Introduction

Islam is a religion that encompasses the secular with the spiritual, the mundane with the celestial. It includes a code for the whole of human life.

Man is the vicegerent of God on earth: Behold! thy Lord said to the angels: I will create a vicegerent on earth (2.30); and He fashioned man in due proportion and breathed into him something of His spirit.

Not only Adam was honoured by Allah, but his descendants also, provided they trod on the right path.

We have honoured the descendants 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)

Human life begins at the time of ensoulment, which is stated in the sayings of the Prophet, upon him be peace, to be the 120th day from the moment of conception. (Bukhari, 1958 edn, vol. 4, p.135). Prior to that moment the embryo has a sanctity, but not reaching that of a full human being. Life ends with the departure of the soul (or spirit), a process which cannot be identified by mortals except by the accompanying signs, the most important of which is the cessation of respiration and circulation. The sanctity of the human body, however, is not lessened by the departure of soul and declaration of death. The human body whether living or dead should be respected.

The Prophet Muhammad, upon him be peace, rebuked a man who broke a bone of a deceased man which he found in a cemetery. The Prophet said: The sin of breaking the bones of a dead man is equal to the sin of breaking the bones of a living man (Abu Dawud, n.d., vol.3, p.212-13; Ibn Hanbal, n.d., vol.6, p.58).

The dead body should be prepared for burial as soon as possible, in order to avoid putrefaction which occurs rapidly in hot climates. Cremation is not allowed.

Due respect and reverence should be given to the funeral. The Prophet himself stood in veneration for the passing funeral of a Jew at a time when Jews were his bitter enemies, One of the Companions of the Prophet exclaimed: It is the funeral of a Jew! The Prophet answered: Is it not a human soul? (Bukhari, vol.2, p. 107).

Historical background

Organ transplantation is not a twentieth century innovation. It was known in some form even in prehistoric eras.

Ancient Hindu surgeons described methods for repairing defects of the nose and ears using autograft from neighbouring skin, a technique which remains in use to the present day. Susruta Sanhita, an old Indian medical document written in 700 EC described elegantly the procedure which was emulated by the Italian Tagliacozzi of the 16th century and by British surgeons working in India late in the 17th and 18 th centuries (Bollinger and Shekel, 1986, pp. 370-80).

Tooth transplantation was practised in ancient Egypt, Greece, Rome, pre-Columbian North and South America. Arab surgeons were experts at this technique a thousand years ago (Guthrie, 1946, p. 12; Peer, 1955).

During the time of the Prophet Muhammad, upon him be peace, one of his Companions called Qatada Ibn Nu‘man lost an eye during the battle of Uhud. The Prophet put it back in place and it became the better of his two eyes (Hawwa, 1971, vol.2, p. 197). In the Battle of Badr, the Prophet replaced the arm of Mu‘awath ibn ‘Afra and the hand of Habib ibn Yasaf (Al-Shibani, n.d., vol.1, p. 244; al-Khafaji, n.d., vol.3, p. 111).

Muslim jurists sanctioned transplantation of teeth and bones which has long been practised by Muslim surgeons.

Imam Nawawi (631-671/1233-1272) discussed fully the subject of bone and tooth transplantation in his comprehensive reference textbook of jurisprudence al-Majmu‘ (n.d., vol.1, p.293) and in his concise textbook Minhaj al-Talibin (1978 edn, vol.1, p. 190). Imam al-Shirbini commented on this subject in his book Mughni al-Muhtaj (n.d., vol.19, p.191). Zakaria al-Qazwini (600-682/1203-1283) advocated the use of porcine bone grafts as they take much better than other xenografts and function more efficiently (1978 edn, p.422), despite the fact that Muslims consider the pig and its produces untouchable. Jurists allowed the use of porcine material in medicine provided there was no other adequate alternative or equivalent.

Some Islamic principles and rules related to organ transplantation

1 Islam considers disease as a natural phenomenon. It is not caused by demons, stars or evil spirits. Indeed, disease is not even caused by the wrath of God, nor by any celestial creature. Diseases and ailments are a type of tribulation which expiates sins. Those who forebear and endure in dignity are rewarded in this world and on the Day of Judgement.

2 Man should seek a remedy for his ailment. The Prophet, upon him be peace, told Muslims to seek remedy and treatment (Ibn Qayyim, 1970, vol.3, p.78). He ordered his cousin Sa‘d ibn Abi Waqqas to seek the medical advice of Al-Harith ibn Khaledah, a renowned physician of his time (ibid.). Further, the Prophet declared that there is a cure for every illness, though we may not know it at the time (Bukhari, 1958 edn, vol.7. 148-82).

