ORGAN DONATION CONSIDERED A NOBLE RELIGIOUS DEED
The Malaysian medical fraternity added another feather in its cap recently with the historic heart transplant procedure performed by a team of cardiothoracic surgeons, cardiologists, anaesthesiologists and other supporting staff of the National Heart Institute.
The effort was a culmination of the heart transplant programme set up by the institute two years ago. It also provides hope for the one percent of the estimated 20,000 Malaysians who experience heart failure every year and require a transplant.
The notion of transplantation has been around for the last few millennia. Susruta Sanhita, an old Indian document written around 700 B. C. contains elegant descriptions of the methods for repairing defects of the nose and ears using autografts from the neighbouring skin.
According to the legend, miraculous surgeons like Pien Chi’iao and Hua T’o who practised in China two thousand years ago, performed transplants on heart patients without inflicting the slightest pain. The Roman Catholic Saints, Cosman and Damian, were said to have risen from dead to replace the cancerous foot of a devout Christian with a transplant from the cadaver of a Ethiopian.
lt was narrated that during the battles of Badr and Uhud fought in 624 and 625 A.D. respectively, Prophet Muhammad (peace be upon him) himself replanted the detached eye of Qatada ibn Noman, and the severed hands of Muawith ibn Afra and Habib ibn Yusof. Muslim jurists, such as Al-Imam Nawawi, and Asshirbini are known to have sanctioned transplantation of teeth and bones. Intra-species (allograft) and inter-species (xenografts) transplantation of most organs were also permitted.
Organ transplantation is a mode of treatment for serious and life threatening diseases that has been proven to be successful, and hence should be applied. Recent advancements in surgical procedures and the availability of anti-rejection drugs have contributed tremendously to the success of organ transplantation.
The primary source of organs for transplantation is a dead body. As the process of death sets in the organs of the body beg in to putrefy rapidly. Thus, if possible organs must be retrieved from a dead body whose vital functions are being sustained artificially. Such bodies are of ten of patients who die after a trauma that destroys their brain but leaves other organs intact. The term “brain-death” or cadaveric is used to describe these bodies. Return to life is considered scientifically and medically impossible. Very strict brain related criteria are used to certify that a patient is brain-dead. And these criteria have been internationally accepted and widely practised.
The first successful transplant procedure was carried out at Boston’s Peter Bent Brigham Hospital in 1954 by a surgical team, led by the Nobel Laureatte, Dr. Joseph Murray. A kidney from one identical twin was transplanted to his brother . And ever since then, transplantation has become the treatment of choice for kidney failure. Today, kidneys harvested from both living and cadaveric donors are suitable for transplantation.
Lungs transplantation was first carried out in 1963. The same year marked the first successfulliver transplant procedure at a hospital in Denver, Colorado. Although the majority of livers for transplantation are obtained from cadavers, partial liver transplant from living donors has now become possible.
On December 3, 1967, in the Schur Groot Hospital, Capetown, South Africa, Dr. Christian Barnard transplanted a living heart from the chest cavity of a presumably dead person into a patient suffering from end-stage heart disease. The patient survived for 18 days. One month later, Dr. Barnard attempted the same procedure to save the life of Dr. Philip Blaiberg, who lived for 18 months. This procedure has been developed further to a stage whereby the survival rate for heart transplant patients is 90 percent for the first post-operative year, 75 percent for the fifth, and 55 percent for the tenth.
Due to the shortage of cadaveric donors, the first heart transplant in Malaysia could only materialise on December 18, 1997. Organ donors are indeed a rare breed in this country. In fact, in the last 22 years there have only been 17 cadaveric donors, the majority being foreigners who are victims of traffic accidents.
Nevertheless, Malaysia’s Ministry of Health must be commended for its effort to encourage the public to pledge their organs for donation. The first thing the ministry did was to obtain the sanction of the religions authority on the permissibility of the Organ Transplantation Treatment.
The matter was discussed at the National Fatwa Committee meeting on Jun 23- 24, 1970. The committee, assisted by a panel of medical experts, made the decision to allow organ transplantation based on acceptable juridical principles.
The first is the principle of “choosing the least of the two evils if neither can be avoided”. Since the saving of life is a necessity that carries more weight than preserving the integrity of the body of the donor or cadaver, and infiicting injury on the body of the donor is less evil compared to letting the patient expire, therefore organ transplantation is sanctioned.
lt goes without saying that the procedure should not pose any danger on the living donor as far as medically ascertainable. Here, the main principle of medical ethics, namely; “primum non nocere” is automatically invoked. Donation must cause no harm or a minimal increased risk to the health of the donor.
The second is the rule of “necessities overrule prohibitions.” Basically, mutilating the human body, whether living or otherwise, is against the precepts of Islam. Prophet Muhammad (pbuh) rebuked a man who broke the bone of a deceased which he found in the cemetery and said, “breaking the bones of a dead man is similar to breaking the bones of a living man” .
Due respect should be accorded to the dead body as exemplified by Prophet Muhammad (pbuh) who stood in veneration for a passing by funeral of a Jew, at the time when Jews were his bitter enemies. One of the companions exclaimed, “It is only a funeral of a Jew!”. The Prophet (pbuh) answered, “is it not a human soul?”.
Nevertheless, under very special circumstances, juridical prohibitions can be waived. Allah says in the Holy Quran in Surah Al-Baqarah verse 173, “But if one is forced by necessity, without willful disobedience, nor transgressing due limits, then he is guiltless. For Allah is Oft-Forgiving and Most Merciful”. A similar decree is stated in Surah Al-Maidah, verse 3 and Surah Al-An’am, verse 145.
Thus, Muslim jurists allow the use of non-permissible materials in medicine if it is deemed indispensable for cure and prescribed by a competent Muslim physician. A thousand years ago, Zakaria Al-Qazwini, a grand Qadhi of Iraq (1203-1283 A.D) noticed that porcine bone graft functioned more efficiently than other xenografts. If that was the only available treatment to save the life of the patient, Muslim jurists would exonerate both the patient and surgeon from any blame.
Donating an organ is not an act of mutilation. Mutilation is done with malice and vengeance and serves no good purpose, while donation of an organ is an act of charity and benevolence as it can save a human life. In Surah Al-Maidah, verse 32, Allah says, “If anyone sayed a life, it would be as if he sayed the life of all mankind. ”
The third principle which supports organ transplantation is contained in verse 185, Surah Al-Baqarah, “Allah intends every facility for you. He does not want to put you to difficulties.” Islam considers a disease as a natural phenomenon. However, man should seek remedy. Allah who causes ailment also brings cure and redemption. Muslims are therefore encouraged to search for new modes of treatment and should apply them if proved successful.
A literature scan indicates that the major religions in the world do not object to organ donation. The Roman Catholic and Jewish traditions consider giving up a bodily part for the benefit of another as morally justifiable. While abhorring mutilation of the body, Buddhism permits donation after death if the explicit consent of the donor has been obtained before death.
Despite the unequivocal sanction for organ donation by the various religious authorities, there is still a severe shortage of organs for transplantation. Malaysians are still reluctant to pledge the ir organs for donation. In a study carried out in Kuala Lumpur a few years ago, only 20 percent of the respondents indicated the willingness to donate their organs. The figure for potential Muslim donors is only 10 percent. Every year, thousands of Malaysians in dire need of an organ transplant, die before a donor can be found.
Nevertheless, the success of the National Heart Institute is set to usher in a new age of organ transplantation in this country. Let’s hope that the same event would spur more Malaysians to pledge to donate their organs. A noble option indeed as a new year’s resolution.