Website: http://www.themodernreligion.com/misc/hh/organ-transplant.html Is organ donation permissible?

Answered by Mufti Muhammad ibn Adam, Darul Iftaa (Leicester, UK) In the name of Allah, Most Compassionate, Most Merciful, The issue of organ transplant has been a matter of great debate and dispute amon g the great contemporary scholars from around the globe. It has been discussed i n various fiqh seminars, and many short and detailed works have be compiled on t he subject. The majority of the Indo/Pak scholars are of the view that organ transplant is n ot permissible, while, the Arab scholars and some scholars of the Indian subcont inent give its permission under certain conditions, (details of these conditions will be mentioned further along). No body has given a general unconditional per mission for the transplantation of organs. It must be remarked here that this issue is contemporary and obviously it is imp ossible for us to find express rulings concerning it in the classical works. As such, the views of the contemporary scholars are based upon the general and broa d guidelines of Shariah. It is obvious that this will result in difference of op inion, thus no one opinion should be condemned, as the intention of all the scho lars is to please Allah, and live a life that is in accordance with Shariah. 1) The view of impermissibility As mentioned earlier, the majority of the Indo/Pak scholars hold the view that o rgan transplantation can not be deemed permissible due to the harms and ill effe cts of it overcoming the potential benefits There view is based on the following grounds: a) The first and foremost is that Allah Almighty has honoured the human. Allah M ost High says: And verily we have honoured the children of Adam (Surah al-Isra, V. 70). As such, it is a well established principle of Shariah that all the organs of a human body, whether one is a Muslim or a non-Muslim, are sacred and must not be tampered with. To take benefit from any part of a human is unlawful (haram). Allah Almighty made humans the best of creations and created everything for thei r benefit. Allah Most High Says: It is He, who has created for you all things tha t are on earth. (Surah al-Baqarah, 2.29). Thus, it is permissible for a human to take benefit from every creation of Allah which includes animals (under certain conditions), plants and inanimate things. As such, it would be unreasonable to place humans in the same category of the a bove things by giving permission to use parts and derive benefit out of their bo dy that necessitates cutting, chopping and amputating parts of the body. This is certainly unreasonable and unlawful on a human body. A very famous Hadith prevents the usage of human parts. Sayyida Asma bint Abi Ba kr (Allah be pleased with her) narrates that the Messenger of Allah (Allah bless him & give him peace) said: Allahs curse is on a woman who wears false hair (of h umans) or arranges it for others. (Sahih Muslim, no. 2122). Imam Nawawi (Allah have mercy on him) writes in the explanation of this Hadith: I f human hair is used, then it is unlawful by consensus, whether its the hair of a man or woman, because of the general narrations that prohibit this. And also, i

t is unlawful to take benefit from the hair and all other organs of a human body due to its sanctity. The hair of a human along with all his body parts must be buried. (Commentary of Sahih Muslim by Nawawi, p. 1600). The Jurists (fuqaha) have stated that in the case of extreme necessity and when there is no alternative available, even unlawful things, such as pork and alcoho l, become permissible. However, even in such a situation, consuming or deriving benefit from a human body still remains unlawful. It is stated in al-Fatawa al-Hindiyya: If a person feared death due to hunger and another person said to him: Cut my hand and consume it or he said: Cut a part of m e and eat it, it will be unlawful for him to do so. Similarly, it is impermissibl e for a desperate person to cut part of his own self and eat it. (al-Fatawa al-Hi ndiyya, 5/310). Allama Ibn Abidin (Allah have mercy on him) explains: Because the flesh of a huma n remains unlawful even in forceful situations. (Radd al-Muhtar, 5/215) Imam Ibn Nujaym (Allah have mercy on him) states: It is impermissible for the one who is dying out of hunger to consume the food of another person who is also dy ing out of hunger; neither will be permissible to consume any part of the other persons body. (al-Ashbah wa al-Nazair, p. 124). The Fuqaha have also stated that if one was compelled by force to kill another h uman, it will not be permissible, even if his own life was in danger. (See: al-K asani, Badai al-Sanai, 7/177 & Ibn Qudama, al-Mugni, 9/331). Imam al-Marghinani (Allah have mercy on him) states regarding the sanctity of a human: It is unlawful to sell the hair of a human, as it is (unlawful) to take be nefit out of it, for a human is honoured and sacred, and it is not permissible t o disgrace any part of a humans body. (al-Hidaya 4.39) A human body is sacred even after his/her death. The Messenger of Allah (Allah b less him & give him peace) said: Breaking the bone of a dead person is similar (i n sin) to breaking the bone of a living person. (Sunan Abu Dawud, Sunan Ibn Majah & Musnad Ahmad). The great Hanafi jurist and Hadith Imam, Abu Jafar al-Tahawi (Allah have mercy on him) writes in the explanation of this Hadith: The Hadith shows that the bone of a dead person has the same sanctity and honour as the bone of living person. (Mu shkil al-Athar). In another Hadith it is stated: Harming a believer after his death is similar to harming him in his life. (Musannaf of Ibn Abi Shayba). Also, the books of classical scholars are full with examples indicating the impe rmissibility of deriving benefit out of a human body due to it being honoured. In conclusion, the human body, dead or alive has great significance. It is honou red and sacred, and because of the sanctity that is attached to it, it will be u nlawful to tamper with it, cut parts of it or dishonour it in any way. b) The cutting of and tampering with a human body amounts to mutilation and defo rmation of a divinely created body (muthla), which has clearly been prohibited i n Shariah. Qatada (Allah be pleased with him) narrates that the Messenger of Allah (Allah b less him & give him peace) used to encourage giving in charity and prevent Muthl a. (Sahih al-Bukhari, 2/206)

