Organ donation (8)

In the previous blog, we looked at the first of 5 angles to analyse the issue of amputating organs from a live person:

• Is amputation allowed at all
• The one from whom the amputation is done
• The amputated organs
• The one to whom the amputation is done
• The goal of transplantation

Let’s consider the person whose body part is being amputated – it can’t be someone who is not able to discern for him/herself and has to be someone baligh and rational (i.e. not insane). In addition, it could be an animal, or a person who is ghayr muhtaram (lit. not respectable – we can discuss what this means below).

Now consider the situation of someone who is insane or not baligh – this would (as with everything else) require the permission of the guardian.

What about a foetus – e.g. one that miscarried/is aborted? This would not be alive but may be allowed subject to the discussions in the previous blogs and the permission of the parents.

Now let’s consider an animal: if it an animal that is allowed to be eaten, then there is no issue; if it is an internal organ of an animal that is not allowed to be eaten e.g. a pig heart, then again there is no issue. If it is transplanting an external organ after slaughter, there are relevant narrations:

-          muwathaq of Zurara who asked Abu Abdullah (AS) about praying in the hair of fox or squirrels, he took out a book which was claimed to be a dictation of the messenger of Allah (S): praying whilst wearing the hair of anything that is Haram to eat…is fasid and that prayer is not accepted (1)

If it is taken before slaughter, or from an animal that is najis al-ayn e.g. dog or pig, then in addition to that, there in addition to the issue of najasah invalidating prayer, it also may invalidate ghusl and wudhu, especially if it is on the place of washing. This same argument would also be applicable if the organ is taken from a Kafir that is not of the Book (as considered by the majority but not all Shii scholars).

However, some of the great scholars believe that after transplantation, the organ becomes from the body of the person who has received the organ i.e. it becomes tahir (although the author is unsure of this).

As for the person who is not respectable – this refers to the following according to Ayatullah Muhsini:

-          prisoner of war (check – harbi), or an apostate – it is allowed to take the organ from him for a Muslim

-          as for the one who has been executed as a punishment (hadd), it is not allowed, as executing must occur in the way the law has prescriped, and taking an organ is an extra point for which there is no evidence for; and it is a dhulm that is haram

-          as for the one who has been executed as a qisas, then it is as above unless he is happy with it

In the next blog, we will discuss the remaining areas of interest for live transplantation.

(1) Wasa`il from al-Kafi, volume 4, Page 345 in the electronic copy

Organ donation (7)

In this blog, we will start looking at the issue of amputating organs from a live person. There are 5 angles to look at this according to Ayatullah Muhsini:
• Is amputation allowed at all
• The one from whom the amputation is done
• The amputated organs
• The one to whom the amputation is done
• The goal of transplantation

In this blog, we will focus on the first point: is amputation from a live individual allowed at all? Firstly, it is not allowed to cause harm (idrar) in shari’a, whether to oneself or to another person. And the importance of saving someone else is through normal means not through amputating the organs of other people and transplanting them into the person who is injured!

There is a principle in Islam called “la darar wa la dirar” (1) which basically means that Islamic law will never cause harm, and if it does, it is not Islamic law. The question that we are asking, is whether this is applicable in this case. So let’s consider the three types of causing harm (idrar):

1. causing oneself to die in any way – this is Haram and there is no doubt in this. You are not allowed to help someone in need, even if you are about to die in a few minutes (although there is discussion on this point especially on the definition of death).

2. causing damage to important organs e.g. hand, leg, tongue, removing your eye and similar things that you know Allah would not be content with things like causing yourself to get serious diseases e.g. TB, cancer, aids, leprosy – this is Haram based our certainty that Allah would not be content with it (whether or not there is specific evidence in the texts for this or not); although it is sometimes based on ihtiyat e.g. in the case of removing your eyes to transplant it into the head of a great scholar of religious stature who is blind. However, there is a question whether giving e.g. one eye only falls into this category. Ayatullah Fadallah, for example, allows it but Ayatullah Jannaati does not. As you can see, it is a judgement call as to whether this falls into the this category or the one below.

