Fiqh of Organ Donation and Transplantation

Organ Donation and Transplantation

-Dr. Md. Habeeb Haris

The magnitude of the 'transplantation problem' and the organ demand - Indian scenario:

As of March 2024, India had over 300,000 patients on the waiting list for organ transplants, with at least 20 people dying each day while waiting. This is due to a shortage of organ donors, especially deceased donors, which has not kept up with increasing demand. The demand for deceased donors is substantial because many families lack suitable living donors.

In 2022, India performed over 13,300 living transplants and about 2,700 deceased donor transplants, but the number of donors only grew from 6,916 in 2014 to about 16,041 in 2022. India's organ donation rate is also low, at 0.52 per million people.

In India, living donors comprise 85% of all donors. Around 70%-75% of donors are female. Wives, mothers, and sisters have emerged as most prevalent sources of donation.

[The above figures were taken from https://www.thehindu.com/sci-tech/health/indias-poor-organ-donation-record-continues-to-cost-lives/article67161978.ece]

These figures show us how many lives are affected by this issue and why is it important for us to address the Fiqh aspects of it.

The Quran and Sunnah do not directly mention about organ transplantation. So, related Shariah topics such as ownership of the body, human dignity, prohibition of mutilation, necessity of treatment to save lives, and various Qawaid (Maxims) of Fiqh such as choosing the lesser harm to avoid greater harm, etc., are used by the Ulama to arrive at a ruling through Ijtihad. This is the reason for multiplicity of views on this and many other recent medical issues.

Types of Transplantation of organs

Transplantation of animal organs (Xenograft)

Transplantation of an organ from one place of the body into another place of the same person (Autograft)

Transplantation of organs of a living donor into recipient (Allograft)

Transplantation of the organs from a dead human donor

Transplantation of animal tissues/organs (Xenograft)

1. From Halal and Islamically slaughtered animals (goat, etc.) 
 It is permissible to use organs of such animals for transplantation or other medicinal purposes. 
 ‘There is no harm in treatment with bone if it is the bone of a goat or cow or camel or horse or any other such animal except the bone of swine.’ (Al-Fatawa Al-Hindiyyah: 5/354)

2. From Haram animals and swine 
Transplantation of their organs is not allowed normally. It's allowed only with the following conditions:

- The organ is necessarily for treatment.

- There is no halal substitute available.

- It has been prescribed by a God-fearing Muslim doctor. 

Transplantation of an organ from one place of the body into another place of the same person (Autograft)

Generally the classical jurists of all the four major schools of Fiqh (Fuqaha) have allowed it for treatment purposes when there is a medical need. (Imam Abu Yusuf’s opinion in Hanafi fiqh (see Badai us-Sanai: 5/133), Imam Ahmad (Al-Jame’ li ulum al Imam Ahmad: Hadith: 30711) and Imam Shafi (as explained by Imam Nawawi in Al-Majmou: 3/139) 

The International Islamic Fiqh Academy (IIFA) of the Organisation of Islamic Countries (OIC), Jeddah resolved, “An organ may be transplanted from one part of the body to another part of the same body, provided it is ascertained that the benefits accruing from this operation outweigh the harmful effects caused thereby; also provided that its purpose is to replace a lost organ, reshape it, restore its function, correct a defect or remove a malformation which is a source of mental anguish or physical pain.” [IIFA Resolution No. 26 (1/4)]

The Fiqh Academy of the Muslim World League (MWL), Makkah resolved, “Taking a part of the human body--a piece of skin or bone and transplanting it into another place of the body of the same person in case of necessity is allowed”. ('Makkah Fiqh Academy': 200-201)

Islamic Fiqh Academy, India also passed a similar resolution. (see 'Naye Masail aur Fiqh Academy ke faisle': 215)

Conditions for Autograft permissibility:

• The part was not amputated as a punishment in judicial amputation (Hadd or Qisas). 
• It is medically necessary and there is no other alternative. It is not allowed just for beautification purposes.
• Harm of this surgery is less than the harm caused if it is not done. 
• There is a high probability for this surgery to be successful. 
  

Transplantation from a Living Human Donor

Allowed if the organ is:
-Self-regenerating, such as blood and skin.
-From part of an organ that was removed due to a medical deficiency, such as the cornea of the eye that had to be removed due to another disease.
-Is not single; and removing it doesn't cause significant loss of function or risk of death, like kidneys, then donation of these organs is allowed to save the life of another human being.

