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Presentation
to 4th year medical students at Salman University Kharj by Professor
Omar Hasan Kasule Sr. on 14th May 2013
Introduction
The first organs involved in transplantations were the skin, the bone, the teeth, and the cornea. Later
kidney, heart, lung, and liver transplants were achieved. Glandular and
neurohumoral organs will be transplantable in the future. Transplantation
decisions are a balance between risk and benefit. Ethical and legal problems of
transplantation are temporary, they will disappear with the use of xenografts,
artificial organs, and cloned organs.
Legal rulings about transplantation
Uses of textual, nass, evidence
has limited success because the issues involved in transplantation are new and
were not dealt with before. General Purposes of the Law, maqasid al sharia, and the General Principles of Fiqh, al qawaid al fiqhiyyat are the more
appropriate tools.
The main guide about
transplantation is the purpose of maintaining life of the donor and the
recipient.
Under the principle of hardship,
necessity and hardship legalize what would otherwise be objectionable or risky
lowering donor risk has precedence over benefit to the recipient the
complications and side-effects to the recipient must be a lesser harm than the
original disease.
Under the principle of injury, transplantation relieves an injury to the body in as far as is possible but its complications and side-effects should be of lesser degree than the original injury.
Abuse of transplantation by
abducting or assassinating people for their organs could lead to complete
prohibition under the principles of dominance of public over individual
interest prevention of harm has priority over getting a benefit and pre-empting
evil.
Under the principle of custom brain death
fulfills the criteria of being a widespread, uniform, and predominant customary
definition of death that is considered a valid custom.
Selling organs could open the
door to criminal commercial exploitation and may be forbidden under the purpose
of maintaining life, the principle of preventing injury, the principle of
closing the door to evil and the principle of motive. Protecting innocent
people from criminal exploitation is a public interest that has priority over
the health interests of the organ recipient. Principle of motive will have to be invoked to forbid
transplantation altogether if it is abused and is commercialized for individual
benefit because the purpose will no longer be noble but selfish. Matters are to
be judged by the underlying motive and not the outward appearances.
Other considerations in
transplantation are free informed consent, respect for the dignity of the human
ownership and sale of organs, taharat
of the organs, sadaqat, and iithaar.
The following are allowed: use of
animal organs, use of artificial organs, auto transplantation, transplantation
from a living donor.
Organs from prisoners condemned
to death can be used provided there is dharuurat.
Indications, side effects, and complications
The indications of
transplantation are irreversible organ failure and sub-optimal organ function.
Transplantation on the basis of preventive maintenance of organs in good
condition is not allowed. The associated side effects and complications of
immune suppression, infection, neoplasia, graft rejection, and drug toxicity
are treated under 2 principles of the Law: hardship, mashaqqa, and injury, dharar.
Procuring and harvesting organs
The demand for organs is more
than the supply. Human organs could be obtained either as voluntary gifts or
voluntary sale. The donor may be living or may be dead. Living donors could be
free persons or prisoners condemned to death. Harvesting organs from an
individual without his or her free consent is not allowed by the law.