3 Organ Donation and Transplantation

 مِنْ أَجْلِ ذَ ‌ٰلِكَ كَتَبْنَا عَلَىٰ بَنِي إِسْرَآئِيلَ أَنَّهُ مَن قَتَلَ نَفْسًا بِغَيْرِ نَفْسٍ أَوْ فَسَادٍ فِي الْأَرْضِ فَكَأَنَّمَا قَتَلَ النَّاسَ جَمِيعًا وَمَنْ أَحْيَاهَا فَكَأَنَّمَا أَحْيَا النَّاسَ جَمِيعًا ۚ وَلَقَدْ جَآءَتْهُمْ رُسُلُنَا بِالْبَيِّنَاتِ ثُمَّ إِنَّ كَثِيرًا مِّنْهُم بَعْدَ ذَ ‌ٰلِكَ فِي الْأَرْضِ لَمُسْرِفُونَ

Because of that, We ordained for the Children of Israel that if anyone killed a person not in retaliation of murder, or to spread mischief in the land- it would be as if he killed all mankind, and if anyone saved a life, it would be as if he saved the life of all mankind. And indeed, there came to them Our messengers with clear proofs, evidences, and signs, even then after that many of them continued to exceed the limits in the land.”
(al-Māi’dah: 32).

Organ donation has been a controversial issue among the Muslim community in Singapore. It places two main principles in Islam – the importance of maintaining and improving the health and well-being of humans, and the duty to respect the inviolability of the dead – in conflict. This chapter will trace the evolution of the organ transplant fatwa and its formulation, and highlight the debates on the interpretations of Islamic principles vis a vis organ donation, and considerations of the needs of the society and medical advancements. Resolving the Islamic legal position is complex because organ donation is a modern development and there is no direct parallel of this medical procedure in Islamic legal history. The debate thus took into account the various branches of Islamic law, national legislation, as well as ethical and medical viewpoints on the status of the human body.

Background & History of Organ Donation

The idea of healing by substituting a healthy body part for a diseased or absent one, first emerged in the 1600s when early attempts at blood transfusions were made. These attempts were first made on animals and with consequent experiments, more about the circulatory system was discovered gradually such that it could eventually be adapted for humans.  The risks and high failure rate associated with such procedures caused mainstream physicians to shun their use until Karl Landsteiner – a physician and biologist – mitigated such risks through his discovery of blood types in 1901. Subsequently, blood transfusion and banking became widely used in medical science, gaining even more traction due to its necessity during the two World Wars. The concept of medical substitutions was later extended to organs. [1] The first successful organ transplant was carried out on the kidneys of a pair of identical twins in 1954.[2]

Successful transplants of the cornea, lungs, heart and liver quickly followed. Such developments provoked discussion in the Muslim world on two fronts: the permissibility of the act of medical transplants itself and the permissibility of using human bodies for the research necessary to find medical cures. Leaders of the Muslim community in Singapore tackled the latter first but found it difficult to arrive at a conclusion. The first meeting of the Fatwa Committee to discuss the use of human bodies in medical research took place in 1972 and failed to reach a unanimous consensus. In that meeting, majority of the Committee members agreed that the ruling is mubāh (permissible but not obligatory) on the basis that medical research can be beneficial and procedures such as autopsies are necessary. However, two members of the committee abstained.[3]  Another extensive discussion on the issue of the permissibility of organ transplants ensued in 1973. In that meeting, the Committee unanimously concluded upon its impermissibility, regardless of whether the donors pledged their organ voluntarily or unwillingly, and whether the transplant was done on a living or dead donor.[4]  The rationale here was that respect for the sanctity of the body, entrusted to man by God, and the risks in transplant operations supersede potential benefits.

Fatwa Decision 31/7/1973
RULING ON DONATION ORGAN AFTER DEATH

Question:

What is the ruling for a Muslim to donate some of his organs to others after his death?

Answer:

The Fatwa Committee in this meeting unanimously prohibit organ donation, whether the donor is alive or otherwise. The evidences that form this decision according to the hadīth of the Prophet(ﷺ) and the Qur’an are as follows:

Donation when the person is alive is prohibited.

The reasons:

  1. Based on Allah’s statement in Surah al-Baqara, verse 195,

وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِۛوَأَحْسِنُوا

And do not throw yourselves into destruction and do good.” ( al-Baqara:195)

2. Based on a maxim of fiqh which states that,

 الضَرَرُ لَا يُزَالُ بِالضَرَرِ
 “Harm is not removed by harm.”1

3. The body and its organs are entrusted by Allah s.w.t. to man. Each one of them will be questioned on the Day of Judgement. Allah states in Surah al-Isrā’, verse 36:

 إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا
Verily, the hearing, and the sight, and the heart, each of those will be questioned (by Allah)”. ( al-Isrā’: 36)

 

Donation after death (through a will) is prohibited 

The reasons:

  1. Every body that can be buried should be buried. Allah states in Surah al-Mursalāt, verses 25-26,

  أَلَمْ نَجْعَلِ الْأَرْضَ كِفَاتًا ۝ أَحْيَاءً وَأَمْوَاتًا
Have we not made the earth a receptacle. For the living and the dead”. (al-Mursalāt: 25-26)

  1. And Allah states in Surah ‘Abasa, verse 21,

 ثُمَّ أَمَاتَهُ فَأَقْبَرَهُ 
”Then He causes him to die and puts him in his grave”. ( ’Abasa: 21)

  1. The sanctity of the human body is assured in its burial. If a particular organ is given to others, it means that it is not buried. Therefore, the whole body could also be given and not buried.
  1. From the hadīth of ‘Aisyah r.a. where Rasulullah (ﷺ) had stated,

    كَسْرُ عَظْمِ الْمَيِّتِ كَكَسْرِهِ حَيًّا
    Breaking the bones of a dead is like breaking them while he was alive.”- hadīth narrated by Abū Dawūd.

    i) From the book “Al-Majmu’ (New Edition)”, Chapter 5- under the heading “Carrying and burying the dead”.
    ii) Muwaṭṭa’ Ibn Mālik

  1. To cut off a body part of the dead is also defined as hurting men and women who are mu’min [believers]. The ruling is harām. Allah states this in his Surah al-Ahzāb, verse 58:

وَالَّذِينَ يُؤْذُونَ الْمُؤْمِنِينَ وَالْمُؤْمِنَاتِ بِغَيْرِ مَا اكْتَسَبُوا فَقَدِ احْتَمَلُوا بُهْتَانًا وَإِثْمًا مُّبِينًا

“And those who hurt believing men and women undeservedly, they bear (on themselves) the crime of slander and plain sin.” ( al-Ahzāb: 58)

Based on the argument that:

الضَرَر لَا يُزَالُ بِالضَّررِ
”Harm is not removed by harm.”2

Since the extraction of an organ from the body of a dead person damages the body, it is deemed a desecration of the body. This is because there is no assurance that the extracted organ provides a benefit that is larger than the magnitude of the desecration. In contrast, the religious obligation of burying and respecting the dead is based upon clear and evident naṣ [text] as well as it being a deed that has been practised by mankind for thousands of years, apart from a small percentage of men.

  1. When it is haram, the deceased’s will be invalidated because Muslims are unable to carry out his will under Islamic law. This is because we have a stronger ordinance– from Allah and His Messenger (ﷺ) – to bury the remains with all its parts intact without exception, and honoring all the body parts as entrusted by God.
  1. Respect for the dead was commonly practiced by the Prophet (ﷺ). The Prophet always stood up in respect of the dead that was carried past him, even it was a kafir [non-believer].

Sayyid Sabiq had quoted in the chapter of Jenazah in “Fiqhus Sunnah” the words of Ibn Hazam, who stated that:

“It is good to stand when a dead is carried past, even if the dead was a kafir.”

Imām al-Bukhārī and Muslim had narrated from Sahl Ibn Hanif, and Qais Ibn Sa‘ad narrated that once when they were seated in front of the Al-Qadisiah area, a body was being carried past and they stood (to respect him). When the people around them said that the body was that of a kafir dhimmi, they replied: “Rasulullah (ﷺ) once stood to respect the body of a deceased person which was being carried past. Then he was told: “It is the body of a Jew.” To which he replied: “Is it still not a life?” Based on this, Islam does not humiliate or disrespect the dead even if the bodies are those of non-Muslims because Allah says:

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ
”And indeed We have honoured the Children of Adam”. (al-Isrā’:70)

Therefore, how do we justify the act of dismembering or cutting up a dead body without reasons acknowledged by the Sharīʿa?

Additionally, the Mufti advised:

Organ donation is not a deed recognized by Sharīʿa for the following reasons:
i) No text or evidence allow such an act as organ donation. Instead there is only evidence of its prohibition.
ii) Based on the hadīth:

 إذَا مَاتَ ابْنُ آدَمَ انْقَطَعَ عَمَلُهُ إلَّا مِنْ ثَلَاثٍ : صَدَقَةٍ جَارِيَةٍ ، أَوْ عِلْمٍ يُنْتَفَعُ بِهِ مِنْ بَعْدِهِ ، أَوْ وَلَدٍ صَالِحٍ يَدْعُو لَهُ
If the son of Adam dies, his deeds are cut off except for three acts: Lasting charity (i.e. endowment), or beneficial knowledge, or a pious child who prays for him. Narrated by al-Bukhari and Muslim.