Forbidden if it is:
- a vital organ, such as the heart, without which the donor cannot remain alive.
- an organ such as the cornea of the eyes, donating which deprives the donor of a primary function of his body. 
-Transplantation of genitals and gonads is not allowed.
[Al Qadhaya al Tibbiya al Muasarah: 490 and IIFA Resolution No. 26 (1/4)]

General conditions:
-Allowed only when no alternative is available.
-It should not be done for financial reasons (selling an organ), because under no circumstances should a person’s organ be sold.
-Proper consent should be taken, which should be fully voluntary and without any pressure (social, emotional, financial, family pressure, etc.).

-After transplantation of an organ, there should be no apparent unsightly changes in the body that resemble mutilation.
-There should be a good chance that the person to whom an organ is given will be benefited by the transplantation.

Mufti Taqi Usmani adds: 
Every effort should be made to find an organ donor who is a Muslim for a Muslim recipient and a Muslim's organ should not be given to a non-Muslim. (Fatawa Usmani: 4/225)
However, other scholars say that this is not an absolute condition but only desirable.

Transplantation from a Dead Human Donor

There is a difference of opinion on this too. The majority of the scholars and Fiqh bodies globally are in favour of it's permissibility.

The International Islamic Fiqh Academy (IIFA) says, "It is allowed to transplant an organ from the body of a dead person, if it is essential to keep the beneficiary alive, or if it restores a primary function of his body, provided it has been authorised by the deceased before his death or by his heirs after his death or with the permission of concerned authorities if the deceased has not been identified or has no heirs. [IIFA Resolution No. 26 (1/4)]

The Islamic Fiqh Academy, India is against it. It resolved, “If someone expressed his wish that after his death his organs may be used for transplantation purpose it cannot be considered as Wasiyat (will) according to Shariah and is invalid according to Shariah and such a wish is not to be honored.” (Islamic Fiqh Academy, India - Fiqhi Seminar in New Delhi 1-3 April 1989)

                                           Range of fatawa on transplantation of human organs

Arguments of those who Oppose human organ transplantation

-Human Dignity and Sanctity: Human body, whether living or dead, should be honoured. The Quran says,
 “We have honoured the sons of Adam and conveyed them on land and sea and provided them with good things and favoured them greatly over many We have created.” (Surah Bani Israil, 17:70) 
 The prophet Muhammad ﷺ rebuked a man who broke a bone of a corpse that he found in a cemetery. The prophet said, “Breaking the bones of a dead man is like breaking the bones of a living man (in sin).” (Abu Dawud: 3207)

-Commodification: Most of the classical Fuqaha have forbidden utilising parts of the human body so that man should not become a commodity. This is against his dignity. (for example, Al Bahr al Raiq 6/81)

-Ownership: Human being is not the owner of his body. Charity requires ownership of the things which one wants to donate, or he should be permitted to do so from the real owner. Our body is an Amanah of Allah so its organs cannot be donated or sold. 

-Prohibition of Mutilation: Separating a part of a human being from his body, which brings no bodily benefit to him, is considered as an act of mutilation.


Arguments of those who Permit human organ transplantation

-Necessity: Harvesting the organs from living or dead human donors for transplantation is allowed due to medical necessity as according to the Shariah, even the prohibited things become permissible for saving life or a critical function of a person.
The Quran says,
“But whoever is forced (by necessity), neither desiring (it) nor transgressing (its limit), there is no sin upon him.” (Surah Baqarah, 2:173)  

The Scholars also cite the famous principles of Fiqh in this - ‘Necessities permit prohibited things’. (Al-Ashbah: 8/84) and 'Difficulty requires ease'. (Ibid.)

Al Binaya, the commentary on the famous Hanafi fiqh text 'Al Hidayah' states, "Drinking blood, urine and eating dead meat for medication and treatment is allowed if a Muslim physician states that his cure lies in it and he finds no lawful medicine which can substitute it." (Al-Binaya: 12/271)

-Organ harvesting is not mutilation or dishonouring: Surgical procedures for organ harvesting do not come under mutilation of human body as there is no disfigurement or disrespect involved in it. It is a professionally performed surgical procedure.
Moreover, it is known from various fiqh examples that even disrespect of honourable things is permitted for saving a life if needed. (Vide Khulasatul Fatawa: 4/361)

-Human dignity: If someone donates a part of his body to others, neither does he feel dishonoured nor do the other people feel so; rather he is more respected in the society. That is why prominent leaders and celebrities of the society bequeath to donate their body parts and this is considered as a virtuous, altruistic and humane act. 

