National Organ Donation Day is celebrated nationally in the US in February and in India on the 27th November. Globally, it is observed on 13th August.
The surge in success rates of organ donation is considered a testament to scientific and technological advancement.
While organ donation is undoubtedly a noble cause, there are several legal and ethical issues and concerns surrounding it which deserve our attention.
What are the ethical issues with organ donation?
There are four main ethical aspects to consider :
1) Autonomy,
2) Benevolence,
3) Non-maleficence,
4) Respecting the dignity, integrity and equality of human beings, fairness, and the common good.
It is concerning these aspects that there is a difference of opinion on organ donation across the ideological spectrum.
The pivotal principle considered is the non-maleficence principle aka the “do-no-harm” code.
According to transplantation ethics, organ donation is founded on the basis of altruism and utilitarianism where the only causes for concern are the consent of the donor and establishing the definition of death.
In both respects, the implications are quite troubling.
In an already non-egalitarian economic system, the high price at which organs are procured should ring alarm bells as to the dystopian consequences. If a poor person is selling their organ to someone who can afford it, out of financial duress; how truly consensual is this exchange? The chilling reality of organ black markets in India vindicates this concern. The majority of donors are socioeconomically struggling people trying to make ends meet. This uncritical promotion of organ donation drives at the national level , portend an almost necropolitical spectre where the rich thrive off the bodies of the poor.
The other pressing concern is that of the biomedical-legal definition of death. The “dead-donor rule” states that patients have to be declared dead before the extraction of life-sustaining organs. The concept of brain death was developed, in part, to allow patients with devastating neurologic injuries to be declared dead before the occurrence of cardiopulmonary arrest. The obvious ethical issue with this is: Is it ethical to pull the plug in patients who aren’t brain dead, then restart their hearts? This particular definition and procedure is an ongoing debate among bioethicists and the medical fraternity.
To bypass this, some have suggested utilizing the do-no-harm principle as opposed to the dead-donor rule or brain death. However, this approach fails to address the complications around consent as aforementioned.
While the issue of establishing death for organ extraction remains a highly dubious ethical issue, the enthusiastic imperative of the government that one donor can “donate up to eight organs”, coupled with the reports of the organ black market in India, is extremely concerning.
Islamic perspective and jurisprudence regarding organ donation
There are differing views within the Islamic tradition with certain scholars taking a comparatively liberal position whilst others adhering to an extremely stringent one.
The Saudi Grand Ulama sanctioned organ transplants in 1982. The 3rd International Conference of Islamic Jurists (OIC) 1986 equated brain death with cardiac death.
The 4th International Conference of Islamic Jurists (OIC) 1988, sanctioned organ transplants and proscribed commercialism & organ trafficking.
Predominantly in the Middle East, the Islamic Fatwas permit almost all types of organ transplantations if the required conditions are fulfilled.
The main principles considered by them are as follows:
1. Seeking Remedy
The gender gap continues to widen in India, now at 62.5%. The report measures four parameters – economic participation and opportunity, educational attainment, health and survival, and political empowerment. India has slipped 28 places this year. How much do schemes like Beti Bachao, Beti Padhao work in our country, with deep-set stigma and socio-cultural biases, as well as outright examples of violence on the basis of gender?
2. The Value of the Human Being
Islam accords great dignity to human beings. Allah SWT states in the Holy Quran, “We have honoured the progeny 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.” (17:70)
Therefore, mutilation of corpses is viewed as a reprehensible act and only justified for the study of medicine. The only instance where organ harvesting is allowed is if the deceased had given consent in his lifetime. In Saudi Arabia, the consent of relatives is also necessary along with the prior consent of the deceased. If the deceased had refused to donate organs, then organ extraction from such an individual is prohibited.
3. Principle of Doing no Harm (Non-Maleficence)
4. The Human Body is the Property of Allah (like everything else in the Universe).
This fourth principle is the most important in the view adopted by scholars such as Maulana Razi-ul-Islam Nadvi, Secretary, Shariah Council, Jamaat e Islami Hind.. In this view, the actual Shari’ah perspective is that organ donation after death cannot be done under any circumstances whatsoever. This is because of the belief that the body and all its parts are actually under the Sovereignty of the Creator, and not in fact, belonging to the human being alone and therefore an individual does not possess the right to give away their organs. (This idea that persons are not their own but rather the stewards of their bodies , is echoed in other religious traditions as well, especially in some branches of Christianity and Judaism.)
Thus, in Islam, the only instance when organ donation can happen is when the individual is definitely alive and that too, of those organs, that are regenerative (blood/blood cells, skin tissue;) or such organ that is more than one and normal bodily functions will not be affected negatively by the removal of one of the pair (kidneys); or such organ whose small part can be extracted from the donor and made into a culture in the body of the recipient (liver). The cornea of the eyes is not included in these categories because both eyes are required for normal functioning and hence the loss of one eventually leads to infection and deterioration in the other.
Such fuqaha (Islamic jurists) hold that organ donation after death is completely prohibited because mutilating corpses for organ extraction purposes would cause the desecration of the corpse which would be an affront to human dignity. It would also delay the proper burial, and the emphasis in the Hadith and Sunnah is to hasten the burial and not to delay it.
Such a ruling effectively rules out any debates on brain-stem death vs whole-brain death.
One can appreciate this seemingly stringent position more in the context of the organ donor markets in India and the horrifying news reports of organ harvesting done on prisoners in China.
The All India Muslim Personal Law Board holds similar positions. According to them, in the growing influence of modern medical science and new research, new Shari’i problems have also arisen, which require Islamic answers. AIMPLB’s position is that blood, being essential to life, Muslims can donate blood to voluntary blood banks, as it is part of service to humanity. Parts of organs like the liver which have regenerative characteristics can be donated to those in need. However, buying and selling are forbidden. Additionally, storing breastmilk in banks, cornea donation (because, medically, having both corneas is considered necessary for healthy functioning of eyesight) and sperm donation; are all considered forbidden under Shari’i principles.
With science able to perform almost-miraculous feats, some are inclined to reiterate their belief in the self-sufficiency of human beings from any spiritual affiliation. However, the numerous complications and problematic implications surrounding this topic, have vindicated the need for a strong framework of ethics rooted in a robust spiritual faith, i.e. Islam; one that emphasizes fearing God and being mindful of accountability for one’s actions in the life-to-come.
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