, before he died, or his inheritors must agree on the donation.
8- There must be a strong belief that the organ donation will not harm the donor’s life and health.
9- Organ transplantation must not be considered as the first alternative, but the last one. When one is obliged, one of two harmful things can be preferred; that is to say; one can prefer living with someone else’s organ to dying. It should be decided by experts in the fields of religion, medical science and psychology.
Another important matter is this: Organ transplantation must be considered the last option. As a matter of fact, according to a hadith of the Prophet (pbuh), a cure will be found for each disease except for aging and death. The thought that an alternative to organ and tissue transplantation will be found within the permitted frame of religious principles should always be kept in mind. Actually, if researches focus on improving transplantation only, of course other alternative methods of treatment cannot be found. For this reason, experts in the field should focus on finding alternative methods of treatment as much as they focus on improving transplantation. Otherwise, while knowledge about organ transplantation, which is considered to be the only option today, increases, the way to find for a more humane alternative will have been closed.
By the way, let us clarify another matter which is questioned quite often:
Someone who donated his eyes and kidneys before he died, of course, will earn thawabs when they are transplanted into a patient, because this will save someone’s life and bring him to life.
Can cardiac valve and the heart of a pig transplanted into human body? Is this kind of transplantation permissible?
Pork and other products made from pig are religiously forbidden. However, in case of an obligation which is a health problem risking one’s life and if there is not another available valve made of something else, it is unobjectionable to use cardiac valve of a pig.
Cardiac valve of a pig is transplanted into human body because pig’s heart is compatible with human heart.
In case of obligation, harams become permissible. In this sense, it is permissible to use a pig’s heart for the treatment of a patient suffering from heart problems. However, if there is not an obligation, it is impermissible.
Can organs of a patient, which is not expected to live anymore, taken, by unplugging the machine?
According to Islam, just like killing one’s own self (suicide) is forbidden, euthanasia – which is demand of ending one’s life, who is suffering severely and for whom there is no hope of recovering – is also forbidden.
However, it is stated that unplugging the machine of a patient, who is living on intensive care devices, is permissible under two conditions. These conditions are as follows:
1- The heart and breathing must totally stop and experts must conclude that the patient cannot be brought back to life.
2- All functions of the brain must totally stop and experts must conclude that it cannot be fixed and the brain has already started to dissolve.
If these conditions are met, intensive unit devices on which the patient lives can be unplugged.