-Sale of human organs is prohibited: Even those scholars who permit transplantation do not allow sale of organs so there is no question of reducing the human body to a commodity.

-Benefit to humanity: Transplantation is a source of removing pain and suffering from human beings and has individual, collective and social benefits. It is a great example of sympathy and sacrifice.

-Ownership and Utilisation of human parts: Blood donation and transfusion from other human beings has been almost agreed upon as permissible in Shariah. If absolute utilisation of any part of the body is regarded to be an act of dishonour or crossing the limits of ownership, it should be unlawful too, as blood is also a part of the body. Moreover, we do not absolutely own our wealth too. It is also an Amanah of Allah but giving it to others is not considered as infringing upon the ownership of Allah. 

The early Fuqaha prohibited utilisation of human organs because in their time, utilisation of human organs was considered to be an act of insult, desecration and objectification. Such methods were also not invented in that age so that organs of the human body could be utilised gently and gracefully. (These arguments have been summarised from 'Jadeed Tibbi Masail' of Mufti Abubakar Qasmi)

How Ilm Must Be Sought! Avoiding the Modern Pitfalls in Learning the Deen

Ilm Must Be Sought!

We live in era in which technology is advancing like never before. Somewhere between the inspirational tweets on Twitter and the quick tutorials on YouTube, concepts of sacrifice and hard work have disappeared and become almost foreign to us. We have mistaken following scholars on Twitter or liking their Facebook pages as a modern form of sitting with a shaykh.

While we are no longer required to travel long distances like the scholars in the past, there are still sacrifices which must be made for ‘ilm. That sacrifice could be adjusting our schedules, taking out time to find a local scholar, and might even require giving up on Halo or Call of Duty for a couple hours of weeks (I never said it was going to be easy!). The ‘ulamā of the past were very particular in making sure they took the proper steps in acquiring knowledge, as doing so would help them appreciate the value of ‘ilm.

Ibn ‘Abbas, a prominent companion and relative of the Prophet ﷺ would say,

“I would sometimes hear that another companion had knowledge of a certain ḥadīth (which I did not know). If I had wished, I could have called him, and he would have taught me the ḥadīth here. But I, myself, would go to his door and learn the ḥadīth there.” [Sunan al-Dārami]

Yes, this is Ibn ‘Abbas, the greatest commentator of the Qur’ān. He understood the only way to gain true ‘ilm was through giving it its due respect and sacrifice.

Avoiding the Milk-Shaykhs

Allah's Messenger (ﷺ) said:

"Verily, Allah does not take away knowledge by snatching it from the people but He takes away knowledge by taking away the Ulama (scholars), so that when He leaves no Alim (scholar), people turn to the ignorant as their leaders; then they are asked to deliver religious verdicts and they deliver them without knowledge, they go astray, and lead others astray.” [Sahih Muslim 2673]

Another phenomenon which has become widespread today is studying without actual ‘ulamā; some choose the path of “self-studying” (with help from Shaykh Google of course), while others decide to study with unqualified teachers who might have good speaking skills (also known as “milk-shaykhs”). We would never adopt these methods to learn medicine, law, or anything else, so how can we be comfortable studying the commandments of Allah and his Messenger ﷺ this way? It is worth noting the Messenger ﷺ, when prophesizing the widespread and rampant ignorance to come before the Final Day, never said it would be due to a lack of resources. Rather, he mentioned two reasons: the absence of ‘ulamā and giving unqualified people positions they shouldn’t have. 

Alḥamdulilāh, many ‘ulamā are still around and can be easily found in our localities. The onus is on us to make sure they aren’t absent from our lives, thus opening the door for the unqualified to fill in the void.

[Adapted from an article by Shaykh Omar Baig (Mississauga, Canada) https://enterthesunnah.com/2015/12/02/seeking-knowledge-then-vs-now/]

Philosophy of Medicine - Islamic vs. Western

Philosophy of Medicine - Islamic vs. Western

-Dr. Md. Habeeb Haris

Islamic and Western philosophies approach medical practice with distinct perspectives shaped by their broader worldviews, though there are some overlaps.