This hadīth excludes organ donation as a charity, because it specifically mentions the three things – namely lasting charities, such as endowments or the bequest of wealth if one possesses such wealth – of which only a third of it can be bequested, a pious child, and beneficial knowledge that has been imparted to others.

The Prophet thus encouraged Muslims to seek wealth that would enable them to perform charity, raise their children to be pious individuals who would pray for their parents, and seek useful knowledge to be imparted to others. These are the required services and deeds which have been enjoined upon us. Let us not engage in unworthy matters because God has said:

 وَلَا تَقْفُ مَا لَيْسَ لَكَ بِهِ عِلْمٌ ۚ إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا
And follow not (O man i.e., say not, or do not or witness not) that of which you have no knowledge. Verily, the hearing, and the sight, and the heart, of each of those one will questioned (by Allah)”. (al-Isrā’: 36)

Religion is Allah’s right, thus when issuing a fatwa or a religious ruling, the pleasure of Allah s.w.t and His Messenger (ﷺ) is sought first before the pleasure of men.

Source:
1 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 210
2 Ibid.

Among the Fatwa Committee’s arguments in the first fatwa on organ donation is the consideration of maṣlaḥa and mafsada, and the extent to which either reaches the rank of certainty and clarity (معتبرة). This discussion needs to be situated in its social context. At the time, organ donation was new, and the Muslim world in general was not ready to accept it. Furthermore, the effectiveness of organ transplantation as a treatment was uncertain. Therefore, the Fatwa Committee was more inclined to take a cautious and careful stand, and decided against it. The Muslim community in Singapore at that time could generally relate to this fatwa although a small segment disagreed with the decision. For example, some of them stressed on the necessity of certain organ transplants.

One of those who expressed disagreement with this fatwa was a Singaporean Muslim intellectual Dr Syed Hussein Alatas who shared his views on the need for cornea transplants in the local Malay paper Berita Harian. The Fatwa Committee responded to his writing, and the debate continued through exchanges on the newspaper forum which lasted for a few weeks. The result was published in a booklet which Alatas authored entitled “Biarkan Buta – (Let (them) be blind)”, in which he argued that the fatwa was based on a literalist interpretation of Islam and was regressive by disallowing procedures that could potentially improve the welfare of the sick and disabled.

There were many factors considered by the Fatwa Committee in arriving at its decision on organ transplant. Although the revealed texts presented as the basis for the prohibition of organ transplant in 1973 highlight the obligation to honor the human body, further reading into the ruling and medical advancements between the 1970s and 1980s showed that they were merely exercising caution in assessing the procedure, which was in its early stages. In addition, the subject was still being debated by other Islamic organisations internationally. In terms of medical development, some types of organ transplants – such as liver and lung – were only successfully conducted in the early 1980s.[5]

The Fatwa Committee took note of international developments in religious discussions of the matter. In January 1985, the Islamic Fiqh Academy (مجلس المجمع الفقهي الإسلامي) under the auspices of the World Muslim League, in its eighth Conference in Makkah, issued a fatwa that allowed organ transplant. The Fatwa Committee examined that decision and debated the issue in a number of meetings between January to November 1985. A new decision repealing the earlier fatwa was issued in December 1985.

Fatwa Decision  3/12/1985
KIDNEY DONATION

Question:

Kidneys are one of the most important organs in the human body and they play a major role in our lives. Kidneys can be afflicted with various life-threatening diseases. Dialysis offers a partial solution for kidney diseases through a process of cleansing the blood. The patient would have to visit the hospital 3 times a week in order to cleanse their blood and the process takes about 5 to 8 hours. This method is inconvenient for the patient in all aspects.

The best solution for the patient is a kidney transplant, which would allow them the opportunity to live life normally. The kidneys would be taken from those who died unnatural deaths or donated by willing parties to the patient. What is the Islamic view on the issue of kidney donation / transplant?

Answer: 

The ‘ulamā have discussed this matter and had agreed upon a fatwa, which allows for a kidney donation/transplant in times of ḍarūra (emergency).1

Donation when the person is alive is prohibited. 

The reasons:

  1. Based on Allah’s statement in Surah al-Baqara, verse 195,وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِۛوَأَحْسِنُوا
    and do not throw yourselves into destruction and do good.” (al-Baqara:195)
  2. Based on a maxim of fiqh which states,
     الضَّرَرُ لَا يُزَالُ بِالضَّرَرِ
     “Harm is not removed by harm.”2
  3. The body and its organs are entrusted by Allah s.w.t. to man. Each one of them will be questioned on the Day of Judgement. Allah states in Surah al-Isrā’, verse 36:

 إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا
Verily, the hearing, and the sight, and the heart, each of those will be questioned (by Allah)”. (al-Isrā’: 36)

Donation after death (through a will) is prohibited 

The reasons:

  1. Every body that can be buried should be buried. Allah states in Surah al-Mursalāt, verses 25-26,
    أَلَمْ نَجْعَلِ الْأَرْضَ كِفَاتًا ۝ أَحْيَاءً وَأَمْوَاتًا 
    Have we not made the earth a receptacle. For the living and the dead”. (al-Mursalāt: 25-26)
  2. And Allah states in Surah ‘Abasa, verse 21,
     ثُمَّ أَمَاتَهُ فَأَقْبَرَهُ
    Then He causes him to die and puts him in his grave”. (’Abasa:21)

  3. The sanctity of the human body is assured in its burial. If it were permissible to donate a particular organ- meaning that it was not buried along with the rest of the body, it would imply that the whole body could also be donated and not buried.
  4. From the hadīth of ‘Aisyah r.a. where Rasulullah (ﷺ) had stated,

     كَسْرُ عَظْمِ الْمَيِّتِ كَكَسْرِهِ حَيًّا 
    Breaking the bones of a dead is like breaking them while he was alive.”- hadīth narrated by Abū Dawūd.

    i) From the book “Al-Majmu’ (New Edition)”, Chapter 5- under the heading “Carrying and burying the dead”.
    ii) Muwaṭṭa’ Ibn Mālik

  5. To cut off a body part of the dead is also defined as hurting men and women who are mu’min [believers]. The ruling is haram. Allah states in al-Ahzāb, verse 58:
    وَالَّذِينَ يُؤْذُونَ الْمُؤْمِنِينَ وَالْمُؤْمِنَاتِ بِغَيْرِ مَا اكْتَسَبُوا فَقَدِ احْتَمَلُوا بُهْتَانًا وَإِثْمًا مُّبِينًا 
    And those who annoy believing men and women undeservedly, they bear (on themselves) the crime of slander and plain sin.” (al-Ahzāb:58)
  6. Based on the argument that,
    الضَرَرُ لَا يُزَالُ بِالضَّرَرِ
     “Harm is not removed by harm.3

Since the extraction of an organ from the body of a dead person damages the body, it is deemed a desecration of the body. This is because there is no assurance that the extracted organ provides a benefit that is larger than the magnitude of the desecration. In contrast, the religious obligation of burying and respecting the dead is based upon clear and evident naṣ [text] as well as it being a deed that has been practised by mankind for thousands of years, apart from a small percentage of men.

  1. Respect for the dead was commonly practised by the Prophet (ﷺ). The Prophet always stood up in respect of the dead that was carried past him, even if the dead was a kafir (non-believer).

Sayyid Sabiq had quoted in the chapter of Jenazah in “Fiqhus Sunnah” the words of Ibn Hazam, who stated that:

“It is good to stand when a dead is carried past, even if the dead was a kafir.”

Imām al-Bukhārī and Muslim had narrated from Sahl bin Hanif, and Qais bin Sa’ad narrated that once when they were seated in front of the Al-Qadisiah area, a body was being carried past and they stood (to respect him). When the people around them said that the body was that of a kafirdhimmi, they replied: “Rasulullah (ﷺ) once stood to respect the body of a deceased person which was being carried past. Then he was told: “It is the body of a Jew.” To which he replied: “Is it still not a life?”

Based on this, Islam does not humiliate or disrespect the dead even if the bodies are those of non-Muslims because Allah states that:

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ
”And indeed We have honoured the Children of Adam”. (al-Isrā’:70)

Therefore, how do we justify the act of dismembering or cutting up a dead body without reasons acknowledged by the Sharīʿa?

Additionally, the Mufti advised:

Organ donation is not a deed recognized by Sharīʿa for the following reasons:

  1. No texts or evidences allow such an act as a donation. Instead there are only evidences which forbid it.
  2. Based on the hadīth:

إذَا مَاتَ ابْنُ آدَمَ انْقَطَعَ عَمَلُهُ إلَّا مِنْ ثَلَاثٍ : صَدَقَةٍ جَارِيَةٍ ، أَوْ عِلْمٍ يُنْتَفَعُ بِهِ مِنْ بَعْدِهِ ، أَوْ وَلَدٍ صَالِحٍ يَدْعُو لَهُ
If the son of Adam dies, his deeds are cut off except for three acts: Lasting charity (i.e. endowment), or beneficial knowledge, or a pious child who prays for him.”
– Narrated by al-Bukhārī and Muslim.

This hadīth excludes organ donation as a charity, because it specifically mentions the three things – namely lasting charities, such as endowments or the bequest of wealth if one possesses such wealth, of which only a third of it can be bequested;  a pious child; and beneficial knowledge that was imparted to others.

