Islam’s rulings on organs transplantation and euthanasia

[bamalli]

In the last article 'Atonement through sickness' I discussed in detail sickness and caring for the sick according to the Shari'ah. In this segment I hope to discuss Islam's stand on organs donations, transplantation, life support and euthanasia, or assisted suicide,. I find it essential to discuss these important topics given the present age of tremendous technological advance in medicines and sciences. This, in sha Allah, will bear in the minds of my readers positive insights on the position of Islam in the given circumstances, although no precedence in these segments of medicines has been recorded during its glorious centuries.

Allah, in His infinite mercies and bounties, has endowed man with intelligence and wisdom in commensurate to his limited natural tendencies. These gifts are unreeled based on times and spaces in tuned with human level of inquisitiveness in uncovering coverable secrets of Allah. In fact, Islam has in store for men of knowledge to achieve whatever they can comprehensively comprehend, into reality within the precincts of the Most Merciful permission. The Qur'an foretold us of these powers which He will avail to man during the world fast approaching expiration. Allah says:

'Verily the likeness of (this) worldly life is as the water (rain) which We send down from the sky, so by it arises the intermingled produce of the earth of which men and cattle eat until when the earth is clad with its adornments and is beautified, and its people think that they have all the powers of disposal over it, Our Command reaches it by night or by day and We make it like a clean-mown harvest, as if it had not flourished yesterday! Thus do We explain the Ayât (proofs, evidences, verses, lessons, signs, revelations, laws, etc.) in detail for the people who reflect' (10:24)

And it continues thus:

'We will show them Our Signs in the universe, and in their ownselves, until it becomes manifest to them that this (the Qur'an) is the truth. Is it not sufficient in regard to your Lord that He is a Witness over all things? Verily! They are in doubt concerning the Meeting with their Lord? (i.e. Resurrection after their deaths, and their return to their Lord). Verily! He it is, Who is surrounding all things! 41:53-54)

The wisdom of Allah's benevolence in the abilities and capabilities to unravel, discover and uudecode some of His secrets, is to demand from, the establishment of strong and contemplative belief in Him, and to convincingly submit to Him as the Ultimate in sovereignty with no beginning or end! Thus, the long rope was purposefully let loose to suffocate us to nothingness in comparison to His Majesty!

Due to medical advancement, patients who have their organs malfunctioning could get them replaced by transplantation methods, just like car's spare parts are replaced for longer life and better performance. This scientific accomplishment has not only opened new chapters in medicine but also posing new challenges for the Islamic scholars to give Fatwah regarding their permissibility or otherwise within the ambit of the Shari'ah.

Vital and non-vital human parts and components such as blood, ova, liver, lobes, kidneys, lungs, whole livers or hearts are now on sale in many nations. In some countries sales of human organs is a thriving 'new business'. Usually the business is called "social" or 'friendly cannibalism." While those engaged in it are referred to as 'body mafia'. Mostly organs of people who die from accident injuries, executed criminals, donors and organ vendors who sell theirs while they are alive, are the ones used in transplantation.

However, there are research centres in the West that are working very hard, and predicting that in the next few years 'altered Pig organs genetically grown' could be ready for use as transplant organs in humans. Mr. Roberts Winston heads a team of scientists working to 'develop a strain of mini-pig with a heart, kidney and liver a human body wouldn't reject'. He asserted that once perfected, the genetically altered pigs could be bred to provide a limitless supply of fresh human organs. Another possible source of human organs is 'Organ-farming laboratories' that are cropping up across the planet where patient's cells will grow new types of tissue in the lab, by using your own cells to custom-engineer you, a new body parts.

Dr. Anthony Atala, otherwise known as 'organ farmer', is the head of the world's largest regenerative medicine research centre-Wake Forest, said that their current research is growing 22 different types of tissue: heart valves, muscle cells, arteries, and even fingers. All these achievements are not surprising to a Muslim who rehearses and understands the words of the Qur'an, although they are posing new challenges for Muslim scholars.

