بِسۡمِ اللهِ الرَّحۡمٰنِ الرَّحِيۡمِ

DOES THE U.K. MUSLIM PUBLIC HAVE A RIGHT TO THE TRUTH?

ORGAN DONATION WEEK 18-24th SEPT. 2023

We are approaching organ donation week once again. And once again there will likely be talks, presentations and campaigns in masaajid, Islamic centres, community centres and elsewhere to nudge UK Muslims towards deceased organ donation. Most ,if not all, of talks, presentations and campaigns are tailored to promote deceased organ donation. The focus on the need for organ donors from the Asian community and the fact that many Isamic scholars and countries conider it permissible to donate organs after death. Both these facts are true but it is not the whole truth.
Does the UK Muslim public have a right to know the whole truth about deceased organ donation before making a decision? If so, whose responsibility is it to tell them the whole truth? Disclosure of all relevant facts is necessary to allow an individual to give informed consent for any surgical procedure. Why not for organ donation?

There is a fear that revealing the whole truth may lead to many Muslims opting out of deceased organ donation. It is a very sensitive and emotive subject which is why most people do not wish to raise the issue for a fully open discussion as it may lead to one becoming unpopular or being shunned.

It should be stressed that there is a great need for Asian organ donors because Asians are over-represented on the transplant waiting list and under-represented on the organ donation register. Asians in the U.K., on average, have to wait longer for an organ than their white counterparts due to lack of suitable organs. Organ transplantation has undoubtedly been one of the great successes of modern medicine. All doctors can testify to that fact. Thousands and thousands of patients have had their lives transformed by organ transplantation.

From an Islamic perspective there are two underlying facts upon which we can say there is unanimous agreement amongst the scholars in the context of deceased organ donation:

1. It is forbidden (ḥarām) to remove organs from a dead body.
2. It is strictly forbidden (ḥarām) to kill a person.

Some scholars have opined that it is permissible to remove organs from a dead body based on the Islamic principle of ḍarūra (necessity). Whether or not the required level of necessity is reached or not is determined by the lslamic scholars. Those who understand what deceased organ donation actually involves realise that the real question is not, “Is it permissible in Islam to remove organs from a dead body?” Those Islamic scholars who consider it to be permissible assume that the organ donors are actually dead. So, the first real question is, “Are the organ donors actually dead?” And, secondly, if they are not actually dead, “Is it permissible to deliberately end the life of an individual whose chances of survival are almost zero in an effort to save the life of another person?”  In the UK Mufti Butt has tackled the first question and Dr. R. Rashid, a traditional Islamic scholar and physician, has addressed both these questions.

Dr. Rashid’s argument is based on the assumption that the role of the soul is to command the body; with the permanent loss of consciousness, sentience (capacity to feel) and volition (capacity for decision making), which are all features of a brain dead individual, it can be deduced that the soul has left the body and the person can be said to be Islamically dead¹.[1] However, there is no scriptural text to support this assumption about the role of the soul nor can the soul be confined to the brain hence the notion of a brain dead person being Islamically dead is debateable. The default status is that a person is alive unless proven otherwise.

Dr. Rashid has also put forward the argument that an analogy can be drawn between brain death and unstable life (al-ḥayāt ghayr al-mustaqarrah), a concept discussed by classical Muslim jurists under criminal law in the context of an external injury leading to a state close to death. An example of unstable life is a sacrificial animal whose throat has been cut such that death is certain in a relatively short period of time. This analogy is objectionable because unlike a sacrificed animal a brain dead individual can be kept alive for long periods of time sometimes years. Anybody can see a sacrificed animal is about to die while a brain dead individual does not even look dead. The removal of organs from a brain dead individual would constitute a criminal offence under Islamic law but the punishment could be overlooked as it is done for a good cause.

On the other side of the debate Dr. A. Hussain has argued that brain death is most certainly not actual death²[2] as understood by the general public since the inception of mankind. His article entitled, “Is brain death actual death? Certainly not!” has been reproduced by Darul Uloom Nadawatul Ulama in their monthly English publication entitled Fragrance of the East³ [3] which implies that these ulama concur with Dr. Hussain’s opinion that brain death is not actual death. Dr. Hussain’s argument is that a brain dead person does not look dead, he has many signs of life, and he may not have even a single organ in his body that is dead while he is being declared dead. To declare such a person dead is irrational. Furthermore, if it was possible to remove organs from truly dead people for the purposes of organ transplantation then there would be no shortage of organs in the UK or for that matter any other country. In the UK there are about 6000 people waiting for an organ transplant whereas the total number of people who die annually is 600,000. The reality is we need “living organs from dead bodies” and the only way to solve this conundrum is to declare individuals diagnosed with brain death (which means loss of brainstem function) as legally dead. Such individuals although not actually dead have near zero chance of recovery, they will remain unconscious and dependent on life-support (ventilator) until actual dead occurs which may take days or even years.

Mufti Butt in this very detailed 2019 fatwa⁴[4] on organ donation commissioned by the NHS concluded that in his opinion removal of organs from a dead body for organ transplantation is permissible within Islam but he does not consider organ donors to be dead. So, from a practical perspective only dead tissue can be removed. Professor A. Padela, an internationally recognised figure in the field of Islamic bioethics, is also of the opinion that brain death is not death as detailed in the FCNA fatwa⁵[5] on organ donation and transplantaion.

In a secular utilitarian society, it may not actually matter if the organ donors are actually dead or not as long as they are dead enough but this stance is not acceptable in Islam.

In the UK it is difficult to judge whether the majority of Islamic scholars are pro or against deceased organ donation. Most probably do not understand what the whole involves. It is proabaly true to say if they were told about the the controversy surrounding brain death they would err on the side of caution and consider it to be imperssible to take the life of an individual who may not be actually dead to try to save the life of another. Most UK Muslim doctors are in favour of deceased organ donation because they have seen the benefits of organ transplantation and most are unaware of the controversy surrounding brain death, during medical training brain death is equated with actual death.

The article is not written to push into towards or away from doanting thir organs after "death" but to provide information which is often deliberately omitted by the promoters of deceased organ donation.

After you have considered the matter carefully and derived at a decision, you can register your decision to donate or register your decision not to donate. 

Dr. A. Hussain, Sep. 2023