ORGAN DONATION FROM ISLAMIC PERSPECTIVE

In Islam, there is no such thing as “giving up”. As khalifah of Allah SWT on earth, mankind should make full use of their reasoning faculty given by Allah SWT to solve any problem and challenge they face. This also applies to treating illnesses and diseases. With the rapid development in modern medicine, various treatments have been discovered. One of the treatments is organ transplantation, which has proven to be successful in treating end-stage organ failure. The effort of curing illnesses is in accordance with the following Hadith, narrated by Usamah Ibn Sharik :-

The desert Arabs then came from here and there. They asked: Apostle of Allah, should we make use of medical treatment? He replied: Make use of medical treatment, for Allah has not made a disease without appointing a remedy for it, with the exception of one disease, namely old age. 

Organ transplantation is the moving of an organ from one body to another or to the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine  is allowing scientists and engineers to create organs to be re-grown from the patient's own cells (stem cells, or cells extracted from the failing organs). Organs or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.Organs that can be transplanted are the heart, kidneys,eyes, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons, cornea, skin, heart valves, and veins.

Organ donation is the donation of  biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation. Transplantable organs and tissues are removed in a surgical procedure following a determination, based on the donor's medical and social history, of which are suitable for transplantation. 

Organ donors may be living, or brain dead. Tissue may be recovered from donors who are cardiac dead up to 24 hours past the cessation of  heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked". 

In Islam, the permissibility of organ transplantation and donation is not specifically mentioned in the main sources of reference, the Quran and Hadith. This is because organ transplantation and donation are modern developments in medicine. Nevertheless, Islamic scholars have discussed these developments since the 1950s. In Malaysia, the issue of organ transplantation has been discussed since the 1960s as evidenced from the decree of the Mufti of Perlis in 1965.  

The opinions of Islamic scholars regarding organ transplantation and donation are ijtihad  in nature, which means that the ijtihad (juristic interpretation) is based on Islamic legal maxims. A fatwa that is based on ijtihad, as described by Dr. Yusuf al-Qaradawi, is a fatwa that is still open for discussion because it is related to a new development that was not discussed by previous scholars. 

Basically, organ transplantation and donation are permissible in Islam. This is because organ transplantation and donation fulfil the requirement in the preservation of human life, which is one of the five objectives in maqasid al-syar‘iyyah (objectives of the Islamic law).

Organ transplantation is performed as a final option to save a patient’s life who is suffering from end-stage organ failure. The methodology used in determining the permissibility of organ transplantation is based on the urgent need to save the life of the patient. In other words, organ transplantation is carried out only in critical and crucial situations. The life of the patient depends greatly on organ transplantation. 

Deeds are judged by their goals and purpose. All deeds are judged by their goals and purpose. The goal and purpose of organ transplantation is to save the patient’s life. Organ transplantation is not performed with the intention of humiliating or agonising the deceased. Instead, it is carried out with the intention of saving a life. 

Harm must be eliminated. Eliminating harm is one of the objectives of  Islamic law. In the context of organ transplantation, this procedure fulfils the objective of preserving human life. Allah SWT promises great rewards for the effort of preserving human life. This is mentioned in the Quran as follows :-

“...and if anyone saved a life it would be as if he saved the life of the whole people...”

Surah al-Maidah (5:32)

Given two situations with different degree of harmfulness, priority is given to avoid the more harmful by choosing the less harmful. In the context of organ transplantation, the more harmful situation is to allow the patient in need of organ transplantation to pass away. Therefore, in this situation, the lesser harm is given higher priority, which is donating organs from a deceased donor to be transplanted to the patient in need of that organ.Organ transplantation provides the option to eliminate harm. A patient has the option to receive organs from a deceased donor in order to replace his/ her damaged organs. In this context, preventing harm takes priority over preserving the body of the deceased. 

Hardship begets facility. Organ transplantation is a facility made available to mankind as a means to overcome hardship faced by patients with end-stage organ failure. This is supported by the following Quranic verse :- 

“...Allah intends every facility for you He does not want to put you to difficulties...”