The position of Islam in matters of organ transplantation has been amicably resolved in a consensus of Ulama at Amman under the auspices of the Senior Ulama Commission's, and was gazetted as 'Decision No. 99 dated 6/11/1402 H (25/09/1982 G).  Underneath is the full text of the Fatwah:

'The board unanimously resolved the permissibility to remove an organ, or a part thereof from a Moslem or Zimmi living person and graft it onto himself, should the need arise, should there be no harm in the removal and should the transplantation seem likely successful.

The board also resolved, by majority, the following:

1.     The permissibility to remove an organ or part thereof from a dead person for the benefit of a Moslem, should the need arise and should the removal cause no dissatisfaction and should the transplantation seem likely successful.

2.     The permissibility for the living person to donate one of his organs or a part thereof for the benefit of a Moslem in need thereof'.

Furthermore, Islam does allow the sale of one's organ for money as no one has absolute right to cannibalize or vendor any part or component his or her body. The second issue is the utilization of human organ harvested from 'genetically altered pigs'. Also is prohibited to coerce poor people to sell their vital organs such as heart, lung and liver as that will tantamount to forceful suicide. On such instances the Qur'an speaks: "it is not given to any soul to die, save by the leave of God, at an appointed time." (Q. 3:145)

The second important medical breakthrough is 'mercy killing' or 'euthanasia'. Even though some people would say prolonging life or delaying death as is common with patients in 'vegetative stage'.

For the purpose of illustration, I will discuss briefly what euthanasia entails. Euthanasia is Greek for good death which translates into English as easy death or mercy killing. It means also 'knowingly and intentionally performing an act that is explicitly intended to end another person's life and that includes the following elements: the subject is a competent, informed person with an incurable illness who has voluntarily asked for his or her life to be ended; the agent knows about the person's condition and desire to die, and commits the act with the primary intention of ending the life of that person; and the act is undertaken with empathy and compassion and without personal gain.  While 'assisted suicide' means knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counselling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs; given the individual the 'right to die'.

The conditions that may call for the administration to 'mercy murder' are when the patient suffers irreversible brain damage.  That is when 'the heart stops and the brain does not get the blood supply which nourishes it with glucose, oxygen and minerals. There is a popular belief that the brain "dies" after 4 to 6 minutes if supply of oxygen stops. In some instances it may take 10 to 16 minutes. However, within four minutes of the blood supply to the brain ceasing, the central nervous system becomes irreversibly damaged'. Nevertheless brain damage which does not involve the brain stem may perhaps result in a persistent vegetative state. Even if such 'patients breathe spontaneously, open and close their eyes, swallow or make facial grimaces, they show no behavioural evidence of awareness.  The electroencephalogram (EEG) of someone who is brain dead shows no electrical activity, and an injection of mild radioactive isotopes into the brain may reveal absolute absence of blood flow. The brain stem is a small area of the brain which controls respiration. If this area is dead the person will never be able to breathe spontaneously or regain awareness'. In this type helpless and painful condition, "when medical acts appear useless, disproportionate, or serve no other purpose than the artificial support of life, they can be suspended or not undertaken."

The most celebrated case in this regards was the Terri Schiavo, who for 15 years was kept alive through the only means that is possible for her; a feeding tube that supplies her with the nutrition she needed to sustain the breath of life. But, who gave the in just 15 days after removing the life support.

Now, what does the Shari'ah says of euthanasia? Also here it will be safer to cite the Fatwah already given and accepted the world over.

'The Council of Islamic Jurisprudence academy in its third session, No.86-07-3D (5)   held in Amman 13-02-1407 H (16-10-1986 G) discussed the supportive means in intensive care units and after comprehensive explanation from consultant doctors decided the following:

The Person is considered legally dead, and all the Shari'ah principles of death apply if one of the following conditions is confirmed.

A.    Complete cessations of the heart and respiration, and the doctors have ruled that the cessation is irreversible.

B.     Complete cessation of all functions of the brain and the consultant doctors have ruled that the cessation is irreversible, and the brain has started to degenerate.