3. causing harm in a fashion less than the above two and this is not Haram because there is no evidence to say it is Haram. The principle of “la darar wa la dirar” does not mean it is always haram to harm oneself e.g. it is allowed to eat a specific type of greasy burger with chips, or choosing to walk up a steep flight of stairs when your ankle is hurting. Therefore, it is allowed based on Asalat al-bara`a (i.e. the principle that everything is allowed, unless you know otherwise) or based on the understanding of the rational people that people have dominion over their wealth and themselves. As for the third case, it is allowed, and if someone’s life depends on it, then it becomes wajib.


Now consider the case where someone who gives one of his kidneys and is not cause any harm to the donor in actuality but he fears for himself that he may get ill in the future and require a kidney but might not be able to get one. Is that person allowed to be a donor? There are two points of interest:

1. It is possible to use istis-hab and assume the initial state of not being ill
2. However, this is not relevant to the state of pain/fear

This means that it is not allowed to give it due to the harm caused, even if the other person is his son, and this fear is of severe discomfort (haraj) for the father.

You have two rules in contradiction: the la haraj (no severe discomfort) rule, and the rule of not being allowed to harm onself. Some may say that there is an issue with the usage of the la haraj principle here (details in earlier part of the book), but one might also argue that the potential of this kind of harm in the future is unlikely and does not require the rational person to push it.

(1) al-Kafi, vol 5, page 280, 292 in the electronic version

Organ donation (6)

In this blog we will focus on donating organs from a dead Muslim that are not necessary to save the life of the other – just to improve the well-being of the other person. Of course, those scholars who only allow donating an organ to save the life of a Muslim would not consider this section relevant to them.

Therefore, the focus here is on Ayatullah Fadlallah’s view on the topic. His position is quite simple, and is actually based on the discussions in the previous blog i.e. if when you way the pros and cons of the situation, and consider the improvement in life of the other person, more important than the negative on the dead individual (of e.g. taking out an eye that he has no relationship with), then you can perform the operation – otherwise you cannot.

He also then moves onto the fact that if someone makes it clear that they want to give up some of their organs after they die, as many do in organ cards…etc – and if it is a serious intention (not just a joke as some do), then this has serious value and is like a will. And in such a situation, there is no issue of respecting the dead individual, because a person is respected based on the personal honour of the individual, and by making this will/signing the card, they are negating their right for their body not to be cut.

Ayatullah Fadlallah also uses the Qur’an to back up this view and considers it more an act of goodness and preference, which is something that is praised from the legal perspective. The Quranic verse he uses is (1):

“but give them preference over themselves, even though poverty was their (own lot)” (Hashr: 9)

Ayatullah Mohsini also discusses Ayatullah Khui’s view here, and notes that if we say that it is allowed for a mu’min to gift his kidney to his brother for example, and there is no darar (harm) for him, and he is not disgraced (based on the ‘urf), what is the problem in allowing to take it after his death if there is a will? Not to save life only, but also to eliminate harm from him. Perhaps for this reason, Sayyid al-Hakim and al-Khui allowed this, if there is a will.

If there is no will, then it is not possible. There is a question when a life of someone is reliant on it but the wujub of saving someone’s life is not absolute, given the right of the person alive, even if it is allowed (or required) in cases. However, no shii scholar allows this.


Now what about amputating organs of dead person for anatomy or teaching students of medicine, based on the wajib kifa`i of teaching medicine?

Ayatullah Muhsini mentions the point that there is no doubt if it is a non-Muslim and if there are non-Muslim dead bodies available, then that would be allowed – even importing such bodies from another country – this would be a way to maintain the respect of a dead body. However, he notes that there is an opinion that this is allowed if it is in the will of the individual, as long as it still results in a burial in the end. Ayatullah Fadlallah (in the texts I read – did not comment on this point directly).

In the next two blogs, we will focus on the more agreed-upon issue about organ transplantation from a live donor.

