Source
Date
Fatwa
Sheikh Maamoon (Grand Mufti, Egypt)
1959
Sanctioned blood transfusion
Sheikh Maamoon (Grand Mufti, Egypt)
1959
Sanctioned corneal transplants
Sheikh Hureidi (Grand Mufti, Egypt)
1966
Sanctioned organ transplants
Islamic Int. Conference (Malaysia)
1969
Sanctioned organ transplants
Algiers Supreme Islamic Council
1972
Sanctioned organ transplants
Sheikh Khater (Grand Mufti, Egypt)
1973
Allowed harvesting skin from unidentified corpses
Saudi Grand Ulema
1978
Sanctioned corneal transplants
Sheikh Gad A1 Haq (Grand Mufti, Egypt)
1979
Sanctioned live and cadaveric donation
Kuwaiti Fatwa of Ministry of Endowment
1980
Sanctioned organ transplants
Saudi Grand Ulema
1982
Sanctioned organ transplants
3rd Int. Conference Islamic Jurists (OIC)
1986
Equated brain death with cardiac death
4th Int. Conference Islamic Jurists (OIC)
1988
Sanctioned organ transplants and trafficking
6th Conference Islamic Jurists (OIC)
1990
Discussed transplantation from embryos, IVF projects, CNS and auencephalics
A Fatwa by Grand Mufti is almost a decree and not a mere juridical opinion; so is a Fatwa by a Conference of Jurists. However, each country legislative parliament should endorse it to become a law.
The majority of the Muslim scholars and jurists belonging to various schools of Islamic law invoked the principle of priority of saving human life and hence gave it precedence over any other argument. Sheikh Hassan Mamoon (the Grand Mufti of Egypt) also sanctioned corneal transplants from cadavers of unidentified persons and from those who agree to donate upon their death (Fatwa No. 1084 dated 14 April 1959) [36]. His successor, Sheikh Hureidi, extended the Fatwa to other organs in 1966 (Fatwa No. 993) [37]. In 1973, the Grand Mufti, Sheikh Khater, issued a Fatwa allowing harvesting of skin from an unidentified corpse [38].
Grand Mufti Gad Al Haq sanctioned donation of organs from the living provided no harm was done and provided it was donated freely in good faith and for the love of God and the human fraternity. He also sanctioned cadaveric donors provided there was a will, testament or the consent of the relatives of the deceased. In the case of unidentified corpses, an order from the magistrate should be obtained prior to harvesting organs (Fatwa No. 1323 dated 3 December 1979) [39]. The Saudi Department of Research Fatwa studied corneal transplantation in H1376 (1976) and H1397 (1977). The Saudi Grand Ulama sanctioned corneal transplant the following year (Decree No. 66 H1398/1978) [40].
In Algiers, the supreme Islamic Council sanctioned organ transplantation in 1972, while in Malaysia, the International Islamic Conference sanctioned organ transplantation in April 1969 [41].
The Saudi Grand Ulama Fatwa No. 99, 1982, addressed the subject of autografts, which was unanimously sanctioned. It also sanctioned (by a majority) the donation of organs both by the living and by the dead, who made a will or testament, or by the consent of the relatives (who constitute the Islamic next of kin) [42]. The Kuwaiti Fatwa of the Ministry of Charitable Endowments No. 132/79, 1980 sanctioned live and cadaveric organ donation [43]. The Kuwaiti law No. 7, 1983, reiterated the previous Fatwa and pointed out that living donors should be over the age of 21 years in order to give their own consent.
The subject of the brain death was not addressed in any of these Fatwas. It was discussed for the first time in the Second International Conference of Islamic Jurists held in Jeddah in 1985. No decree was passed at that time, until further studies and consultations were obtained. In the Third International Conference of Islamic Jurists (Amman 1986), the historic resolution (No. 5) was passed with a majority of votes, which equated brain death to cardiac and respiratory death [44]. Death in the true Islamic teaching is the departure of the soul, but, as this cannot be identified, the signs of death are accepted. This decree paved the way for an extension of organ transplantation projects, which were limited to living donors. Campaigns for organ donation from brain-dead persons were launched both in Saudi Arabia and in Kuwait.
The unfortunate high incidence of road accidents in the Gulf area provides many cases of brain death. The tragedy should be averted by issuing and pursuing stricter traffic laws, and by other means. Meanwhile, it is a pity to waste such candidate cadavers without trying to save the life of many others who need their organs.
The Islamic Fiqh council of Islamic World League held in Makkah Al Mukaramah (December 1987), which passed Decree No. 2 (10th session), did not equate cardiac death with brain death. Although it did not recognize brain death as death, it did sanction all the previous Fatwas on organ transplantation. This decree received little publicity in the media, and cardiac and kidney transplants from brain dead individuals continued 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 in February 1988 (Resolution No. 1). It endorsed all previous Fatwas on organ transplantation, clearly rejected any trading or trafficking of organs and stressed the principle of altruism [45].
