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      Clarification on Islamic Jurisprudence and Transplantation

      , MD 1 , , , MD 1 , , PhD 2
      Transplantation Direct
      Lippincott Williams & Wilkins

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          We read with interest the article by Padela et al 1 on Islamic jurisprudence, organ transplantation, and the recent Fiqh Council of North America ruling. 2 Transplantation has long been contentiously discussed in Islamic medical ethics communities. In such dilemmas where the Qu’ran or Hadīth do not clearly describe the proper course of action, principles including ijtihad (independent legal reasoning), 3,4 istihsan (preferential reasoning of jurists), al-urf (local customary precedent), and al-masalih al-mursalah (public interest or welfare) may offer guidance. 5,6 Ijtihad-generated rulings (fatawa), however, are case specific and not globally binding. 5,7,8 Jurist disagreements (ikhtilaf) are common and key to understanding the Islamic legal tradition. 9 This means that a jurist’s ruling on 1 case (eg, transplantation) is not by default invalidated or reversed by an opposite finding by a different jurist on a different case of the same topic. 10,11 This may in part be because the merits, context, and participants in each case differ. A Muslim scholarly saying states: our opinion is a right one with the possibility of being wrong, and others’ opinions are wrong ones with the possibility of being right. 10 Failure to understand this concept may generate uncertainty, confusion, and aid conflict. Important theological elements for understanding Islamic views toward transplantation include the sacredness of life (Qur’an 5:32), respect for the human body and its use (Qur’an 17:36,70) and Hadīth of the Prophet Muhammad (‘alayhi as-salām). i12,13 Accordingly, some may believe that organ transplantation/donation is prohibited; however, several Islamic jurisprudential principles have allowed others to determine its permissibility including (1) necessity-breaks-the-law (darūra); (2) working for the public interest or wellbeing of society (al-masalih al-mursalah); and (3) altruism (al-ithar). Darūra may allow for exceptions to general rules, while al-masalih al-mursalah and al-ithar may allow arguments that overrule the individual in favor of greater society. 14 Disagreements exist regarding transplantation fatawa. Of 42 identified fatawa (Table 1), 23 were Sunni (13 permissible, 7 conditional, 3 prohibited), 16 were Shi’a (4 permissible, 11 conditional, 1 prohibited), and 3 were joint Sunni/Shi’a (1 permissible, 2 conditional). Thirty-six (86%) of fatawa permit organ donation conditionally or unconditionally. Autologous transplantation is widely accepted if performed for medical indication (ie, not cosmetic), success is likely, and it carries no mortality risk. 14 Proposed restrictions to allogeneic transplantation including (1) donor has full mental capacity; (2) donor consent (may be granted postmortem by closest relatives) 15 ; (3) adult (preferable >21 y); 15,16 (4) medically determined to be lifesaving or able maintain the recipient’s quality-of-life without suitable alternative; (5) recipient benefit exceeds donor harm and some stipulate; and (6) live donation only of nonvital (ie, self-renewing) or nonsingular organs (eg, hematopoietic cells, skin, kidney, lung, liver). 14 Gonad transplantation is forbidden; however, other internal sex organs (eg, uterus) may be permissible. 14 TABLE 1. Summary of Islamic fatawa regarding the permissibility of transplantation Given the quantity, language, and timeline of rulings, topic knowledge of individual religious leaders may vary. Public awareness of transplant fatawa is suboptimal. 9,55–61 Fatawa have limitations and are case specific; context is important. A dissenting ruling arising within 1 context, time, or location is not necessarily binding on those in another, and vise-a-versa. Accordingly, transplant permissibility may justifiably vary by circumstance, time, location, and context.

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          Organ transplantation: A Sunni Islamic perspective

          This paper reviews the standpoints of Muslim jurists within the Sunni tradition on organ transplantation. Muslim jurists allowed different forms of bone grafts (autograft, allograft and xenograft) for widely broken bones. Ibn Sina in 1037 discussed this subject in Al-Kanoon 1000 years ago. In 1959, the Muftis of Egypt and Tunisia allowed, under specific conditions, corneal transplants from dead persons. Thereafter, many fatwas (jurisprudence) on organ trans-plantation have been issued from different parts of the Muslim world. In Amman, Jordan, the International Islamic Jurist Council recognized brain-death as a recognized sign of death in Islam in October 1986. This paved the way for organ transplantation from brain-dead persons, which started immediately in Saudi Arabia. In 1990 and 2003, the International Islamic Fiqh Academy (IIFA) and the Islamic Fiqh Academy (IFA) issued important fatwas on organ transplantation. By the end of 2008, more than 3600 organs were transplanted from brain-dead persons in Saudi Arabia.
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            Improving the potential for organ donation in an inner city Muslim American community: the impact of a religious educational intervention.

            We aimed to assess the willingness of Muslim Americans to be potential organ donors, to describe potential religious barriers to organ donation, and to evaluate the efficacy of a brief religious educational intervention. Face-to-face survey with English-, Arabic-, and Urdu-speaking Muslim American adults in places of worship and gatherings. The two-part survey included questions about demographics and organ donation. A brief educational intervention followed, which included an explanation of organ donation, along with the evidence for Islam's support for organ donation. After this intervention, the questions about organ donation and brain death were repeated. The response rate was 81% (231 of 285). Fifty percent of the respondents would donate their organs. Twenty-five percent changed their opinion and accepted the idea of being donors after the educational intervention. Lack of awareness of the support of Islam to organ donation and fear of disfigurement were the most common barriers cited. Muslim Americans are less likely than Caucasian Americans to be organ donors, and the perceived lack of support from Islam for organ donation is a factor. The effectiveness of our brief religious education intervention suggests that further education may improve organ donation rates among the Muslim community. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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              Relationships between Islamic religiosity and attitude toward deceased organ donation among American Muslims: a pilot study.

              Religion-rooted beliefs and values are often cited as barriers to organ donation among Muslims. Yet how Islamic religiosity relates to organ donation attitude among Muslims is less studied.

                Author and article information

                Transplant Direct
                Transplant Direct
                Transplantation Direct
                Lippincott Williams & Wilkins (Hagerstown, MD )
                August 2020
                17 July 2020
                : 6
                : 8
                : e583
                [1 ] Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA.
                [2 ] Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
                Author notes
                Correspondence: Andrew C. Miller, Department of Emergency Medicine, Nazareth Hospital, 2601 Holme Ave, 3rd Floor, Marian Bldg, Philadelphia, PA19152. ( Taqwa1@ 123456gmail.com )
                Copyright © 2020 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                : 5 March 2020
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                : 30 April 2020
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