The Prophet thus advocated Muslims to seek wealth that would enable them to perform charity, raise their children to be pious individuals who would pray for their parents, and seek useful knowledge to be imparted to others. These are the required services and deeds which have been enjoined upon us. Let us not engage in unworthy matters because God has said:

وَلَا تَقْفُ مَا لَيْسَ لَكَ بِهِ عِلْمٌ ۚ إِنَّ السَّمْعَ وَالْبَصَرَ وَالْفُؤَادَ كُلُّ أُولَـٰئِكَ كَانَ عَنْهُ مَسْئُولًا 
And follow not (O man i.e., say not, or do not or witness not) that of which you have no knowledge. Verily, the hearing, and the sight, and the heart, each of those will questioned (by Allah)”. ( al-Isrā’: 36)

IN THE TIMES OF ḌARŪRA

The definition of ḍarūra means that there is a necessity to save lives. Kidney transplants are allowed under conditions of “ḍarūra”. The word “ḍarūra” must be emphasised. This is based on a maxim of fiqh:

الضَرُورِيَّاتُ تُبِيحُ المَحظُورَات
Neccessity makes the unlawful lawful .”4

In Surah al-Baqara, verse 173, Allah states that:

فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلَا عَادٍ فَلَا إِثْمَ عَلَيْهِ ۚ إِنَّ اللَّهَ غَفُورٌ رَّحِيمٌ
But if one is forced by necessity without willful disobedience nor transgressing due limits, then there is no sin on him. Truly, Allah is Oft-Forgiving, Most Merciful”:( al- Baqara: 173)

 

If the donor is still alive:

  1. The donor must be a mukallaf.5
  2. The donor must be willing and cannot be coerced.
  3. It can be ensured that the operation would normally succeed.
  4. It does not put risks on the donor.

If the organ is taken from someone who has died:

  • The inheritor has given permission.
  • The deceased had expressed willingness when he was still alive, verbally or otherwise, to donate his kidneys.
  • If the person had pledged to donate his kidneys after his death and the plan had been discussed with his inheritors when he was alive. Therefore, if both the donor and the guardians signed an agreement, then it could be concluded that the guardian is agreeable to the donation, so long as his agreement is not withdrawn. To prevent the decay of the kidneys while getting the permission of the guardians, such a transplant is considered as a ḍarūra. Therefore, the permission of the guardian is no longer necessary.

This is based on the following fish maxims:6

إِذَا ضَاقَ الأَمْرُ اِتَّسَعَ
If a problem constricts, then it should expand.”

المَشَقَّةَ تَجْلِبُ التَيْسِيرِ
“Difficulties bring about facilitation.”

الضَرُورَاتُ تُبِيحُ المَحْظُورَاتِ
“Necessity makes the unlawful lawful.”

In general, we have to ensure that kidneys do not become commodified. Kidney donations should also be spontaneous and not kept in “banks”.

Source:
Majalla Al-Majmaʿ al-Fiqh al-Islāmī li Muʾtamar al-Fiqh al-ʿAdad al-Rābiʿ,(1988), vol.1,267.
2 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 210
3 Ibid.
4 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 211.
5  A person who is obliged to act in accordance with Allah’s orders and to perform worshipping.
6 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 208.

This 1985 fatwa allows organ transplants in cases of dire emergency, based on the Islamic principle that the preservation and protection of a human life is more important than maintaining the integrity of a human body. It thus marks a shift in the Fatwa Committee’s thinking.  One of the reasons for this shift was the sharp increase in the number of people afflicted with kidney problems requiring organ transplants, almost to a critical level. Such circumstances were considered an emergency. Changes to the Fatwa Committee’s opinion can also be pinned to their increased awareness of the difficulties and suffering faced by patients, which was relayed through various studies to the Fatwa Committee, and its greater exposure to the discussions on the issue by Muslim scholars at the international level.

In the 1980s, organ donation was a relatively new issue for the community, and the discussions persisted until the 1990s among local religious teachers and Muslim organizations. One of the platforms for such discussions was a seminar organized by Jamiyah Singapore. This seminar, which took place from 6-8 May 1994, brought together religious teachers and international religious experts, including those from Brunei and Saudi Arabia. The Mufti of Singapore at the time, Shaikh Syed Isa Bin Mohamed Bin Semait, was one of the five paper presenters. The seminar discussions indirectly contributed to an increased awareness and acceptance by the Muslim community of the need to review the ruling on organ donation. The seminar also demonstrated that it was not a local issue; scholars from other countries recognised the need to provide religious guidelines to help patients who needed organ transplant. The 1990s observed a shift as discussions moved from the question of  permissibility of organ transplants to the types of organs that were permissible for transplantation. The changes in the views of international scholars and the Fatwa Committee contributed to this revision. The need for organ transplants also became more apparent as the demand for donors increased. In consideration of these rulings, the need (ḥājah in usūl al-fiqh) for these organs and the functions they play became the primary consideration of the scholars, as well as the need to alleviate patients’ burden and deliver them from harm. In consideration of these rulings, the need (ḥājah in usūl al-fiqh) for these organs and the functions they play became the primary consideration of the scholars, as well as the need to alleviate patients’ burden and deliver them from harm. The organs that are discussed in the following fatwas pertain to the human cornea and heart.

Fatwa Decision 20/12/1995
CORNEA TRANSPLANT

Question:

What is the Fatwa Committee’s opinion on cornea transplant?

Answer:

Islam is a religion of mercy. The Islamic Sharīʿa was sent by Allah to protect mankind’s affairs – be it in this world or the hereafter. Islam enjoins upon its followers to do things which will bring them benefit, and forbids others which cause them harm. Principally, the Sharīʿa aims to maintain five basic rights of a human being:

(1) Religion
(2) Mind
(3) Life
(4) Generation
(5) Wealth.1

There are numerous laws and aḥkām introduced by Islam to protect a person in these five aspects – one of which is his life, whereby Islam directs its followers to respect one’s life as well as that of others. Any form of persecution or oppression, let alone killing, is considered a very sinful act in Islam. Thus, in order to maintain social harmony and assure the safety of every individual, a heavy qiṣāṣ punishment is imposed upon those who commit murder. Besides that, Muslims are also forbidden from harming themselves or others. For example, suicide – for whatever reason – is not allowed in Islam.

Allah says:

وَأَنفِقُوا فِي سَبِيلِ اللَّهِ وَلَا تُلْقُوا بِأَيْدِيكُمْ إِلَى التَّهْلُكَةِۛوَأَحْسِنُواۛ إِنَّ اللَّهَ يُحِبُّ الْمُحْسِنِينَ
And spend in the cause of Allah and do not throw yourselves into destruction and do good. Truly, Allah loves those who do good.” (al-Baqara:195)

Based on this, Islam allows a person to seek medical help if he is unwell. This matter has been exhaustively explained by the hadīth – such as the following as conveyed by ‘Abdullāh Ibn Mas’ūd,

‏مَا أَنْزَلَ اللَّهُ دَاءً إِلَّا أَنْزَلَ لَهُ شِفَاءً2
Allah will not give you a sickness unless He readies for you its cure.” – Ibn Mājah

This permission, however, is bound by the condition that the treatment does not involve any haram products like alcohol, carcasses, poisons and others. This has its basis in a few hadīths, such as the following as conveyed by Ummu Salamah:

إنَّ اللَّهَ لَمْ يَجْعَلْ شِفَاءَكُمْ فِيمَا حَرَّمَ عَلَيْك- لبيهقى وابن حبان
Allah does not create for you a cure from that which he has forbidden.”– al-Baihaqī & Ibn Hibbān.

The same is conveyed by Abu Hurairah, in another hadīth:

نَهَى رسولُ الله صلى الله عليه وآله وسلم عَنِ الدَوَاءِ الخَبِيثِ ، يَعْنِى السُمّ3
Rasulullah (ﷺ) forbade (seeking treatment)- through medicine containing poison.

In a hadith conveyed by Wā’il ibn Hajar al-Ḥaḍramī, Tāriq ibn Suwaid once asked Rasulullah (ﷺ) about the use of alcohol as medicine. Rasulullah replied:

 إِنَّهَا لَيْسَتْ بِدَوَاءٍ وَلَكِنَّهَا دَاءٌ
Alcohol is not a medicine, but a disease.”4

However, this does not mean that Islam is rigid and inflexible. In circumstances where a halal cure for a disease has not yet been discovered, Islam extends leniency in using treatments involving prohibited substances. Rasulullah (ﷺ) himself instructed a number of people to drink camel’s urine because they could not adapt to the Medinan climate.5 This is further strengthened by the permissibility of eating carcasses and drinking alcohol in cases of extreme emergency. Such concessions are reflected in Allah’s words:

مَا يُرِيدُ اللَّهُ لِيَجْعَلَ عَلَيْكُم مِّنْ حَرَجٍ وَلَـٰكِن يُرِيدُ لِيُطَهِّرَكُمْ وَلِيُتِمَّ نِعْمَتَهُ عَلَيْكُمْ لَعَلَّكُمْ تَشْكُرُونَ
Allah does not want to place you in difficulty, but He wants to purify you, and to complete His favour to you that you may be thankful.” (al-Mā’idah: 6)

Cornea transplants have proven to be a reliable treatment for people suffering from blindness. According to the original ruling, cornea transplants from a person who has passed away to a living receiver is not permitted in Islam because Islam requires an individual to be buried whole after his death, together with all his organs. However, there is no alternative treatment available for those suffering from blindness as yet. Blindness is recognized in Islam as a condition which weighs down a person’s life, and therefore from this perspective, cornea transplants are permissible as a form of leniency (رُخْصَة).