3 We are encouraged to search for such a cure (Muslim, 1972 edn, vol.14, pp.191-200). New modalities of treatment should be searched for and applied if proved successful.

4 The Prophet ordered Muslims to be compassionate to every human being. He also said: All mankind is the family (‘iyal) of God; those who best serve their family are best loved by God.

5 The human being should always keep his dignity even in disease and misfortune. The human body, living or dead, should be respected.

6 However, doing a necessary post-mortem examination or donating organ from a cadaver does not mean mutilation of the corpse or an act of disrespect. The harm, if any, of removing any organ from a deceased person should be weighed against the benefit obtained, and the improved life provided, for the recipient. In short, the principle of saving human life takes precedence over whatever assumed harm might befall the corpse.

7 In the case of a living donor, the principle of doing no harm is invoked. The donor cannot give a vital organs risking his life. That would be an act of homicide or suicide, both of which are considered among the most detestable crimes in Islam. Donation of an organ whose loss would usually cause little harm or minimal increased risk to the health or life of the donor is acceptable. It invokes the principle of accepting the lesser harm when faced with two evils. The harm done by the disease, which can kill a human life, is not to be compared to the harm incurred by donation.

8 Organ transplantation is a new modality of treatment that can save many human lives and improve the quality of life for many others. As noted above Islam encourages searching for cures and urges Muslims not to despair, for there is certainly a cure for every ailment, albeit we may not know it as yet.

9 Donation of organs is an act of charity, benevolence, altruism and love for mankind. God loves those who love fellow humans and try to mitigate their hardships and relieve their misfortunes.

10 Good intention: any action carried out with good intention and which aims to help others is respected and indeed encouraged, provided no harm is done.

11 The human body is the property of God, but man is entrusted with his body, as well as with other things. He should use it in the way prescribed by God as revealed by His Messengers. Any misuse will be judged by God on the Day of Judgement, and transgressors will get their punishment. Suicide is equated in Islam with homicide. Even cremation of the corpse is not allowed. The only accepted, dignified way is burial of the corpse, which should be done as soon as possible.

12 Donation of organs is not an act of transgression against the body. On the contrary, it is an act of charity and benevolence to other fellow humans, which God loves and encourages.

13 The human organs are not a commodity. They should be donated freely in expression of altruistic feelings of brotherhood and love for fellow humans.

Fatwas regarding organ transplantation
Muslim surgeons have long practised autograft transplantation which they learned from other nations, especially Indians. They practised tooth and bone grafting from both animal and human sources (i.e. xenograft, and homografts), after obtaining the consent of the jurists. In the twentieth century, the Muslim jurists sanctioned blood transfusion, though blood is considered as najas i.e. unclean. The fatwa of the Grand Mufti of Egypt (No. 1065, June 9th, 1959) is an example of Islamic jurists’ attitude to new modalities of treatment (Dar al-Ifta al-Misriyya, 1982, vol.7, p.2495).

The majority of Muslim scholars and jurists belonging to various schools of Islamic law invoked the principle of the precedence of saving human life over any other argument. Sheikh Hassan Ma’mun (The Grand Mufti of Egypt) also sanctioned corneal transplants from cadavers of unidentified persons and from those who agree to donate after their death (No. 1087, April 14th, 1959; ibid., p.2552). His successor, Sheikh Huraidi extended the fatwa to other organs in 1966 (No. 993; ibid., vol.6, pp. 2278-82).

Sheikh Khatir, the new Grand Mufti of Egypt, issued a fatwa allowing harvesting of skin from unidentified corpses in 1973 (ibid., vol.7, 2505-7).

Grand Mufti Jad al-Haq sanctioned donation of organs from the living provided no harm is done and provided the gift is made freely in good faith, for the sake of God and care of mankind. He also sanctioned taking organs from cadavers provided there is a legal testament or consent of the relatives. In case of unidentified corpses, an order from the Magistrate should be obtained prior to harvesting organs (No. 1323, December 5, 1979; ibid., vol.10, pp. 3702-15).

The Saudi Grand Ulema Fatwa No. 99, 1982 addressed the subject of autografts which were unanimously sanctioned. It also sanctioned, by majority, donation of organs both by the living and by the dead by legal testament or consent of relatives (Majallat al-Majma‘ 1987, vol 1, p.37).

In Kuwait, Law No. 7 (1983) reiterated the previous fatwas and pointed out that the living donor should be over 18 in order for his informed consent to be legally acceptable.