In this condition there is permissibility to discontinue the supportive means from the patient even if some of his organs, like heart, still work artificially.

Additionally, Dr. Muzammil Siddiqi, president of the Fiqh Council of North America, states the following contribution after in-depth analysis in the lights of both Shari'ah and modern medicine:

Allah Almighty says: "Nor take life—which Allah has made sacred—except for just cause. And if anyone is slain wrongfully, We have given his heir authority (to demand qisas or to forgive): but let him not exceed bounds in the matter of taking life; for he is helped (by the law)" (17:33).

And, "Say: Come, I will rehearse what Allah has (really) prohibited you from: join not anything as equal with Him; be good to your parents; kill not your children on a plea of want—We provide sustenance for you and for them—come not nigh to shameful deeds, whether open or secret; take not life, which Allah hath made sacred, except by way of justice and law: thus does He command you, that you may learn wisdom)" (6:151).

Islam considers human life sacred. Life is to be protected and promoted as much as possible. Thus, it is important for us as Muslims to understand our position and also to prepare ourselves in case we or our dear ones confront such a situation. There are a number of important questions:

1. Euthanasia or "mercy killing": There is no provision in Islam for killing oneself or another person to reduce his/her physical or emotional pain or suffering from sickness or injury. It is the duty of the doctors, patients' relatives, and the state to take care of the sick and to do their best to reduce the pain and suffering of the sick, but they are not allowed under any circumstances to kill the sick person. The sick person also should patiently endure the pain and should pray to Allah. Faith and patience bring both comfort and blessings in this life and in the eternal life.

If, however, a number of medical experts determine that a patient is in a terminal condition, that there is no hope for his/her recovery, and that all medications have become useless, then it permissible for them, through a collective decision, to stop the medication. Otherwise under no condition it is permissible to induce death. As long as a person is alive, it is his/her right to be fed. Medical experts and relatives should not withhold nutrition from a living person. They should do their best to provide him/her with necessary nutrition by whatever method is possible.

2. Prolonging life artificially: The Shari`ah favours life and emphasizes that life should be protected as much as possible. According to the Qur'an, "...saving one life is like saving the whole humanity" (5:32).

Thus the Shari`ah scholars are in favour of using all methods, including artificial resuscitation to protect life.


3. When there is dispute, as to who makes the final decision? Shari`ah would prefer a consensus and collective decision in this matter. The decision should be made with compassion and by bringing all the family members together by explaining the whole situation and consequences. It is better that courts should not interfere in this matter unless there is a suspicion that, for example, the doctor belongs to an organ transplant group or the family member is interested in the inheritance or bequeathment or anyone in the team is accused of professional misconduct. It is better to err and save life rather than err and lose life.

4. Defining death: When is a person dead? Muslim medical experts have defined death in the following way: An individual is considered dead in one of the following two situations:

a. Complete irreversible cessation of respiratory and cardiovascular systems

b. Complete irreversible cessation of the functions of the brain including the brain stem. This should be confirmed by the accepted medical standards. In case of brain death it is required to have the presence of a reliable medical specialist well experienced in the clinical diagnosis of brain and brain stem death and the various implications of such diagnosis.


However, no individual is given the right to end his or her life by whatever means. This is so we are our Creator's exclusive properties; hence we do not own ourselves as to warrant taking or terminating the dwelling souls in us. Allah says:

"Allah gives life and He makes it to die. (Q. 3:156

Thus, under no circumstance should terminate his life or ask for the termination of his or her life.



Finally, I ask Allah the Merciful to grant us good health, quality life and good ending, when our time comes. Similarly, I  ask Allah in Whose hands rests the power over everything that He may guide us toward that way of life which is preferable for this world and which will lead to greater happiness in the world to come. For, if we were left without His kind care, mercy and customary benevolence, we would be lost, doomed and forsaken forever and ever!

Note: If you need further readings, or you have question or suggestions, please e-mail me to:

Islamexplained35@yahoo.com or send a text message me only to +234-8052952900