Organ Donation, Transplantation and Religion

Michael Oliver; Alexander Woywodt; Aimun Ahmed; Imran Saif

Disclosures

Nephrol Dial Transplant. 2011;26(2):437-444. 

In This Article

Islam and Organ Donation

Violating the human body, whether living or dead, is forbidden in Islam. However, altruism is also an important principle of Islam, and saving a life is placed very highly in the Qur'an—'Whosoever saves the life of one person it would be as if he saved the life of all mankind' (chapter 5:32). In this dilemma, the principle that reconciles the two is 'necessity overrides prohibition' (al-darurat tubih al-mahzurat). This principle has been used previously to approve the use of pork insulin and porcine bone grafts [6]. In a formal decision in 1996, the UK Muslim Law Council issued an Ijtihad (religious ruling) that organ transplantation is entirely in keeping with Islam.[7] Accordingly, Muslims in the UK may carry donor cards, and live donation is seen as an act of merit. Previously, the Islamic Jurisprudence Assembly Council in Saudi Arabia approved deceased and live donation in a landmark decision in 1988.[7] Similar formal rulings are in place in, among others, Egypt, Iran[8] and Pakistan.

However, although internationally most Islamic scholars endorse organ donation, many individuals within the faith are still reluctant, particularly regarding deceased donation. Thus, most transplants in many predominantly Muslim countries are still live donations. In Iran, deceased donation amounted to only just 13% of renal transplants performed in 2006.[8] In Turkey, Saudi Arabia and Kuwait, the numbers are ~ 25%.[8] It is, however, premature to conclude that all of the differences in deceased and live donation activities are necessarily due to religious factors alone, as logistical problems may play a major role as well.

One explanation for these observations is the fact that Islam, as all religions, is not monolithic. Of note, there appears to be some discrepancy between Indo-Asian and Arab Muslim scholars in that the former are often less approving of organ donation.[9] Singapore may serve as an extreme example in that a countrywide presumed consent system is in operation, but Muslims are automatically exempt.[10] Various reasons are given for the ongoing scepticism, including the thought that the human body is entrusted to man and not for man to interfere with at leisure. The concept and definition of brain stem death are also controversial as described elsewhere.[11] Muslim burial customs deserve consideration as well: it is traditional for Muslims to be buried within 24 h, and a lengthy organ retrieval procedure may raise concerns.[12] It is also noteworthy that religious concerns play a role even among Muslim physicians. A survey in 2005 in Turkey showed that as many as 21% of doctors cited religious concerns as a reason not to be more proactive about organ donation.[13] Efforts to promote organ donation may therefore have to include Muslim physicians as well.

Due to these ongoing uncertainties, Muslims may seek the advice of their local imam, and ultimately, the decision/advice of this scholar is respected. A recent review of 70 contemporary fatwas confirmed some degree of heterogeneity, although all supported transplantation.[14] It is therefore vital that education in organ donation be targeted at those individuals who are most influential within a community. A recent study from Iran suggested that Ramadan with its emphasis on altruism may be a good opportunity to foster organ donation among Muslims and described an increase of organ donation cards in that period.[15]

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