(1) Medical morality and the morality of life; a lecture by Ayatullah Fadlallah at the university of Qadis Yusuf, 1 March 2002

Organ donation (5)

In the previous blogs, we have concluded that the base position is that it is impermissible to cut the body of a dead Muslim in general. We also covered why it is allowed to cut the body of a non-Muslim because of the importance of respecting their viewpoints where it is not against the state law.

So the question in this blog is whether it is always the case that it is impermissible to cut the body of a dead Muslim.

Consider the situation of saving a Muslim life – this is a wajib act. Therefore, we have a situation where we have two rules in parallel:
1. It is wajib to respect the dead body and therefore haram to cut the dead body of a Muslim
2. It is wajib to save the life of a Muslim

These are seemingly contradictory, and therefore, you have to analyse which takes priority (based on the usuli law of “tazahum” (Shii name) or “masalih al-mursalah” (Sunni equivalent)). Clearly, you cannot do both, and therefore you have to consider which has a greater weight and based on that, choose one to determine the final law.

In many usul works, you see the example of if there is someone drowning in the river, and saving him requires breaking a door down, in order to be able to get to the person drowning before he drowns – in such a situation, it is wajib to save the drowning person, because that is more important. (1 for example provided by Syed Fadlallah)

We are therefore faced with the situation – giving the dead person respect, and saving the life of any person, it is clear that saving the life of a person takes precedence, according to Ayatullah Fadlallah.

[there is a discussion about whether any diya must be paid in this case, because you are intentionally doing something haram – but I will not go into the details of this here (2)]

A VITAL point must be drawn out here – and that is that Ayatullah Muhsini only discusses this with regards to saving a Muslim life, whilst Ayatullah Fadlallah does not make this distinction and considers it to be allowed to save the life of both a Muslim and a non-Muslim.

Many Shii scholars, including Ayatullah Seestani, consider it allowed to amputate an organ from a Muslim to save the life of a Muslim but consider it “problematic” to save the life of a non-Muslim. (3)

I have looked but have not found any detailed discussion of why this might be the case, although I have my own thoughts, which we can discuss if anyone is interested. Liyakat Takim, author of Shi’ism in America, has put forward his view on the reasoning: “In all probability, the differentiation is a anchored in classical texts on warfare where it was declared that if non-Muslims refuse to accept Islam or pay the jizya, male unbelievers may be killed. This implies that the guilt of refusing to adopt Islam deprives a non-Muslimof the right to life, and therefore, such a person deserves whatever harm may come to her/him. The moral guilt of not accepting Islam means, in the case of medical ethics, that beneficence is optional with respect to non-Muslim lives, whereas it is obligatory with respect to the lives of Muslims. The implication is that Muslim lives are more important than non-Muslim lives.” (4)

In the next blog, we will consider the discussions concerning whether it is allowed to amputate organs from a dead Muslim, for non-life-saving reasons e.g. the eye, or for research…etc.

(1) Al-tib wa al-din, lecture at the “Mustashfa al-Sharq al-Awsat” (lit. the hospital of the Middle East), in Beirut, 12/9/1995
(2) There is a discussion about whether you have to pay diyah because you are causing harm (in the same way as you pay compensation if you cause harm to someone when they are alive): some say it is absolutely wajib in all cases, others say it is not wajib in any case (because there is no diya in saving someone else’s life as it has been legislated as wajib and the rule in this case has been agreed that it is the right thing to do), and some say it is wajib if there is no will, or if there is a will – Ayatullahs Khui and Seestani for example considers diya only required if there is no will; some also discuss the importance of seeking the permission of the family/their viewpoint because their honour may be affected but others consider this irrelevant, as the family do not own the dead body, and the dead body is not inherited by its family…etc.
(3) http://www.al-islam.org/laws/contemporary/muamalat4.html; http://www.alulbayt.com/rulings/16.htm; http://www.najaf.org/english/book/2/inside/41.htm, I also emailed najaf.org directly to confirm this point, and the wording used was unambiguously clear that he did not allow the amputation of organs from a Muslim other than if the life of a Muslim depended on it.
(4) Shi’ism in America, P168-169