This issue is subject to the fiqh maxim6(المَشَقَّةُ تَجْلِبُ التَّيْسِيرِ): A burden, or difficulty draws simplicity. This means that in certain circumstances where a person suffers, Islam facilitates alleviation by repealing the impermissibility of certain deeds. Rasulullah (ﷺ) allowed some of his companions to wear silk despite it being ḥarām for Muslim men. This exception was given because they suffered from a skin disease which required that they only wear silk. In a similar situation, those who cannot tolerate cold weather are allowed to perform tayammum in place of wuu` and ghusl.

Additionally, the concession given for the cornea transplants in Islam parallels the fiqh maxim 7(الْحَاجَةُ تَنْزِلُ مَنْزِلَةَ الضَّرُورَةِ) “necessity may take the form of exigency.” In other words, where there is a need that must be fulfilled lest harm ensues, it becomes equal and similar in ruling to a situation of emergency which nullifies its prohibition. However, this comes under several conditions:

First: The need to be fulfilled must be something critical, lest it causes harm or difficulty to the individual.

Second: The above difficulty must not be unique, but general that may afflict average individuals should they find themselves in a similar situation.

Third: The need must be the only solution to release the individual from the burden or difficulty. If there are other solutions available which are halal in Islam, then the need do not qualify for concession.

Fourth: The degree of concession is similar to that in an emergency situation – only enough to alleviate the emergency.8

Since a cornea transplant fulfils all the four conditions stated above, it is deemed permissible until an alternative treatment becomes available. When this happens, it ceases to be an ‘emergency’. Cornea transplant is similar to kidney transplant in its process, whereby the person from whom the cornea is transplanted, as well as his next-of-kin, must have given prior permission in his lifetime to have his cornea removed after his death.

This concession is in accordance with a hadīth related by Ibnu ‘Abbās:

إنَّ اللَّهَ شَرَعَ الدِّينَ فَجَعَلَهُ سَهْلًا سَمْحًا وَاسِعًا وَلَمْ يَجْعَلْهُ ضَيِّقًا

 “Verily Allah has ordained this religion and made it easy and forgiving, and He did not make it difficult.”

However, the concession given to cornea transplantation does not mean that it is mandatory. In Islam, seeking treatment to cure a certain disease is mubāḥ and not wājib. Therefore, a Muslim has a choice: to seek a cure for his illness, or to endure the pain that Allah is testing him with so that he may be rewarded. This is based on a hadīth related by ‘Abdullah ibn ‘Abbās:

 أَلَا أُرِيكَ امْرَأَةً مِنْ أَهْلِ الْجَنَّةِ؟ قُلْتُ بَلَى! قَالَ: هَذِهِ الْمَرْأَةُ السَّوْدَاءُ أَتَتْ النَّبِيَّ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ فَقَالَتْ: إِنِّي أُصْرَعُ وَإِنِّي أَتَكَشَّفُ فَادْعُ اللَّهَ لِي. قَالَ: إِنْ شِئْتِ صَبَرْتِ وَلَكِ الْجَنَّةُ، وَإِنْ شِئْتِ دَعَوْتُ اللَّهَ أَنْ يُعَافِيَكِ” فَقَالَتْ: أَصْبِرُ، فَقَالَتْ: إِنِّي أَتَكَشَّفُ فَادْعُ اللَّهَ لِي أَنْ لَا أَتَكَشَّفَ، فَدَعَا لَهَا9
“Do you want to see an occupant of Paradise? I said: Please do so. He said: This black woman once approached Rasulullah (ﷺ) and asked: I am suffering from fits, and I often unknowingly flip the cloth which is covering me when I have an attack, so please pray to Allah for me. Rasulullah replied: “If you wish to be patient then your reward is Heaven, but if you would like to be cured than I will pray to Allah to cure you.” The woman then said: “If that is the case, then I will be patient. But I often embarrass myself when my clothes are flipped and tossed, therefore pray to Allah for me that it will not happen again.” Rasulullah (ﷺ) then prayed for her.

Therefore, no matter how burdened a person is by a certain illness, he is required to trust his affairs to Allah and be patient. He must have full conviction that the illness is a test from Allah and that he must go through it bravely, accepting what Allah has given him. This is so that in the case that his effort to cure the illness fails, he will not sigh and be disappointed. In a hadīth related by Suhaib bin Sinān, Rasulullah (ﷺ) said:

عَجَبًا لِأَمْرِ الْمُؤْمِنِ إِنَّ أَمْرَهُ كُلَّهُ خَيْرٌ وَلَيْسَ ذَاكَ لِأَحَدٍ إِلَّا لِلْمُؤْمِنِ إِنْ أَصَابَتْهُ سَرَّاءُ شَكَرَ فَكَانَ خَيْرًا لَهُ وَإِنْ أَصَابَتْهُ ضَرَّاءُ صَبَرَ فَكَانَ خَيْرًا لَهُ

 “A believer’s condition is special, and this is characteristic of only he who believes. When he is in a good situation he will be thankful, and this is good for him. When he is in bad situation he will be patient, and this is good for him too.

With this, the Fatwa Committee concluded that cornea transplantation is permissible in order to remove harm.

Source:
1 Wahba al-Zuḥailī. Usūl al-Fiqh al-Islāmī (Dār al-Fikr: 1986), Vol.2, 1017.
2 Muḥammad Bin Yazīd Bin Mājah al-Qazwīnī, Sunan Ibn Mājah, Kitāb al-Tib, vol. 2, hadīthno. 3438.
3 Ibid., hadīth no.3459.
4 Full text hadīth:
‏ أن ‏ ‏سويد بن طارق ‏سأل رسول الله ‏‏صلى الله عليه وسلم ‏عن الخمر فنهاه عنها أن يصنعها فقال إنها دواء فقال رسول الله‏ ‏صلى الله عليه وسلم ‏ ‏إنها ليست دواء ولكنها داء
ʿAbdullāh bin ʿAbd al-Rahmān Al-Dārimī. Sunan Al-Dārimī , Kitāb al-Ashriba, Hadith no.2140. (Arab Saudi: Dār al-Mughnī Li al-Nashr Wa al-Tauzīʿ : 2000), Juz 2.
5 full text hadīth:
أن ناساً اجتوو في المدينة، فأمرهم النبي (صلي الله عليه وسلم) أن يلحقوا براعية – يعني الإبل – فيشربوا من البانها وأبوالها، فلحقوا براعيه، فشربوا من ألبانها وأبوالها حتى صلحت ابدانهم، فقتلوا الراعي وساقوا الإبل، فبلغ النبي (صلى الله عليه وسلم) فبعث في طلبهم، فجىء بهم، فقطع أيديهم وأرجلهم وسمر أعينهم
Aḥmad Bin Alī Bin Ḥajar al-ʿAsqalānī, Fatḥ Al-Bārī bi Sharḥi Saḥīḥ al-Bukhārī, Kitāb Al-Tib, hadīth no.5686. (Cairo: Dār al-Hadīth, 1998), Vol.10.
6 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya, 194.
7 Ibid., 218.
8 Wahba al-Zuḥailī. Naẓariyya al-Ḍarūra al-SharʿiyyaMuqārana Maʿa al-Qānun al-Waḍʿī. 4th.ed, (Beirut: Muassasah al-Risālah, 1985), 275.
9 Aḥmad Bin Alī Bin Ḥajar al-ʿAsqalānī, Fatḥ Al-Bārī bi Sharḥi Ṣaḥīḥ al-Bukhārī, Kitāb al-Marḍā, hadīth no. 5652, Vol.10

The above fatwa on cornea donation is a marked change in Muslim law, as the permissibility of cornea donation was no longer limited to emergencies and life and death situations. Hājiyyāt (such as improving a patient’s eyesight) was given the same level of consideration as a ḍarūra, in line with the the maxim (الحاجة تنزل منزلة الضرورة) “Necessity may take the form of exigency”. It also considers the maqāṣid and places emphasis on the importance of prioritizing and balancing between the two types of harms; i.e. leaving the patient blind or using donated corneas from a deceased person without violating the sanctity of the deceased’s body. The fatwa above also demonstrates the Fatwa Committee’s inclination to ease the suffering of patients and improve their quality of life. Additionally, the Fatwa Committee’s decision can also be seen as a contribution towards solving public policy issues – in this instance finding a solution for those in need of organ transplant from third parties.

The Fatwa Committee had also stressed that organ transplant is a form of treatment that is accepted by religion, and not a procedure that violates the sanctity of the deceased. Such a paradigm shift is important in the development of religious rulings in Singapore, particularly in the realm of organ donations. This is because treatments using donated organs have increasingly become more successful, and the technology has been expanded to treat chronic diseases including those caused by organ failure. This fatwa thus started a new chapter in the Fatwa Committee’s assessment of subsequent issues on organ transplants.

From another standpoint, the 1973 fatwa did not distinguish between the transplant of regenerative and non-regenerative organs. Regenerative forms such as blood donation and transfusions were generally not included under the prohibition as the discourse was restricted to transplantation of non-regenerative organs. These were also not raised in public discourse. However, in 1997, a fatwa was issued on the permissibility of transplantation of bone marrow on the grounds that bone marrow is regenerative and replaces itself in about four weeks. Because of its regenerative nature, it was not likely to inflict permanent damage on a donor or leave him handicapped whilst still alive, unlike organ transplants.

