Approaching Organ Transplant in Islam from a Multidimensional Framework

The subject of organ transplant has been highly contested within Islam. Though the majority of Muslims now accept the validity of the practice from both live and deceased donors, this is by no means a universal consensus. In particular Islamic contexts, the subject of organ transplant remains a major subject of debate. Intertwined with the debate of organ transplant is the sensitive and complex issue of what constitutes death. Bioethical decision-making in Islam takes place within a multi-dimensional framework of authorities and themes. With no central authoritative body for the Islamic community, general consensus on bioethical matters is difficult to locate. The central thesis of this article is that because Islamic bioethics takes place within a multidimensional framework, there remains no common consensus on the question of organ transplant. Though a majority of Muslims have accepted the practice, others continue to find it haram, or forbidden. Approaching Organ Transplant in Islam from a Multidimensional Framework 1) Introduction The subject of organ transplant has been highly contested within Islam. Though the majority of Muslims now accept the validity of the practice from both live and deceased donors, this is by no means a universal consensus. In particular Islamic contexts, the subject of organ transplant remains a major subject of debate. Intertwined with the debate of organ transplant is the sensitive and complex issue of what constitutes death. What is more, when applying the issue of authority—the Qur’an, Sunna, and Sharia—in Islam to the question of organ transplantation, the matter of interpretation and possessing no singular Islamic response to the topic becomes apparent. Bioethical decision-making in Islam takes place within a multi-dimensional framework of authorities and themes. With no central authoritative body for the Islamic community, such as the Magisterium for the Catholic Church, general consensus on bioethical matters is difficult to locate. Therefore, the central thesis of this article is that since Islamic bioethics takes place within a multidimensional framework, there remains no common consensus on the question of organ transplant. Though it does appear that the majority of Muslims have accepted the practice, others continue to find it haram, or forbidden (Budiani and Shibly, 2008). This article will proceed as follows: section 2 will focus on the background of organ transplant within Islam. Section 3 details the resistance to organ transplant, and section 4 provides an overview of the rationale used by those who accept the practice within the Islamic community. 2) Background Organ transplant in Islam has experienced a somewhat contentious history. The Qur’an and Sunna, the divine revelation within Islam from which Muslims look to for instruction, is silent on the issue of organ donation and transplant. For a document revealed to Muhammad in the early seventh-century, it is not surprising that the Qur’an and the Prophet’s sayings do not speak explicitly to this area. Though there is no explicit address in the Qur’an or the Sunna, this is not to mean that they cannot aid Muslims in their quest for a decision on the matter. This section will explore two of the principles generally employed in Islam when approaching the issue of organ transplant. 2.1) The Use of Islamic Authority in Organ Transplant Decisions As stated above, there is no single consensus on organ transplant in the Islamic community; this is not entirely surprising. In Islam, there is no papacy, as in the Roman Catholic Church, to articulate dogma on certain contentious matters. While legal opinions (i.e., fatwas) may be sought about controversial or contemporary issues from Muslim scholars who are acknowledged experts in matters of Islamic law and ethics, these still may profoundly differ based upon the scholar’s interpretation of the authoritative texts (Brockopp, 2003). The primary source of references for reaching a fatwa is the Qur’an, the Sunna, and then the volumes of sharia that are based on the Qur’an and Sunna. Further, authority proceeds in this order with the Qur’an serving as the basis for ethical inquiry and the ultimate authority of appeal; there is no contesting this in Islamic ethical theory (Brockopp, 2003). While these three sources of authority contain great Islamic teaching, they do not explicitly address the host of challenges faced in bioethics today. Thus, Islamic bioethics becomes a process of drawing out general principles from the authorial texts and attempting to apply them to a modern-day context. Unquestionably, this creates divergent opinions and positions on ethical matters within the Islamic community. Thus, with this short background on the nature of Islamic bioethics, the multidimensional framework that is deeply embedded within the religion becomes evident. Since there is no central teaching office in Islam as there is in the Roman Church, Muslims reading the same text to gain insightful values on ethical matters may reach different conclusions. Therefore, this inevitably leads to an extensive array of opinions on bioethical matters, including organ transplant, within the various schools of Islam. 