Surah al-Baqarah  (2:185)

Islamic law permits one who is in an urgent situation to do the unlawful (haram) in order to eliminate the harm he faces, under the condition that there are no other lawful options available. In this context, the last available option to save the life of a patient with end-stage organ failure is by organ transplantation. This permissibility is supported by the following verse in the Quran :-

“...But if one is forced by necessity without wilful disobedience, nor transgressing due limits then is he guiltless. For Allah is Oft-Forgiving Most Merciful.”

Surah al-Baqarah (2:173)

When one is in a difficulty that is unbearable if the situation persists, allowance should be given to him/her to eliminate the difficulty. In the context of organ transplantation, a patient with end-stage organ failure is facing death. Thus, organ transplantation is an option allowed in Islamic law as an effort to save the patient’s life.

The issue of organ transplantation has been discussed since the 1960s. As a result, a fatwa regarding organ transplantation was issued in 1970 by the National Fatwa Council. The fatwa is used as reference for matters pertaining to organ transplantation and donation in Malaysia, and is adopted by states which do not have a specific fatwa regarding the issue. States with their own fatwa regarding organ transplantation and donation are Perlis (1965), Sarawak (1996), Selangor (2000), Johor (2001), and Penang (2010). 

The National Fatwa Council, which sat on 23rd and 24th June 1970, deliberated on organ transplantation, specifically on eye and heart transplants.  The Council decided that eye and heart transplants from cadaveric donors to living recipients are permissible in Islam,  under a few considerations. It is carried out in critical and crucial situations where the life of the recipient depends on the organ transplantation, and the transplantations have a high degree of success. In heart transplantation, the death of the donor must first be ascertained. Necessary actions must be taken so that no human killing and organ trading are involved. Permission must be obtained from the donors prior to transplantation (in cases of normal death) or from the family members (in cases of death resulting from accidents). These are based on a few legal maxims which is harm must be eliminated, hardship begets facility, and choosing the lesser of two harms.

The permissibility of donating and transplanting organs is also bound to the following conditions which are meant to protect all interests in accordance to Islamic law. Living donors are not inflicted with harm such as death or disabilities. Transplantation is performed with the permission from the donors. The permission is obtained from donors who are legally able to do so. As such, permission cannot be given by children, mentally-incompetent people, or individuals who are confused, under pressure or coerced to donate. Not conducted in ways that could violate human dignity such as organ trading. It should be done for altruistic reasons. Doctors involved in the transplantation have sufficient knowledge to assess the donors’ and recipients’ conditions based on the principles of  maslahah (benefits) and mafsadah (harms) according to Islamic law.

In 1986, the Islamic Religious Council of Singapore issued a fatwa that permits organ transplantation in critical and crucial situations for the purpose of saving lives. The principle used on this matter is the Islamic legal maxim of “emergency (darurah) permits matters that are prohibited”  Aside from this general fatwa on organ transplantation, there are also other fatwas on the transplantation of specific organs issued by the Islamic Religious Council of Singapore, such as a fatwa issued in 1995 on the permissibility of cornea transplantation to relieve the sufferings of those with vision impairment. Other fatwas were issued in 2003 and 2004 that permit the donation of heart and liver for the same reason as the transplant of kidneys that is to save the life of patients. 

As early as 1967, the Senior Ulama Council of Saudi Arabia has permitted cornea transplant.  In 1982, the Senior Ulama Council of Saudi Arabia permitted the transplant of whole or parts of organs from cadaveric donors to living persons provided that there is no other alternative.  This council also unanimously permits living organ transplant.

In 1995, the Islamic Sharia Council of United Kingdom issued a fatwa that the council supports and recognises organ transplantation as an approach to cure illness or save lives based on Islamic legal maxims. The council also permits the legal guardian of the deceased to give their consent for the deceased’s organs to be donated in order to save lives of others. This fatwa is in line with the Islamic legal maxim of “emergency permits matters that are prohibited” as well as meeting one of the objectives of the maqasid al-syar’iyyah that is “preserving life”. 

Dr. Yusuf al-Qaradawi, a well-known contemporary scholar from Egypt, stated that the donation and transplantation of organs from a living or a deceased person is permissible in critical and crucial situations provided that the act does not bring significant harm to the donor or those who have the rights on the donor.  He also stressed on the permissibility of organ donations to non-Muslims,  and prohibition of organ trading.  Legal guardians are allowed to donate organs of their deceased family member who has not instructed otherwise,  and it is permissible for Muslims to receive organs from non-Muslims. 