Moreover, bone marrow transplant is effective in treating leukaemia (blood cancer). In the treatment of blood cancer patients, a healthy donor with the suitable bone marrow may donate it to a patient in need. The Fatwa Committee ruled as follows:

Fatwa Decision 7/4/1997
BONE MARROW TRANSPLANT

Question:

What is the Islamic position (hukum) on bone marrow transplants?

Answer:

An Islamic position (hukum) is determined by Allah swt, through the Qur’an or Sunnah Rasulullah (ﷺ).  Rasulullah (ﷺ) explains the ruling, and we as Muslims are asked to accept and abide by them as in God’s words:

وَمَا آتَاكُمُ الرَّسُولُ فَخُذُوهُ وَمَا نَهَاكُمْ عَنْهُ فَانتَهُواۚ

”And whatsoever the Messenger (Muhammad  ﷺ) gives you, take it; and whatsoever he forbids you, abstain (from it). And fear Allah; verily, Allah is severe in punishment.”
al-Hashr:7.

It has been acknowledged that leukemia is a type of cancer which causes the bone marrow to stop functioning. Those who have the illness will suffer due to the lack of blood (anemia). He will regularly have fever, as well as bleed and contract other diseases easily. This illness (leukemia) is complicated and cannot be cured. Of late, it has been discovered that leukemia patients can be treated via a bone marrow transplant from another person who has similar tissues as that of the patient.

The Fatwa Committee notes that bone marrow has an important function in a person’s body. It produces blood cells for the body, including the white blood cells which help a person’s body to resist or fight other diseases contracted by the red blood cells. Meanwhile, the function of the red blood cells is to transport oxygen and deposit unwanted substances from the body’s organs and tissues which can cause blood clot.

The bone marrow transplant is done by piercing a needle into the patient’s posterior, and inserting it into the person’s body. Medical experts have also clarified that the donor’s health will not be adversely affected and that his bone marrow will regrow within a few days. They also affirm that the process of transplanting the bone marrow is not difficult and in fact easy and safe. The risk is small, and most donors can move freely after resting for only a few days. The donor’s health will also not be affected in the future.

Bone marrrow transplants were not known in the past. It was not mentioned by the jurists because the treatment is a modern innovation as a result of medical research. It is Allah who teaches mankind what they do not know.

Blood has a critical function in a person’s body. Therefore, what is the religion’s perspective on the benefit of transfusing blood from one person to another?

The international ‘ulamās have debated this issue numerous times. They concluded that it is permissible to do so under certain conditions1

First: It is an urgent need.
Second: It can be confirmed by a Muslim doctor, or a non-Muslim one (according to Malikī school of law) that the blood will help the recipient and will not cause harm to the donor.
Third: There should not be any form of buying and selling in the process, as selling of human blood is forbidden in Islam.

When it can be confirmed that the bone marrow transplant will not bring harm to the donor and can really help the patient, then the Islamic position in this matter is that it is permissible.

 Source:
Majallah Majmaʿ al-Fiqh al-Islāmī Daurah al-Thāniah Li Mu’tamar Majmaʿ al-Fiqh al-Islāmī ʿAdad al-Rābiʿ, 2nd.ed,. (1986), Vol.1, 135.

This fatwa first acknowledges the benefits of a bone marrow transplant. Unlike other organs of the body that could be donated such as the heart, liver, kidney and cornea, bone marrow can regenerate in a short time. Therefore, there is no hindrance to the donation of bone marrow as it will be replaced naturally. However, there are ethical principles that should be observed to ensure the welfare and safety of both donor and patient.

In consideration of this, bone marrow donation is permitted only when there are urgent medical needs pertaining to the patient and his quality of life. To ensure that this requirement is met, the recommendation for transplant must come from physicians. The Fatwa Committee also took into consideration that Singapore is a multi-religious country. In view of the fact that there are non-Muslim medical professionals, the Committee adopted the view of Malikī school of law and stated that consenting physicians need not be Muslims. It further added that bone marrow donation is only permitted if no trade is involved. This stance is similar to that outlined by international ethics bodies in assessing issues pertaining to clinical science. This stipulation is necessary to prevent injustice and the exploitation of the underprivileged in organ trading practices.

With rapid advances in clinical science, other forms of transplantation followed suit, one of which was heart transplantation. It has proven to achieve a good success rate and has been accepted as a viable treatment for heart patients. The Ministry of Health consulted the Fatwa Committee regarding heart transplants as part of its proposal to amend HOTA and to include in the Act organs such as liver, heart, and cornea that can be harvested from a cadaveric donor. The fatwa issued in 2003 on heart transplants also relied on the principles of needs to allow emergency medical procedures to be performed.

Fatwa Decision 7/10/2003
DONATION AND TRANSPLANT ON THE HUMAN HEART

The Fatwa Committee notes that under the proposed amendments to the Human Organ Transplant Act (HOTA), Muslims are excluded as per the current arrangement.

After deliberation, the Fatwa Committee is of the view that on the issue of heart donation and transplant, the Shari’a viewpoint that the remains of a Muslim must be buried properly is crucial. This is based on God’s words in Surah ‘Abasa:

ثُمَّ أَمَاتَهُ فَأَقْبَرَهُ
”Then He causes him to die and puts him in his grave”. (al-’Abasa:21)

However, the donation of a human heart is permissible on the basis of emergency or urgent need. This is based on the legal maxim:1

الضَرُورِيَّات تُبِيحُ المحظُورَات
 Necessity makes the unlawful lawful.

Nonetheless, the level of emergency that allows for human organ donation or transplant must be restricted in accordance with the extent of the necessity. This is based on another legal maxim:

ما أُبِيح للضرورة يقدَّر بقدرها
What is allowed due to emergency, is limited only to its rightful measure.

As heart transplant is also categorised as an emergency to save lives, the Fatwa Committee views that the ruling is the same as kidney donation and transplant, in that it is permitted.

 

Source:
1 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 211.

 

As part of the proposed amendments to HOTA, the Fatwa Committee was also asked the Muslim view on establishing an organ bank for the storage of corneas, which the Committee consented to. Among the organs included in HOTA, only corneas are allowed to be stored for a brief period of not more than two weeks as transplants cannot be done immediately in some cases and may be postponed for medical or logistical reasons. In discussing the issue, the Fatwa Committee considered the need for banking, as well as the benefits and advantages that can be achieved. These were weighed against the harm and hardship that it may result in.

Fatwa Decision 2/3/2004
ORGAN STORAGE AND ESTABLISHING AN ORGAN BANK

Question:

The Ministry of Health explained that the organs included in HOTA are kidney, heart, liver and cornea. Among these organs, only the cornea can be stored for a period of up to two weeks for the purpose of transplantations, or frozen for longer periods of time for therapeutic purposes.

Cornea storage for transplantation is sometimes necessary because of the lack of suitable recipients, or because the corneal transplant surgery had to be postponed due to medical or logistical reasons. What are the views of the Fatwa Committee in this matter?

Answer:

The Fatwa Committee ruled that, in principle, cornea storage is not allowed. However, if there are necessities as highlighted by the Ministry of Health, then there are religious provisions that may allow the storage of corneas.

Human Organ Transplant Act (HOTA)

HOTA was introduced in Singapore in 1987. At that time, the Muslim community was excluded from the scheme based on a 1985 fatwa that requires expressed consent from the donor during his lifetime. This consent must be witnessed by two of the donor’s next-of-kin. These conditions did not correspond with the way HOTA was implemented, which allowed for organ transplant on the basis of presumed consent. This meant that every citizen over the age of 21 years is automatically considered as an organ donor unless they opt out of the scheme. Although Muslims were not included under HOTA, Muslims could still pledge their organs by means of a voluntary pledge (i.e. opt-in) under another act called the Medical Therapy, Education and Research Act (MTERA).

MTERA was introduced in 1972 but proved insufficient to fulfilling the demand for kidney transplants at the time. For instance, between 1970 and 1978, only 22 kidney transplants were successfully performed. The government then introduced an opt-out system. The impact of this change was significant. Between 1987 and 2004, 222 patients received kidney transplants under HOTA.[6]

HOTA was amended in 2004 to include the transplant of liver, heart and cornea, alongside kidney.[7] This amendment also included changes to the cause of death as a condition for an organ to be transplanted, whereby it was no longer limited to deaths caused by accidents, but included deaths from other causes. Nonetheless, the requirement that a donor must be from among those whom doctors have declared as brain dead was maintained.

Religious communities had raised concerns about the permissibility of transplants. In Christian circles, there was also a debate on whether the gift of organ donation violates biblical teachings of resurrection of the whole body and prohibition of self-mutilation, even if the act of donating an organ itself is consistent with the Christian values of humanitarianism and love for one’s neighbour.[8] However, no church prohibited donating or receiving organs, and the public discourse about the procedure in Singapore was generally supportive.[9]Muslims were thus the only community excluded from HOTA because of a clear religious injunction which the Fatwa Committee relied upon in its fatwa of 1985.

As mentioned above, the number of Singapore donors pledging their organs before HOTA was implemented was relatively low. After HOTA, studies noted that although there was no change in the number of suitable donors, the number of successful transplants increased among non-Muslims.[10] For kidneys, the number of successful transplants increased to 16% per year in 1990. [11] By virtue of their exclusion, Muslims were placed on a lower priority for receiving donated organs. The burden faced by kidney patients is very taxing; the cost of weekly kidney dialysis is exorbitant while many lose their jobs because of the need for dialysis treatment.[12] Although they could opt in, relatively few Muslims signed up for the scheme. In the decade between 1997 and 2007, the number of Muslims as a percentage of the total number of patients on dialysis jumped from 15% to 25%.[13]  Muslim kidney patients who required dialysis thus represented a large percentage of the general Muslim population.