The subject of brain death was not addressed in any of these fatwas but discussed for the first time in the Second International Conference of Islamic Jurists held in Jeddah, in 1985. No decree was passed then, until further studies and consultations had been done. In the Third International Con¬ference of Islamic Jurists held in Am¬man in 1986, the historical Resolution No. 5 was passed by majority, which equated brain death to cardiac and res¬piratory death (Jeddah Fiqh Academy, 1988, p.34).

In strict Islamic teachings, death is the departure of the soul, but since this cannot be identified the signs of it are accepted.

This 1986 decree paved the way for extension of organ transplant projects previously limited to living donors. Campaigns for organ donations from brain dead persons were launched both in Saudi Arabia and Kuwait. We note, sadly, that the high incidence of motor vehicle accidents in the Gulf area provides many cases of brain death.

While this tragedy should be averted by issuing and enforcing stricter traffic laws and by other means, it is also quite proper that organs from suitable cadavers should be used for the living.

The Islamic League conference of jurists, (Makkah, December 1987) decree No. 2, 10th session, did not equate cardiac death with brain death. In fact, it did not recognize brain death as death. However it sanctioned all the previous fatwas on organ transplantation. This decree has received little attention in the media, and the authorities in Saudi Arabia seem to ignore it. Cardiac and kidney transplants from brain dead individuals continue without any hindrance from the jurists.

The most detailed fatwa on organ transplantation was that of the Fourth International Conference of Islamic Jurists held in Jeddah, February 1988 (Resolution No. 1). It endorsed all previous fatwas on organ transplantation, clearly rejected any trading or trafficking in organs and stressed the principle of altruism (ibid., pp.55-8).

Jurists have begun to discuss new subjects related to organ transplantation, namely a) transplantation of nervous tissues as a mode of treating Parkinsonism or other ailments; b) transplantation from anencephalics, c) transplantation of tissues from embryos aborted spontaneously, medically or electively; and d) pre-embryos remaining from IVF projects (Fiqh Academy, Kuwait, 1989).

The Sixth International Conference of Islamic Jurists addressed these issues in March 14-20, 1990. In sum, while the frontiers in medical technology continue to be pushed back, Islamic jurists are keeping abreast of the changes and applying established Islamic principles to guide Muslims in new circumstances as good illustration as any of the continued health and vitality of Islam as a code for the whole of human life.

REFERENCES
ABU DAWUD (n.d.) Sunan Abu Dawuii, Homs, Syria.
BOLUNGER, R. & Stickel, D.(1986) ‘Historical aspects of transplantalion’, in Sabisron, D. ed., Textbook of Surgery, 13th edn, London.
AL-BUKHARI (1958 edn) Sahih al-Bukhari, Cairo.
DAR AL-‘IFTA AL-MISRIYA (1982) al-Fatawa al-islamiyya, The Supreme Islamic Council, Ministry of Endowments, Cairo.
FIQH, ACADEMY JEDDAH (1987) Majalat al-majma‘ al-fiqhi (Journal of Fiqh Academy).
FIQH ACADEMY JEDDAH (1988) Book of Decrees.
FIQH ACADEMY KUWAIT (1989*) Seminar on New Issues in Organ Transplantation, Fiqh Academy and Islamic Organization of Medical Sciences, Kuwait. [*Awaiting publication.]
GUTHRIE, D.A. (1946) A History of Medicine, Philadelphia, USA.
IBN HANBAL (n.d.) : Musnad Ahmad ibn Hanbal (Commentary of Ahmed Shakir), Cairo. HAWWA, S. (197l) al-Rasul, 2nd edn, Beirut.
AL-KHAFAJI, A.S (n.d.) Nasim al-riyadh, Beirut.
AL-NAWAWI, M.S. (n.d.) al-Majmu‘ (Commentary by M. al-Mutti‘i). Cairo.
AL-NAWAWI, M.S. (1978) Minnaj al-talibin, Beirut.
PEER, L. A, (1955) Transplantation of Tissues, Baltimore.
IBN QAYYIM, M. (1970) Zad al-ma‘ad fi hadyi khayr al-‘ibad, Cairo.
AL-QAZWINI, Z. (1978) ‘Aja’ib al-makhluqat, 3rd edn, Beirut.
AL-QUSHAIRI, M. (1972) Sahih Muslim (Commentary of al-Nawawi), Beirut.
AL-SHIBANI, A. R.(n.d.) Hada’iq al-anwar wa matali‘ al-asrar fi siirat al-nabi al-mukhtar, 2nd edn, Ministry of Endowments, Qatar.
AL-SHIRBINI, M. (n.d.) Mughni al-muhtaj, Beirut.

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