Is organ donation similar to torturing the dead? In a Hadith, the Prophet SAW said :-

From `Aisyah RAH, she heard the Prophet SAW said, “Verily the act of breaking the bones of the deceased is the same as breaking the person’s bones while he is alive.” 

Basically, the Hadith prohibits any kind of humiliation on the deceased. Islam is very strict in giving due respect to the deceased, whether they are Muslims or non-Muslims. The act of breaking the bones of the deceased is regarded as an act of torturing the deceased as mentioned in the Hadith. This is because such act is malevolent and does not bring any benefit at all. 

However, organ donation and transplantation are not done because of any malicious intent or without any beneficial purposes. These acts are performed as a final resort to save the lives of patients who are in need of organs. Preserving life is one of the elements in maqasid al-syar’iyyah or purposes of Islamic law. The prohibition in the Hadith becomes void when there exists a more crucial and critical need that is to save human lives. The intention behind the act of donating organs is virtuous and benevolent. Organ donation will only be done when there is no other alternative to save a patient’s life. In this matter, the following verse applies :- 

But if one is forced by necessity, without wilful disobedience, nor transgressing due limits, then is he guiltless. For Allah is Oft-forgiving Most Merciful.

Surah al-Baqarah (2: 173)

Are organ donors violating the rights and trust given to him in preserving his body’s dignity and honour when he donates his organs? Mankind is the best and the most noble creature created by Allah SWT. This is mentioned in the Quran as follows : -

We have honoured the sons of Adam; provided them with transport on land and sea; given them for sustenance things good and pure; and conferred on them special favours, above a great part of our creation.

Surah al-Isra’ (17:70)

The verse explains that Allah SWT ennobles mankind as His greatest creation, and this includes the human body. As a Muslim, we believe that the body that we have is a gift and a trust from Allah SWT. This means that we need to take care of our body and to duly give our body its rights both during life and death. The rights of the body include maintaining physical health, safeguarding the body from self-inflicted injuries and so on. Its rights upon death are to be bathed, shrouded, prayed upon, and buried.

The act of donating organs while someone is alive or after his death does not mean that the person is violating the trust and rights of his body, because the organ donor does not mutilate his body intentionally. On the contrary, the act of donating organs is made with good intention that is to save other people’s lives. In other words, organ donation gives other people the chance to continue living. With regard to this, Dr.Yusuf al-Qaradawi said that the act of donating parts of a deceased’s body does not violate the dignity of the deceased. If we believe that our body belongs to Allah SWT, we should not feel begrudged to donate our organs to be used by others. As a matter of fact, the lives that are to be saved also belong to Allah.

Will the donor bear the sins of the persons who receive his/her organs? No, because every mukalaf (a person who has reached the age of maturity and of sound mind) is responsible for his own deeds. Allah SWT said in the Quran :- 

Say: “Shall I seek for (my) Cherisher other than Allah, when He is the Cherisher of all things (that exist)? Every soul draws the meed of its acts on none but itself: no bearer of burdens can bear the burden of another. Your goal in the end is towards Allah. He will tell you the truth of the things wherein ye disputed.”

Surah al-An’am (6:164)

On the other hand, Dr. Yusuf al-Qaradawi opines that those who donated their organs will be rewarded because the act of donating organs is one of the three deeds that is continuously rewarded even after his death. In a Hadith, the Prophet SAW is reported to have said :-

From Abu Hurairah RA verily the Prophet SAW said, “When a person dies, his actions come to an end except in three matters: Continuous charity (jariah), knowledge from which benefit can be derived, or a virtuous son who prays for him.” 

Will organ donors be raised on the Day of Judgement with the organs that were donated? Every Muslim believes that the Day of Judgement will come. When the Day comes, everything will be destroyed. Nothing will escape unharmed including the human body. Only Allah SWT will remain. After that, human will be resurrected in the Hereafter according to their deeds when they were alive. If a person has many good deeds, he will be resurrected in a condition which is better than when he was alive on Earth. If his evil deeds outweigh his good deeds, he will be resurrected in the worst of conditions. Thus, as faithful Muslims, the issue of whether we will be resurrected with or without the donated organs does not arise, because we believe that everything will be destroyed on the Day of Judgement. We will be resurrected by Allah SWT to be judged for all the deeds that we have done. The Might of Allah SWT to give life is stated in the Quran :-

“He will give them life Who created them for the first time! for He is Well-versed in every kind of creation!