Number of patients in waiting list (as of 15 March 2007)

Kidney Liver Heart Cornea Total Percentage
Malay/ Muslim 115 2 0 1 118 20.80%
Total 541 17 1 7 566 100%

The move to amend HOTA to include Muslims had substantial support from the Muslim grassroots. It was first facilitated by the 1985 fatwa which allowed kidney transplants for medical emergencies. [14] This was followed by the fatwa that permitted the donation of all types of organs covered under HOTA. However, the opt-in rate was still low despite many public education campaigns. This prompted Muis to review the 1985 fatwa which required a Muslim donor’s pledge to be consented to by two of his next-of-kin. A fatwa issued in 2004 removed this condition; donors no longer needed to nominate their next-of-kin as witnesses.

Fatwa Decision 26/6/2004
CONDITION OF WITNESS FOR ORGAN DONATION PLEGDE

Question:

Must anyone wishing to pledge an organ obtain the signature of his next-of-kin on the pledge form?

Answer:

The Fatwa Committee has reviewed the requirement of obtaining the consent of one’s next-of-kin in organ donation in six of its meetings held between January to June 2004. As result of these discussions, the Fatwa Committee decided that if someone had, during his lifetime, pledged to donate his organs, then the next-of-kin must respect the pledge and execute it, as long as the pledge falls within the limits of Islamic law. If the deceased has not made a pledge, then the matter is decided by the next-of-kin.

This means that, if someone wants to make a pledge to donate his organs — kidneys, heart, liver and corneas — he is not required to get his kin’s signature on the pledge form. What he needs is to obtain his signature of any two adult male Muslim witnesses to sign the pledge form.

After the fatwa was issued in 2004, the number of organ pledgers remained low, and the chances for patients to receive organs remained slim. Patients and their families suffer from various afflictions while awaiting their turn, including financial hardship that affects their daily lives, as well as worsening health conditions. In such circumstances, the mafsada (distress) and the difficulties experienced by patients must be relieved through appropriate solutions in Islam.

Among the measures through which this could be achieved is to assess the potential benefits from including Muslims in HOTA as this could boost the number of organ pledgers. HOTA functions on the basis of presumed consent, whilst respecting the individual choice to exclude oneself from the organ donation system. Even though participation in HOTA is not compulsory, it facilitates those who wish to become donors.

As the presumed consent system was still new, especially to the Muslim community, the Fatwa Committee studied it in great detail and discussed the concept of presumed donor’s consent.

Fatwa Decision 17/7/2007
THE INCLUSION OF MUSLIMS UNDER THE HUMAN ORGAN TRANSPLANT ACT (HOTA)

Question:

What is the opinion of the Fatwa Committee on the participation of the Singapore Muslim community in the Human Organ Transplant Act (HOTA)?

Answer:

1.         After considering carefully the latest updates on the issue of Muslims and organ donation in Singapore, as presented by the Office of the Mufti, which included:

  • Latest developments provided by the Muslim Kidney Action Committee (MKAC), included in the presentation by the Office of the Mufti, on the problems and sufferings of Muslim kidney patients in Singapore, and the outcomes of public awareness campaigns on the importance of rendering help to kidney patients by becoming organ pledgers, and the current number of Muslim pledgers, and whether this number can help alleviate the problems of the kidney patients in the future, and
  • Latest developments provided by the Ministry of Health, included in the presentation by the Office of the Mufti, on the process of transplantation and the statistics and status of Muslim kidney patients, as compared to other patients in Singapore, and the benefits for the Muslim community from their inclusion in the Human Organ Transplant Act (HOTA),

2.         The Fatwa Committee takes the position that it is permissible for Muslims to be included in the Human Organ Transplant Act (HOTA) for the following reasons:

  • The general consensus of Muslim jurists is that organ transplant and donation by the deceased is permissible in Islam. Among the reasons quoted by jurists are:
    • Islam calls for the seeking of cure and treatment for illnesses, and the most effective treatment for those who suffer from organ failure, currently, is by receiving a new organ in place of the failed one.
    • The objectives (maqāid) of the Sharī’a clearly state the importance of protecting and saving human lives. This is mentioned in the Holy Qur’an:


وَمَنْ أَحْيَاهَا فَكَأَنَّمَا أَحْيَا النَّاسَ جَمِيعًا  
“…and whoever saves one life, then it is as though he has saved the whole of humanity.
(al-Māidah : 32)

    • The Sharī’a is built upon values such as care and compassion. The shariah thus calls for mankind to help one another, and to contribute in alleviating human suffering and pain, such as the suffering of kidney patients.
    • Donating one’s organs is an act of jāriyah (continuous charitable deed) in which the rewards accrue even after one’s death.1
  • The current pledging system for Muslims (through the opt-in in MTERA) is not helping kidney patients overcome their medical condition. Although a fatwa was issued in 2004 to simplify the process of making a pledge [by lifting the condition that a pledge must be witnessed by two family members (waris)], the number of pledgers is still very low. Whilst waiting for organ donors, patients and their family members suffer in many ways, including having to go through financial and emotional distresses. Thus, the mafsadah (harm) and maḍarrah (difficulties) that these patients encounter must be alleviated in an appropriate manner. This is in accordance with numerous legal maxims2 in Islamic jurisprudence, such as:

إِذَا ضَاقَ الأَمْرُ اِتَّسَعَ 
 “If a problem grows acute, then it shall be relieved”

المَشَقَّةُ تَجْلِبُ التَّيْسِيرِ
 “Difficulty calls for facilitation”

  • To safeguard public interest and welfare (maṣlaḥa), leaders of the community (waliyyul-amr) should decide for the community what is in their best interest. This is in line with the legal maxim3:

تَصَرَُفُ الإِمَامَ مَنُوطُ بِالمَصْلَحَةِ
The actions of an Imam (leader) is driven by the interest of the community.

  • The presumed consent or opt-out system in HOTA is a method of obtaining early consent from the donor. The donor is given the option to object and not give consent during his/her lifetime. He or she can do so by opting-out from HOTA. As such, there is no conflict with the requirement in Islamic law of consent to be made during the person’s lifetime for organ donation, as agreed upon by majority of Muslim jurists.
  • Muslims stand to gain from inclusion in HOTA.4 Upon inclusion, the Muslim community will have the same opportunity as other communities in receiving transplants. Due to the waitlist system, Muslims who are not pledgers are disadvantaged, as they are not placed in the priority list for available transplants.

Without inclusion in HOTA, the plight of kidney patients and those suffering from organ failure will remain. They will also need to bear the high cost of dialysis treatment.5

3.     The Fatwa Committee puts forth the following recommendations, alongside the position that Muslims can be included in HOTA:

  • The relevant authorities should ensure a transparent and fair system of choosing recipients for available organs.
  • The relevant authorities should ensure an extensive public education on organ donation and HOTA. Each individual Muslim should receive information on how HOTA will affect them, together with a clear explanation on the opt-out scheme.
  • The relevant authorities must also ensure that the community has the option to be excluded from HOTA, either by excluding all organs, or only selected ones.6
  • The relevant authorities should seek the opinion of the Fatwa Committee on prospective amendments to the HOTA which will affect Muslims.
  • The Muslim community must be given a clear explanation on the hukum (ruling) and need for organ donation. This can be done through public education before and after the fatwa has been issued.

 

Source:
1 Yūsuf al-Qaraḍāwī, Fatāwā Muʿāṣara, 532 dan 537.
2 Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 208.
3 Ibid., 278.

4 Muslim kidney patients (21% of all patients) are proportionately higher than the Muslim population in Singapore (14-15%).
5 According to MOH, every patient needs to spend around $40,000 annually in medical expenses. Dialysis does not cure patients, and the survival rate of those undergoing dialysis treatment after 5 years is 65% compared to 91% of those who receive kidney transplants.
6 “HOTA only covers the kidney, heart, liver and cornea. All other organs from HOTA donors will be subjected to the provisions of the MTERA”. Ministry of Health. Manual on Organ Donation and Transplant. (2005).

The proposition to include Muslims in HOTA started emerging in public forums and newspapers in the early 2000s.[15] A few years before the HOTA amendment was proposed in 2007, the Ministry of Health (MOH) in Singapore held public discussions with members of the Muslim community to clarify the process of organ donation and dispel misconceptions surrounding it.[16] When the Singapore Parliament passed the amendment to include Muslims in 2008, many measures were taken to ensure that the Muslim community were adequately informed of this change. This included letters sent to every Muslim household, attached with informational pamphlets on the legal application of HOTA and the religious opinions on organ donations and transplants in Islam.  Opt-out forms were also included in the mailers for those who wished to opt out. However, since 2008 not many Muslims have chosen to opt out. This reflected the support and progressive religious thinking of the Muslim community who were receptive to the fatwa issued by the Fatwa Committee. Public education efforts to raise awareness on organ failure appeared successful, and the Muslim community agreed with the need to help patients regardless of race or religion. As a result of the amendment to include Muslims under HOTA, the number of successful transplants among the Malay Muslim community almost doubled in 2008 compared to the preceding year, making up 19% of of all organ transplants in Singapore.[17]

Analysis of the Fatwas on Organ Donation

The Consideration of Maṣlaḥa and Mafsada

The Fatwa Committee in its 1976 fatwa prohibited organ donation on the grounds of uncertainty as to whether “the benefit from the organ is commensurate with what was inflicted on the body.” As organ transplant technology was still new at the time, and the outcome of organ donation was yet unclear, the Fatwa Committee’s decision was therefore expected. The Fatwa Committee, in consideration of the ruling, not only looked at the principles of uṣūl al-fiqh but also took into account the degree of maṣlaḥa and mafsada. As the maṣlaḥa could not be determined, while its mafsada remained certain, the Fatwa Committee took a more cautious stance and decided not to permit it.

