Sayyed Fadlullah's Interview with "At-Tawasul" Magazine

Organ Donation

 

One day I will be laying on a white bed sheet in a hospital and in a certain moment, the doctor will decide that my brain has stopped working and that my life has ended. At that time, do not try to bring life back to my body through machines and do not say that this is the bed of my death but call it the bed of life, and take organs from my body in order to save the lives of other living people.

Tens of thousands of people need organ transplantation as a solution of some incurable diseases that might cause the destruction of the essential organs that are necessary for the continuity of life.

The organs that are needed to be transplanted for the patient can also be taken from a living donor, meaning any of the family members: the husband, wife, or any other relative.

They might be also taken from a deceased donor who is in a state of brain death, resulting from the arrest of all brain functions. It is diagnosed by two clinical exams performed by two doctors one of them is a neurologist. [In this case the blood circulation, respiration and heart function are maintained by artificial means]. The interval between the first and the second exam is 16 to 24 hours. After performing the EEG to make sure that the blood circulation is not reaching the brain, the functions of the respiratory system have stopped, and that the brain's electricity is static for ten minutes, in addition to other indications …after that, the heart and other organs may be preserved by means of artificial respiration machines or through medicines.  

The organs and tissues that can be procured, in case the donor is a living person, are:

The kidney, a part of the liver or the pancreas, one lung and the medulla or the bone marrow.

The organs and tissues that can be procured, in case the donor is a dead person, are:

The heart, the two kidneys, the liver, the two lungs, the pancreas, the intestines, the bones, the cornea (of the eye), the arteries, the valves, the skin, and the medulla…  

The conditions of donations are:

Firstly: The process of transplantation from a deceased donor differs from that of a living donor. Concerning the deceased donor, decree 1442 has stipulated the followings:

The functions of the respiratory system of the deceased person have stopped and he is in a motionlessness state with no brain reflexes. He must also be an adult person who has determined, by a will, to donate his organs after his death in addition to the consent and signature of the deceased person.

Secondly: Concerning the living person, the following conditions should be met:

-         He must be an adult person between 18 and 65 years.

-         He must have a good health that enables him to endure the surgical operation without being subjected to any side effects.

-         He must not have any cancerous diseases, blood pressure, or any diseases of the liver, heart or kidneys.

-         He must not have any viral diseases such as AIDS, hepatitis… etc.

Concerning the laws that protect the process of donation, there are many legislative decrees that have organized this issue whether with respect to the donation of a living donor or a dead one.

The one who can donate is:

-         Every person who meets the above-mentioned conditions.

-         Every person who has signed during his lifetime a donating form which represents the will of the donor after his death.

-         Every person who has announced before he died that he intends to donate his organs (through a written or an oral will statement).

Decree no. 109 (17/11/1983) and its modification decree no. 1442 (20/1/1984), legalize the "donation of human tissues and organs for medical and scientific purposes". However, the family's consent is essential [whether the card is present or not].

Besides, the success or failure of the operation depends on the immunity of the receiver. Every human being has certain and unique HLA (Human Leukocytes Antigens) that can differentiate between what belongs to it what is an intruder to the body. For that reason the process of refusing the organs appears in different periods of time.   

Many jurisprudential fatwas have permitted free organ donation. They considered it permissible for a living person to donate one of his body organs on condition that there is a reliable medical consent and that the process of donation does not cause the donor a big harm. Besides, the donation should be free aiming at preserving the life of the receiver. Those fatwas have also deemed it permissible to donate any of the human organs after death on condition that there is a consent of a reliable doctor and that the donation and transplant would benefit the receiver provided that that the permission of the inheritors are taken.

In order to clarify the religious opinion concerning the operations of organ donation, "At-Tawassol" magazine conducted an interview with the Religious Authority, His Eminence, Sayyed Muhammad Hussein Fadlullah.

Q: Would you please tell us what is the position of the Islamic religion concerning the operations of "organ donation"?

A: When we talk about organ donation in the moral Islamic aspect without going into details, we find that the donation of one's organ to another person, especially if that person has a serious health problem that threatens his life, represents a moral value on the level of benevolence and altruism. Besides, altruism is considered an Islamic moral value that Allah, the Almighty has talked about. He said: But give them preference over themselves, even though poverty was their (own lot). (59:9) Therefore, the issue in principle is considered a moral value.

If we want to study this issue in details on the religious level, we say that there are some basic organs in the human body that man's life depends on. Thus, naturally, it is impermissible for a person to donate his heart or any of his body parts if it threatens his life. For example, if a person owns one kidney or one eye, it is impermissible for him to donate any of them. Besides, if the organ is not essential for life such as if a person owns two kidneys but there is a health problem in one of them. In this case, it is impermissible for him to donate the healthy kidney and stay with one unhealthy kidney thus threatening his life. But if his two kidneys are healthy, it is permissible for him to donate any of them in order to save a person's life. Thus, in principle, we divide the organs into two groups. The first is the organs that negatively affect the person's life and the second group is the organs that do not have any negative effects on his life.

Q: Is there any difference between the living donor and the deceased donor on the religious level?

A: What we have discussed above is related to organ donation in case the donor is a living person. But, regarding organ donation after death, this is considered permissible in case the person has determined by will to donate any of his organs to another person. That is because Islam encourages this humanitarian attitude. In addition, for a will to be valid, it is not necessary that a Muslim person donates to another Muslim one; it is also permissible for him to donate his organs to a non-Muslim person.

Q: How is death determined from the religious viewpoint?

A: With respect to determining death, there is a jurisprudential position that considers that one is dead when his hearts stops beating and consequently it is prohibited to take the organs before the heart stops beating. Another jurisprudential position says that a person is considered dead when brain-death occurs, meaning that when his brain is medically considered dead and all its functions arrest, while the heart is maintained through artificial means. So, if we adopt the latter's positions which considers that death occurred when there is s brain-death – and that is what we jurisprudentially deem right – then, it is permissible to donate his organs because the continuity of the heart beats through medical means helps in keeping the cells alive and not the human being. Therefore, we have issued a fatwa that we still adopt: it is permissible not to keep the heart and the lungs working by artificial means. Hence, when brain death occurs, it is permissible to execute the donating operation.

Q: What is the religious position in case the guardian refused to execute the donor's will?

A: The guardian should execute the donor's will since Allah, the Most Exalted says: If anyone changes the bequest after hearing it, the guilt shall be on those who make the change. (2:181) that is because Allah has deemed it obligatory for the guardian to execute the will.

Q: What is the position of religion concerning organ donation in return for money?

A: We consider that the organ donation does not represent a mere material value, but some Fuquaa (religious scholars) consider that the receiver has to present for the donor a sum of money that he might be in need of. But, we do not encourage or prefer it to be a commercial matter, but we want it to be an exchange of gifts.