Surah Yasin  (36:79)

Can Muslims receive organs from non-Muslims? There are no restrictions in Islam to transplant organs from non-Muslims to Muslims. This is because human organs cannot be categorized as Islam or otherwise, because organs are tools used by humans to perform his religious duties and his means for living. When an organ is transplanted from a non- Muslim to a Muslim, that organ will become a part of a Muslim’s body that can be used for the purpose of fulfilling his responsibilities as ordained by Allah SWT. Furthermore, Dr. Yusuf al-Qaradawi decreed that the organs of non-Muslims are considered to be Muslim. This is because, according to him, a person’s faith whether a Muslim or a non-Muslim does not depend on his organs, but his soul.  Thus, there are no restrictions for Muslims to benefit from the organs of non-Muslims.

Can Muslims donate organs to non-Muslims? In the Malaysian context, donors cannot indicate who can or cannot receive the organs to be donated. Instead, the organs will be transplanted to those who are most suitable and with the biggest chance of success. At the same time, Malaysian non-Muslims are categorized as kafir dzimmi (non-Muslims who pledge their loyalty to the country), and hence they must be protected, aided and saved when they are in distress or pain. This includes saving their lives through organ transplantation. Thus, in the context of Malaysia, the issue of whether it is permissible or not to donate organs to non-Muslims does not arise because they (the non-Muslims) should be help when they are in need. This matter is explain in the following verse :-

“Allah forbids you not, with regard to those who fight you not for (your) Faith nor drive you out of your homes, from dealing kindly and justly with them: for Allah loveth those who are just.”

Surah al-Mumtahanah (60:8)

The Prophet SAW also reminded us that Muslims should always give to others and help those who are in need. This is mentioned in a Hadith from Abdullah bin ‘Umar RA which is narrated by Imam Bukhari :- 

I heard Allah’s Apostle SAW while he was on the pulpit speaking about charity, to abstain from asking others for some financial help and about begging others, saying, “The upper hand is better than the lower hand. The upper hand is that of the giver and the lower (hand) is that of the beggar.” 

Funeral rites may be delayed because of the medical procedure to transplant organs. Is this permissible? In Islam, funeral rites should not be delayed without valid reasons. However, the process of transplanting organs for the purpose of saving human lives is considered to be a valid reason in Islamic law for such a delay. Thus, it is permissible in Islam to delay the funeral rites in this case. However, hospital authorities seek to ensure that the delay is minimised as much as possible.

The issue of brain death was first discussed in 1985 by international Islamic scholars who gathered in Jeddah, Saudi Arabia even though at that time, no decision was made. The issue was later discussed in greater detail in 1986 in Amman, Jordan. The fatwa from this conference stated that death can occur due to two reasons. Brain death refers to the total and irreversible cessation of all functions of the brain. A person who is brain dead will not be able to breathe on his own and will need to be supported on a ventilator. Once the ventilator is switched off, all bodily functions including the beating of the heart will cease, since the brain has already stopped functioning. A person who is brain dead is truly and unequivocally dead.This is the scientific position of international medical communities. In determining death, medical professionals need to satisfy strict, internationally recognized conditions in order to determine brain death.Therefore, Islam accepts brain death as death.

As the conclusion, Ibn Qayyim al-Jawziyyah placed the sacrifice of the body and soul as the highest level of sacrifice from ten categories of sacrifices that he mentioned in Madarij al-Salikin. Organ donors can be categorized under the sacrifice of body and soul as mentioned by Ibn Qayyim al-Jawziyyah. This is because the donors willingly donated their organs to patients who are in need. Saving human lives is also one of the objectives of Islamic law. 

Organ donation can also inculcate altruism in individuals and society. Altruism will drive people to help each other regardless of religion, race, status and wealth. Islam also encourages its followers to help each other as stated in the following verse from the Quran :-

“Help ye one another in righteousness and piety, but help ye not one another in sin and rancour: fear Allah. for Allah is strict in punishment.”

Surah al-Maidah (5:2)

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