Considerations of maṣlaḥa and mafsada also formed the basis of the Fatwa Committee’s subsequent fatwas on organ transplant. After more than 30 years, organ transplant technology showed rapid advancements and transplants were carried out successfully and effectively. Concurrently, the issues faced by organ failure patients also became more varied. The Fatwa Committee thus decided not only on the permissibility of kidney, cornea, heart and liver donations, but that Muslims could be included in the “opt-out” system (on the basis of presumed consent).[18]

Gradual Application of the Maxim ‘Constrictions Demand Relief’ 

In the development of fatwa in organ donation, various Fatwa Committee sittings applied the following Islamic legal maxims:

  1. إِذَا ضَاقَ الأَمْرُ اِتَّسَعَ[19]
    “If a matter becomes constricting, it demands relief”
  2. المَشَقَّةُ تَجْلِبُ التَّيْسِيرِ[20]
    “Hardship begets facility.”

Both these principles offered latitude for the easing of hardship. However, the Fatwa Committee took a cautious approach, and the process of permitting organ donation was observed in gradual stages according to the needs of each era. This was based on the maxim:

[21]ما أُبِيح للضرورة يقدَّر بقدرها
Which means: “What is allowed due to emergency, is limited in accordance with it.

Among the basic principles that the Fatwa Committee used since the beginning of its discussions on organ donation is that each organ is entrusted by Allah SWT and each individual will be accountable for them. On this premise, an organ is not a right that can be transferred freely without an urgent need.[22] The Fatwa Committee also referred to the prohibition of actions that might hurt or violate the sanctity of the dead. This principle was maintained in the fatwas of 1973, 1976 and 1985. [23]  This phased approach was not free of criticism. Dr Syed Hussein Alatas objected to the prohibition of cornea donation as evinced in his article in the local newspaper and his booklet “Biarkan Buta – (Let (him) be blind)”. However, the Fatwa Committee only allowed cornea donation some 20 years later. This phased approach is illustrated in the following diagram depicting the development of fatwas issued on organ donations, before the eventual fatwa permitting Muslims to be included in HOTA in 2007.

The three decades taken by different Fatwa Committees demonstrate how the fatwa institution in Singapore did not review its positions except with extreme caution and thoughtful consideration. At all times, the fatwa institution assessed the context and evolving needs of the community, and examined the implications of its rulings on every issue.

Stewardship versus Ownership of the Human Body and Soul

In a press statement made in 1973 on organ donation, [24] Mufti Shaikh Isa Semait emphasised a Qur’anic concept that the human body is held in trust for which one would be accountable to Allah SWT. The physical body and the soul are regarded as a single entity that cannot be distinguished. The former is therefore considered to be a blessing and a gift by God, over which man does not bear full ownership, nor can he do unto it as he pleases, because man is regarded only as the trustee of God. This trusteeship has a deeper implication: his freedom to do as he wills towards his body is limited.[25] Because of this, Islam forbids suicide, as well as other actions that could bring harm or cause adverse effects on the health and well-being of the body.[26] This prohibition also includes inserting or removing something from a dead body, such as organ harvesting, so as to protect the sanctity of the dead.

Nevertheless, the approach of maqāṣid al-sharīʿa which forms the basis of Islamic ethics permits operating on the dead when the need arises, such as in determining the cause of death, resolving inheritance issues, or saving the life of another. In classical fiqh works, scholars permitted surgery to be performed on a deceased pregnant woman if there is a high probability that the baby in the womb could be saved.[27] Thus, the idea that humans are only trustees and not absolute owners of the body is still subject to other considerations as provided for in religious texts. Included in this consideration is the issue of organ donation either during lifetime or after death. As such, the donation of critical organs (which cannot regenerate, or whose removal may threaten the life of the owner, or that may affect one’s physical form or functionality – such as eyes or ears) during one’s lifetime is forbidden based on the Qur’anic principle mentioned above.[28] But if there is a need to preserve the life of another human being by taking organs from the dead, then it is permitted based on the legal maxim that allows choosing the lesser of two harms (إذا تعارض مفسدتان روعي أعظمهما ضررا بارتكاب أخفهما) [29] in order to preserve the maqāṣid al-sharīʿa of protecting the life of a living person.

Brain Death from an Islamic Viewpoint

In the consideration of fatwas related to organ donation after death, one of the ethical and legal issues brought up was whether brain death – the cessation of brain stem function- can be accepted as a criterion for determining death.

There are many verses in the Qur’an that mention death, but none that clearly explicates the criteria for death, particularly from a clinical standpoint. This issue is very significant in medical science, especially in determining the time of death for various reasons, such as surgery. The criteria for determining death from a religious standpoint is therefore a new and complex matter, and has to be determined through means of ijtihād.[30] The criteria for determining death from a religious standpoint is therefore a new and complex matter, and has to be determined through means of ijtihād. Following this, jurists have expressed various ethical and jurisprudential opinions.

In debating the criteria for death, the relationship between body and soul is vital. There are two theories regarding this relationship. The first theory states that the nature of true human existence lies in the soul, while the body is simply an instrument that serves the soul’s existence. This means that the soul does not merge with the body to form a single entity. Instead the soul is the source of life for the body. Here, the soul is regarded like a master who commandeers and controls the body. Imām al-Ghazalī was of the view that the soul is the essence of God’s creation (al-laṭīfa al-rabbāniyya) that affords people the ability to think and learn. The soul – according to him – is synonymous with the terms heart (qalb), self (nafs), and intellect (‘aql). It is able to think and feel for itself without having to merge with the body. According to this view, the body is just an instrument that manifests what the soul thinks and demands. Death therefore occurs when the soul leaves the body, even though the body has not stopped functioning.[31]

Another theory states that the soul is an attribute inserted into the foetus by God. This means that body and soul merge into one, and only then is personhood realised. Death occurs when the soul starts to leave the body, and the body begins to stop functioning.[32]

In the texts of Islamic law, the permanent cessation of breathing is sufficient to determine a person’s death. This is different from brain death, which is determined by the absence of reaction to external stimuli or internal needs; the cessation of body movement and breathing for at least an hour under the supervision of medical experts, as well as the absence of physical responses which are attributed to brain activity.[33]

Jurists discuss two types of life that may provide guidance in determining the criteria for physical and neurological death: stable life (mustaqarr) and unstable life (ghayr mustaqarr).[34] The Hanbali and Shafi’i schools of law see a difference between the two, whereas the Maliki school holds the view that there is absolutely no difference. Those who distinguish between these two types place several key criteria, including the cessation of breathing and heart activity for a specified period; if it functions only for a certain time and then stops permanently, then it is regarded as unstable life, marking the beginning of death.[35]

However, some scholars view that such criteria is still incapable of determining the occurrence of death. This is because movement, pulse and respiration can still occur even after death. Such criteria are more appropriate as a guide for the general public. Medical experts with a more complex understanding of the human body should have a more robust criteria beyond mere external indicators. For example, physical movements may still occur in those who have died, due to the presence of certain chemicals and reactions caused by internal organs. [36]

Clinically, brain death is defined as a permanent and total loss of brain function, including the brain stem.[37] When the brain permanently ceases to function, all bodily organs will also stop. According to medical experts, when a person is brain dead, the process of death has already begun because a person will no longer be able to return to life.[38] It is only through modern medical technology that a heart which has experienced momentary failure is able to continue circulating blood to the vital organs despite the brain dead patient not responding to any external and internal stimuli. In Singapore, the Ministry of Health (MOH) has very strict conditions in the determination of death, including the administration of seven specific clinical tests. Due to the stringent criteria, brain death is accepted by state law as legal death. Contemporary scholars have also ruled that brain death is legal death.[39] This is in line with traditional Islamic interpretations of the relationship between the body and soul discussed above, in which the cessation of bodily functions indicate that the soul has separated from the body, which is evident in brain death.

The legal maxim “the actions of a leader are driven by the interests of the community” (taṣarruf al-imām ʿalā al-raʿiyya manūṭun bi al-maṣlaḥa)

The 2007 fatwa did not only permit Muslims to donate organs such as cornea, liver, heart and kidney, but also included the Singapore Muslim community in the HOTA opt-out system. This legislation was enacted with the aim of increasing the number of organ donors.

