Download Definition of death, organ donation and interruption of treatment in

Nephrol Dial Transplant (1996) 11: 964-965
Nephrology
Dialysis
Transplantation
Minisymposium
Definition of death, organ donation and interruption of
treatment in Islam
Abdel Moneim Hassaballah
Internal Medicine, Cairo University and The Arab Contractors Medical Center, Nasr City, Cairo, Egypt
Introduction
Islam as a religion is unique in providing a complete
code of life. In Islamic countries religious rules and
values form the main source of personal and professional concepts and ethics. Therefore, it is impossible
to separate religion from the discussion of current or
new laws covering different aspects of life. Accordingly,
it is very important to take this into consideration
when we discuss the subject of organ donation and the
interruption of treatment in Islamic countries.
Islamic principles on the person's relationship to his
body
• Human life is very valuable, killing a soul is like
killing the whole of humanity and saving a soul is
like saving the whole of humanity.
• Human lives are equal. That is why Islam uses a
single criterion for the reparation of physical
damage sustained by a human being regardless of
his social status, wealth or degree or knowledge.
• The donor of life is God and the determinant of
death is God. No man or authority has the right to
decide the fate or end of a human life (aside of applying criminal laws).
• Man is honoured in himself, his thinking power, his
dignity and his physical wholeness.' We have honored
Adam's offspring1 {Holy Koran 17:70). Life manifests itself in the existence of one human being or in
thousands, millions or billions.
The principle of donating organs from dead persons
Initially there was some resistance to accept organ
transplantation in the Islamic world. Objections were
mainly based on cultural rather than religious reasons.
Thus Muslim Jurists have permitted transplantation of
Correspondence and offprint requests to: Prof. Dr A. Moneim
Hassaballah, M.D., The Arab Contractors Medical Center, Nasr
City, PO Box 9033, 11765 Cairo, Egypt.
teeth and bones—practiced by muslim surgeons for
over a thousand years. Even porcine bone grafts were
advocated by some Muslim surgeons in spite of the
fact that the pig is considered the most 'unclean'
animal in Muslim life. These grafts 'take' much better
than other xenografts, and heal more quickly.
In support of transplantation the following sayings
of the Prophet PBUH (The Hadith) can be quoted:
'The faithful in their mutual love and compassion are
like the body...if one organ complains of an ailment, all
other organs will rally in response'
'The faithful to one another are like the blocks in a
whole building...they fortify one another'.
From the holy Koran we learn its respect for human
life, and its encouragement of Muslim Jurists in
modern days, through a most important piece of
documentation, to legitimize medical advance to save
human lives:
'Whosoever killeth a human being for other than manslaughter or corruption on earth, it shall be as if he has
killed all mankind. And whosoever saveth the life of one,
it shall be as if he saved the life of all mankind' {Holy
Koran 5:32).
Over and above such documentation and as a means
of interpretation and implementation, the following
are the integral rules and general principles in Islam:
• Need and necessity are equivalent.
• Necessity allows 'prohibited' matters.
• Injurious 'harm' should be removed.
• Prevention of evil has priority over obtaining
benefit.
• The greater benefit prevails over the lesser benefit.
Thus the greater 'harm' can be removed by a lesser
'harm' i.e. it is permitted to remove a greater harm by
a smaller harm (quote intervention). Accordingly, we
find that there is a general acceptance of the principle
of organ donation from living and/or dead persons in
all Islamic countries. Thus, the Head of the Azhar
Islamic Institute, the Grand Mufti in Egypt, the Saudi
Grand Ulama Council, the Grand Mufti in Kuwait
1996 European Dialysis and Transplant Association-European Renal Association
Definition of death, organ donation and interruption of treatment in Islam
and in Iraq, Algiers Supreme Islamic Council as well
as the Council of Islamic Ideology in Pakistan have
all approved organ donation from dead persons.
In some countries specific laws to legislate cadaveric
organ donation have been approved such as in Saudi
Arabia, Iraq, Kuwait, and Jordan. In Egypt a law
regulating corneal donation has existed since 1959, but
donation of other organs has not been formally
approved as yet.
Brain death and organ donation
The subject of brain death was discussed at the 3rd
international conference of Islamic Jurists held in
Amman, Jordan, in 1986. A historical resolution was
taken equating brain death with cardiac and respiratory death. Fatwa no. V (religious proclamation) of the
conference in Amman 1986 declared the following:
'A person (is) considered legally dead and all the
shariah's principles (Islamic Law) can be applied when
one of the following signs is established:
(i) Complete stoppage of the heart and breathing which
are decided to be irreversible by doctors.
(ii) Complete stoppage of all vital functions of the brain
which are decided to be irreversible by doctors and the
brain has started to degenerate.
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approval of the necessary law which has been under
study and discussion for the past 5 years.
Financial 'reward' and organ donation
Paid organ donation has been strongly condemned by
several Fatwas all over the Islamic world. Confirming
this attitude a fatwa has been passed at the 4th
international conference of Islamic Jurists held in
Jeddah in 1988 and by the Grand Mufti in Egypt
(1988). This was also condemned by Jordanian law
no. 23 (1977) and no. 17 (1980), and the Iraqi law no.
85 (1986) and by Saudi Center for Organ
Transplantation in 1993. Accordingly, it is generally
accepted that selling of body organs is absolutely
prohibited by Islam as the body of the human being
and its organs are not for sale.
Discontinuation of treatment by will
Although life is the gift of God, body is the divine
trust given to mankind to enable it to serve God as
completely and fully as the wonderful creation of God
has made that serving possible. God has set limits on
what human beings may do with their own bodies and
only the transgressors of the divine boundaries would
indulge in torturing themselves in any form.
Consequently, suicide and homicide are both
prohibited.
Moreover, man is not the owner of his self 'Do not
Under these circumstances it is justified to disconnect
life supporting systems even though some organs continue
to function automatically (e.g. the heart) under the
effect of the supporting devices.'
kill thy self God is merciful to thee. He who does so, we
shall put him in hell. God shall do so' {Holy Koran
Since then successful campaigns for organ donation
from brain dead cadavers were launched in Saudi
Arabia, Kuwait, and Jordan and now donation from
heart beating cadavers is acceptable and is actually
performed in these countries. They now practice
kidney, liver, and heart transplantation in a reasonable number.
In Egypt some delay has been encountered as some
members of the medical profession have as yet not
accepted the concept of brain death. Consequently
some Jurists are still opposing acceptance. Hence the
'Peoples Council' (Parliament) has delayed the
4:30). God honoured man when he gave him his
humanity.
Therefore, it is against Islamic rules to stop treatment
of a living person whether by his will if he is competent
or by the will of his near relatives if he is demented or
non-competent. The role of the medical profession is
to try to cure his ailment and to relieve his pains, but
not to help him to end his life.
Again in the percepts of Islam, the sick patient who
shows fortitude and acceptance of his suffering, gains
great credit with his Creator: killing him or ending his
life will prevent such credit and is abhorrent to
islamic beliefs.