2.2) Islamic Principles on a Person’s Relationship to the Body The authoritative sources within Islam are replete with principles that may be employed when encountering organ transplant. It is necessary for our discussion to examine several of the most fundamental Islamic principles concerning the relationship of the individual to the body. In subsequent sections these will appear again and be used by Muslims both in support of and against the practice of organ transplant. Islam places a high value on human life. For this reason, killing a soul is akin to killing the whole of humanity, and saving a soul is like saving the whole of humanity. The high value that Muslims place on the respect for human life and the importance of preserving life is integral to the fabric of the Islamic community. Further, all human life is seen as equal in Islam. This can be seen by the way that Islam uses a single criterion for the reparation of physical damage sustained by a human being regardless of his social status or wealth (Hassaballah, 1996). An essential principle in Islam regarding the relationship between the individual and their body is the belief that God is the creator and sustainer of human life. The giver of life is God and the determinant of death is God. Aside from applying criminal laws, no man or authority has the right to decide the fate or end of a human life (Hassaballah, 1996). This leads to a great emphasis within Islam on the dignity of the human body, including the dignity of corpses (Sachedina, 2009). Indeed, because human beings do not possess absolute ownership or their body or spirit, this oftentimes leads to the concept of inviolability—a notion that will be discussed more extensively in a further section. In summary, the Islamic community utilizes the divine revelation found in the Qur’an and the Sunna to reach their bioethical conclusions. What is more, they also rely on a long history of Islamic law that is dependent upon the divine revelation. Moreover, there is a great emphasis within Islam on the human dignity of the person. This is based upon the belief that mankind owes his life to Allah and the belief that the body is not merely material, but also possesses a soul or spirit. Thus, the multidimensional framework of Islamic bioethics on this issue can be seen. 3) Resistance to Organ Transplant The debate over organ transplant in Egypt is often regarded in the literature as the prime example of resistance to the procedure (Hamdy, 2008). Opposing fatwas have been issued on the matter in Egypt, which highlights not only the lack of accord on the issue but also the need to analyze Islamic positions within the particular social contexts that they are issued. This section will focus on the resistance to organ transplant in Egypt and in other contexts. 3.1) General Principles that Guide Resistance: Brain Death and Inviolability The issue of brain death is a major point of resistance to organ transplant. As noted above, in Islam there is no separation between the soul and body; they are regarded as integrated units (Sachedina, 2009). This complicates matters when attempting to use cessation of brain activity as a qualifier for death. Brain death has been an accepted qualification for death in Western nations for a number of years. However, it has received selected pushback from a minority of Muslims for exactly this point of the psychosomatic integration of the person. Due to the body-soul integration that is prevalent in Islamic thinking, any surgical procedure that entails making an incision on the recently deceased patient for purposes of organ harvesting evokes reprehension. Further, any suggestion to retrieve their organs, even for humanitarian purposes, before the heart has stopped beating (though the brain may be dead), similarly evokes repugnance because the patient’s consent has not been secured. Those who criticize the concept of brain death as a proper qualifier for death have made the argument that using the cessation of heartbeat as a criterion for death may make it too easy for the parents or legal representative of the comatose patient to decide to withdraw life support and terminate the patient’s life (Sachedina 2009). Due to a limited supply of organs, thoughtful questions have been prompted concerning the proper criterion of death by cases concerning those patients who have suffered brain damage and whose families have given consent to remove organs. A terminal patient on a respirator desiring to be weaned off the machine may request that his organs be used for transplant after his passing. The respirator is then removed in an operating room and, not less than three minutes after the patient’s heart stops beating, the organs are harvested. However, the questi