Islamic law also recognizes the paramount importance of the interests and welfare of the community and nation, in matters of public administration. The philosophy is not foreign to Islam, as it was practiced by the Prophet Muhammad (ﷺ). On this basis, jurists assert that state policies and programs will be void if they do not benefit the populace, whether in this world or the hereafter.[40] Such considerations are in accordance with the following principle in Islamic governance:

[41]تَصَرُّفُ الإِمَام مَنُوطٌ بِالمَصلحة
The actions of a leader are driven by interests [of the community]”

The notion of public interest (maṣlaḥa) in Islamic jurisprudence falls within the categorisation of ḍarūriyyāt al-khams, which is the prioritization of religion, life, intellect, lineage and property. All that can cause distress and burden to the community must be denounced or prevented. In addition, there are several key principles recognized by Islam in state administration such as:

  1. karāma insāniyya (human dignity),
  2. ʿadāla (justice),
  3. musāwā (equality),
  4. urriyya (freedom),
  5. wafāʾ bi al-ʿahd (fulfilling covenant),
  6. muʿāmala bi al-mithl (reciprocity of treatment),
  7. tasāmuḥ (compromise),
  8. taʿāwun (cooperation),
  9. manʿu al-fasād (prevention of harm).[42]

This maxim is tied to the scholars’ practice of accepting maṣlaḥa as a principle in producing religious rulings and fatwas. Imam Mālik, in particular, employed maṣlaḥa mursala[43] as a foundation in Islamic law. This view was shared by the likes of Imām al-Shāfiʿī (d.204H), Imām al-Ḥaramain al-Juwaynī (d.438H) and Imām Aḥmad ibn Ḥanbal (d. 241H).[44]

Conclusion

This chapter on organ donation has outlined the evolution and development of the Fatwa Committee rulings over a period of three decades. Apart from explaining scholarly opinions on organ donation, this chapter also shows how medical advancements, awareness of patient needs, and public readiness to accept organs harvested from a dead person contributed to the Fatwa Committee’s decisions. Discussion and analysis of the organ donation fatwas also indicate how fatwas interacted with national legislation and public policy, thus creating a confident Muslim society in a secular country that does not have to compromise its religious principles.

At the same time, the Fatwa Committee’s decisions also took into account the ethical dimensions in organ donation. This includes accepting brain death as true death, which has allowed the harvesting of vital organs. The Fatwa Committee also solved the dilemma between protecting life and preserving the sanctity of the deceased, by following priorities according to maqāṣid al-sharīʿa. All these demonstrate the confidence and competence of local Muslim thinkers and scholars in producing a much needed religious leadership to guide the community through contemporary and emerging challenges.


  1. For more information on how successful blood transfusion helps organ transplant, see Susan E Lederer, Flesh and Blood: Organ Transplantation and Blood Transfusions in 20th Century America (Oxford University Press: 2008).
  2. Hakim Nadey, Living Related Transplantation (World Scientific: 2010), 39.
  3. Recorded in the Fatwa Committee Meeting held on 29-08-1972.
  4. Recorded in the Fatwa Committee Meeting held on 31-07-1973.
  5. C. J. E. Watson and J. H. Dark, “Organ transplantation: historical perspective and current practice” in British Journal of Anaesthesia, (2012), Vol. 108.
  6. National Library Board Singapore.  http://eresources.nlb.gov.sg/infopedia/articles/SIP_1401_2009-01-08.html (2008).
  7. http://statutes.agc.gov.sg/
  8. Bobby A. Howard, “What the Bible Says about Organ Transplants”, in Journal of Christian Nursing, Vol. 15:4, (2005).
  9. See “Donate Kidney Calls to Church Members” The Straits Times, 8 September, 1975; “Confused by Priest” The Straits Times, 12 July, 1986 and “Last week’s focus: Do other countries have laws like HOTA?” The Straits Times, 23 July, 2003.
  10. See Low H. C. et al “Impact of New Legislation on Presumed Consent on Organ Donation on Liver Transplant in Singapore,” in Transplantation. Vol. 82:9. (2006).
  11. Inaugural Workshop of the Singapore Renal Registry, 39.
  12. Statistics for the unemployment rate and subsidy cost of dialysis treatment can be found in Woo Keng Thye and Grace SL Lee (eds), First report of the Singapore Renal Registry 1997, Singapore Renal Registry (1998).
  13. See Choong Hui Lin (ed), Seventh Report of the Singapore Renal Registry 2007/2008, Singapore Health Promotion Board (2008); and Woo Keng Thye and Grace SL Lee (eds), First report of the Singapore Renal Registry 1997, Singapore Renal Registry (1998).
  14. Please refer to the Fatwa Committee's second fatwa on organ transplant dated 3rd December 1985
  15. See “Peserta forum syor Muslim disertakan dalam HOTA [Forum participant suggests Muslims to be included in HOTA],” Berita Harian, 18 February 2003; “Ramai Muslim tak keberatan diserta dalam HOTA [Many Muslim do not mind being included in HOTA]”, Berita Harian, 9 January, 2004, and “Masyarakat alu-alu rancangan pemerintah pinda HOTA [Community welcomes government plan to amend HOTA]”, Berita Harian, 21 August, 2007.
  16. “Alami: Muis akan sokong MOH perjelas tentang derma organ dan HOTA [Alami: Muis supports MOH explaining organ donation and HOTA]”, Berita Harian, 21 August, 2007.
  17. See “More Muslims receive transplants,” Today, 11 February, 2009.
  18. The opt-out scheme is subject under HOTA, where every Singaporean included in the system is treated as prospective donors unless they choose to exclude themselves.
  19. Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya.208.
  20. Ibid. 194.
  21. Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 212.
  22. This is based on a press statement by the Mufti on the first organ donation fatwa issued by the Fatwa Committee. “Derma organ ḥarām: Fatwa Mufti [Organ donation prohibited: Mufti’s fatwa]”, Berita Harian, 2 August, 1973, 1.
  23. The fatwa permitting cornea donation was decided by the Fatwa Committee on 20 December 1995.
  24. “Derma organ haram: Fatwa Mufti [Organ donation prohibited: Mufti’s fatwa]”, Berita Harian, 2 August, 1973, 1.
  25. Abdulaziz A. Sachedina. Islamic Biomedical Ethics: Principles and Application. (Oxford, Oxford University Press: 2009). 175-176.
  26. This is based on verse 195 in Surah al-Baqara: “And spend in the way of Allah and do not throw [yourselves] with your [own] hands into destruction [by refraining]. And do good; indeed, Allah loves the doers of good.”
  27. ʿIzz al-Dīn ʿAbd al-ʿAzīz bin ʿAbd al-Salām, Qawāʿid al-Aḥkām fī Maṣāliḥ al-Anām. Vol. 1. (Cairo, Dār al-Sharq: 1968). 97; Jād al-ḤaqqʿAlī, “Naql al-Aʿḍāʾ Min Insān Ilā Ākhar, in Majalla al-Azhar, No. 10, (1983), 1375-1384.
  28. Ibn ʿĀbidīn, āshiya Ibn ʿĀbidīn. Vol. 5. (Beirut, Dār al-Fikr; 1992). 58.
  29. Jalāl al-Dīn Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. 217
  30. Sachedina, Islamic Biomedical Ethics: Principles and Application, 149.
  31. Abu Hamid Muhammad Al-Ghazālī, The Remembrance of Death and The Afterlife. Translation, note and introduction by Timothy J. Winter. (Cambridge, Islamic Texts Society: 1989),122-123.
  32. Al-Rāzī, Tafsīr al-Kabīr, Vol. 21, 45.
  33. Sachedina, Islamic Biomedical Ethics: Principles and Application, 158-163.
  34. ʿAbd al-Raḥmān al-Jazīrī, al-Fiqh ʿalā al-Madhāhib al-Arbaʿa. Vol. 2. (Beirut: Dār al-Kutub al-ʿIlmiyya, Second ed.: 2003). 23-24.
  35. Ibid, 23.
  36. Sachedina, Islamic Biomedical Ethics: Principles and Application, 154-155
  37. More information on HOTA is available on the Ministry of Health website at https://crms.moh.gov.sg/FAQ.aspx
  38. Ministry of Health. Among the description of brain death is: A person who is brain dead is truly and unequivocally dead and will never wake up nor regain consciousness again. Brain death occurs when there is total and irreversible cessation of all functions of the brain in a person. When a person is declared brain dead, he will not be able to breathe on his own and will need to be artificially supported by a ventilator. Once the ventilator is switched off, the person’s heart will cease to beat as his brain has already stopped functioning.” Ibid.
  39. The Islamic Fiqh Academy in its 10th Conference in Mecca on 17 October 1987 ruled that “Patients on life support, if it was verified by three doctors that he is brain dead and could not recover, then it is permitted to disconnect the life support even though the heart and respiratory systems are still functioning with the help of the paired device.”
  40. Aḥmad bin Muḥammad al-Zarqāʾ, Sharḥ al-Qawāʿid al-Fiqḥiyya. (Damascus, Dār al-Qalam: 1989). 309.
  41. Al-Ṣuyūṭī, al-Ashbāh wa al-Naẓāir fī Qawāʿid wa Furūʿ al-Shāfiʿiyya. Vol 1. 278.
  42. ʿAbd al-Karīm ʿUthmān, al-Niẓām al-Siyāsī fī al-Islām. (Beirut, Dār al-Irsyād: 1968),138.
  43. A benefit that is not explicitly supported or opposed by religious texts, is intended by the Shariah to be preserved.
  44. Tājʿ al-Dīn ʿAlī bin ʿAbd al-Kāfī al-Subkī, Al-Ibhāj fī Sharḥ al-Minhāj: ʿAlā Minhāj al-Wuṣūl ilā ʿIlm al-Uṣūl (Beirut, Dār al-Kutub al-ʿIlmiyya: 1984), Vol. 3,178.  

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