Later, the Islamic jurists started to discuss new subjects related to organ transplantation, viz. (A) Transplantation of the nerve tissue as a method for treating Parkinsonism or other ailments
Transplantation from anencephalics;
Transplantation of tissues from embryos aborted spontaneously, medically or electively;
Leftover pre-embryos in vitro fertilization (IVF) projects [46].
The Sixth International Conference of Islamic Jurists, held in Jeddah in March 1990, addressed all these issues fully [47]. It sanctioned transplantation of nerve tissues to treat ailments such as Parkinsonism, if this method of treatment proved superior to other well-established methods of treatment. The source of the nerve tissues could be:
1.
The suprarenal medulla of the patient himself (autograft);
2.
The nerve tissues from an animal embryo (xenograft);
3.
Cultured human nerve cells obtained from spontaneous abortion or medically indicated abortions.
However, the conference deplored the performance of abortion for the sake of procuring organs. It reiterated the Islamic views against elective abortion, which is only allowed to save the life or health of the expectant mother. If, however, the fetus is not viable, organs can be procured if the parents donate and only when the fetus is declared dead. The aborted fetus is not a commodity and commercialism is not allowed.
Anencephalics cannot be used as organ donors until declared brain or cardiac dead. The fully informed consent of the parents should be obtained in every case.
Regarding leftover pre-embryos from IVF projects, the jurists recommended that only the needed ova should be fertilized by the husband’s sperms. However, if excess fertilized ova were found, they should be left to die spontaneously. Cryopreservation or donation of these fertilized ova was not allowed.
The jurists also discussed transplantation of genital organs. They did not allow the transplantation of gonads, as they carry all the genetics inheritance from the donor. However, they sanctioned the transplantation of the other internal sex organs.
In 2003, the Islamic Fiqh council of Islamic World League, Makkah Al Mukaramah in its 17th session passed a Fatwa No. 3, which allowed using leftover pre-embryos for stem cell research and treatment of serious ailments.
Organ Donation Among Muslims in Europe
In his article, ‘‘Religio-ethical discussions on organ donation among Muslims in Europe,’’ Dr Ghaly sheds light on the discussions among Muslim religious scholars on organ donation particularly related to Muslims living in Europe. The article examines three main religious guidelines (fatwas) issued respectively by the UK Muslim Law (Shari’ah) Council in 1995 in the UK, the European Council for Fatwa and Research (ECFR) in 2000 in Ireland and the Moroccan religious scholar Mustafa Ben Hamza during a conference on ‘‘Islam and Organ Donation’’ held in March 2006 in the Netherlands.
The three fatwas studied in this article show that by the end of the twentieth century Muslim religious scholars started to specifically address Muslims in Europe.
The three fatwas examined in this article shared one main purport; organ donation is in principle permitted in Islam [48].
The fatwa issued by the ECFR in 2000 quoted the pro-organ donation fatwas issued earlier in the Muslim world but further added some points of specific relevance to Muslims in Europe. For instance, the fatwa stated that there are no ethical objections to directed organ donation and that donor’s wishes should be respected in this regard as much as possible. As for the role of the deceased’s family, the fatwa opined that if the deceased did not make up his/her mind before death about organ donation, then the deceased’s family has the right to decide. The ECFR went even further by giving the same right to ‘‘the authority concerned with the Muslims’ interests in non-Muslim countries’’ if the deceased’s family was missing. The ECFR fatwa also indicated that there are no objections, from an Islamic perspective, to the opt-out system [49].
The second fatwa analyzed in this article was issued by the UK Muslim Law (Shari’ah) Council in 1995. Different to the ECFR fatwa, this fatwa was much less dependent on the religio-ethical discourse in the Muslim world. The UK fatwa also dedicated much more space to the concept of brain death and argued that this death-criterion is accepted from an Islamic perspective. The fatwa also clearly stated that Muslims may carry donor cards. Like the ECFR fatwa, the UK fatwa expressed no objection to the idea that the deceased’s family can decide if the deceased did not have a donor card nor expressed his/her wish before death. Finally, the fatwa stressed that organ donation should be done freely without reward and that trading in organs is prohibited [50].
The third fatwa studied in this article was issued by a Moroccan scholar, Mustafa Ben Hamza, during a conference on ‘‘Islam and organ donation’’ held in 2006 in the Netherlands. This fatwa approved for a Muslim to donate his/her organs to a non-Muslim. A similar Fatwa was issued by Mufti of Singapore Sheikh Bin Sumait in early 1990s.
Contemporary English Sunni E-Fatwas on Organ Donation
Van den Branden and Broeckaert analyzed 70 English Sunni e-fatwas and subjected them to an in-depth text analysis in order to reveal the key concepts in the Islamic ethical framework regarding organ donation and blood transfusion [51].
They found all 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity.
They state that their findings are very much in line with the international literature on the subject. They also found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity.
The impact of globalization and migration on Muslim minorities living in non-Islamic countries during the past 20 years has been very strong [52].
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