 1. Theological Foundation vs. Secular Foundation:

   - Islamic Philosophy: Islamic philosophy of Medicine is deeply rooted in the Islamic Epistemology. It's values are based on the Qur'an and Sunnah. The approach is theocentric, meaning it places God at the center of all considerations. Medical practice is seen as a form of worship, a part of fulfilling God's will, and serving humanity, with a strong emphasis on the sanctity of life, the spiritual role and moral responsibility of the physician, and the importance of intentions (niyyah).

   - Western Philosophy: Western medical practice often stems from a secular, humanistic foundation and is influenced by ancient Greek, Roman, and Enlightenment philosophies. Philosophical approaches in the West may vary widely, from utilitarianism to deontological ethics, often focusing more on individual rights and social contracts. 

 2. Holistic vs. Analytical Approach:

   - Islamic Philosophy: Islamic medicine tends to take a holistic approach, considering not only the physical aspects of a person but also the spiritual, psychological, and social dimensions. The mind, soul (ruh) and body are interconnected, and medical treatment often involves addressing all these aspects. Prayers, supplications, family and community support, and trust in God play a role.

   - Western Philosophy: Western medical practice is typically more analytical and reductionist, often focusing on the physical body and biological mechanisms. Cartesian duality which has significantly influenced the Western medicine envisions the mind and body separately. (Rene Descartes, a prominent philosopher, proposed the concept of mind-body dualism.) However, in recent years, there has been a growing interest in holistic approaches, but these are often seen as complementary or alternative to mainstream medicine.

 3. Ethical Decision-Making:

   - Islamic Philosophy: Ethical decisions in Islamic medical practice are guided by the objective morality of the Sharia (Islamic law), which derives from religious texts. Scholars may issue fatawa (legal opinions) to address new medical issues, ensuring that practices align with Islamic values.

   - Western Philosophy: In Western medical ethics, decision-making is based on a subjective morality primarily guided by secular ethics. Less influenced by religious or cultural norms. It often involves balancing the four main ethical principles—autonomy, beneficence, non-maleficence, and justice. Patient autonomy is particularly emphasized, with individuals having the right to make informed decisions about their own care, even if these decisions conflict with medical advice.

 4. Preventive vs. Curative approach:

   - Islamic Philosophy: There is a strong emphasis on disease prevention. Many Islamic teachings inherently have a benefit of disease prevention. Encourages the use of natural treatments alongside conventional medicine.

   - Western Philosophy: Often prioritizes treatment and intervention over prevention.

 5. Community vs. Individual Focus:

   - Islamic Philosophy: Learning and practicing medical science is a collective obligation (Fardh e Kifayah) on the community as a whole and the physicians are honoured for discharging this religious obligation on behalf of the entire community. There is a strong emphasis on community welfare in Islamic medical practice. The health of the community is often considered alongside individual needs, and public health measures are encouraged as a collective responsibility. Islamic teachings promote the idea of mutual care and responsibility among believers. 

   - Western Philosophy: While public health is an important aspect of Western medical practice, the emphasis is often on individual rights and choices. Medical decisions are typically seen as the domain of the individual, with less emphasis on the community’s role in personal health decisions.

 6. Understanding of Health and Disease, Life and Death:

 - Islamic Philosophy: Health and life are considered as a trust and gift of God to be preserved and protected as well as a means of test, to be utilised properly for achieving eternal success in the Hereafter. Disease, pain and suffering are considered as a part of Destiny and a test from God to be shown patience for, even as prevention and treatment are sought. Sickness is also considered as a means of spiritual growth, forgiveness of sins and increasing one’s rewards and ranks with God.

Seeking treatment is considered as  religiously encouraged (Sunnah) and, some times, even obligatory. Death is not considered as an end. Rather it is seen as a gateway to an eternal life and a means of meeting with God Almighty. However it is not to be sought or desired and generally all possible effort is to be made to preserve life.

   - Western Philosophy: Sees them only through a biological lens and disease is seen mostly in a negative light.

 7. Role of the Physician:

   - Islamic Philosophy: The physician in Islamic thought is seen as a Khalifa (Agent) of God in healing the sick on His behalf and as a steward of God's creation. They are not only responsible for the physical health of their patients but also their mental and spiritual well-being. The physician is expected to act with Ihsan (excellence) and Taqwa (God-consciousness), viewing their work as a form of worship.

   - Western Philosophy: In Western practice, the physician's role is primarily of a professional providing medical care based on scientific knowledge. The spiritual dimension is ignored.

In summary, the Islamic and Western philosophies differ significantly in their foundational principles, approach to ethics, and the role of spirituality in medical practice.