In another Hadith, the Messenger of Allah (Allah bless him & give him peace) sai d: Abstain from Muthla. (Sahih Muslim, 2/82). This is also supported by the verse of the Quran, where Allah Allah Almighty ment ions the words of Shaytan, when he said: I will mislead them and I will order the m to slit the ears of cattle, and to deface the (fair) nature created by Allah (4 : 119). To deface the fair nature created by Allah, both physically and spiritually, is what Shaytan likes and orders to practise. As far as the permissibility of blood transfusion in cases of need is concerned (See below, for the ruling on blood transfusion and donation, which was posted e arlier), it does not necessitate the cutting of human parts or any surgical proc edures on the body, rather it is drawn and transfused by means of injection, thu s it is akin to human milk that is extracted without any surgical procedures. c) The human body and parts are not in our ownership in that we may fiddle with them as we desire. It is a trust (amanah) that has been given to us by Allah Alm ighty. As such, it will be impermissible for one to sell, give or donate any org ans of his body. Islam has forbidden suicide for the same reason. There are many texts of the Quran and Sunnah that clearly determine this. Thus, it will be unla wful for one to give his organs to another. d) It is unlawful for an individual to inflict harm upon himself or others. The Messenger of Allah (Allah bless him & give him peace) said: It is unlawful to inf lict harm upon your self and others, (la dharar wa la dhirar). (Mustadrak of al-H akim) The famous principle states: Harm can not be removed by a similar harm (meaning, i n order to remove harm from another individual, it is impermissible for one to h arm himself). (Ibn Najaym, al-Ashbah, P. 123). Therefore, it will be impermissible for a living person to donate part of his bo dy due to it being harmful for him. e) The principle of Islamic jurisprudence states: When the evidences of prohibiti on conflict with the evidences of permissibility, preference is given to prohibi tion. (Ibn Nujaym, al-Ashbah wa al-Nazair). In view of the above and other evidences, according to this group of scholars, i t is unlawful to transplant organs, whether it be of a living person or a dead b ody, and whether there is a need or otherwise. In other words, there is no permi ssibility whatsoever for the transplantation or donation of organs. 2) The view of permissibility According to almost all of the major Arab scholars and also some contemporary In do/Pak scholars, the transplantation and donation of human-organs would be permi ssible subject to certain conditions (which will be mentioned later). This view is based on the following grounds: a) The famous principles (qawaid) of Islamic Jurisprudence based on the teachings of the Quran and Sunnah permit the use of unlawful things in cases of extreme ne ed and necessity. In case of Necessity, certain prohibitions are waived, as when the life of a person is threatened the prohibition of eating carrion or drinkin g wine is suspended. Allah Most High says: He (Allah) has only forbidden you dead meat, and blood, and the flesh of swine, and that on which any other name has b een invoked besides that of Allah. But if one is forced by necessity, without wi

lful disobedience, nor transgressing due limits, then he is guiltless. For Allah is Most Forgiving and Most Merciful. (Surah al-Baqarah, v. 173). The Quran also permits the utterance of disbelief (kufr) in order to save your li fe. Allah Most High says: Anyone who, after accepting faith in Allah, utters unbe lief, except under compulsion whilst his heart remaining firm in faith (Surah al-N ahl, V. 106). The principle of Fiqh, based on the above Quranic guidelines, states: Necessity ma kes prohibition lawful (See: Ibn Nujaym, al-Ashbah wa al-Nazair, P. 85 ). According to Imam Shafii (Allah have mercy on him), it is permissible for a perso n dying out of hunger to consume the meat of another human. (See: Ibn Qudama, al -Mugni, 9/335). Therefore, in cases of need and necessity, impure, unlawful and Haram things bec ome permissible. When a persons life is in danger and he is in dire need for tran splantation, he is in such a situation, thus the transplantation of organs will be permissible. b) With regards to the aspect of human sanctity, there are two things that need to be taken into consideration. Firstly, spected, o honour a human it is true that a human body, whether dead or alive, is honoured and re but does the modern procedure violate this sanctity? Islam ordered us t a human body but did not prescribe any fixed methods for it. Disgracing body may change from one time to another and from one place to another.

Thus, it could be said that the current procedure of organ transplantation is no t considered dishonouring a human body. The surgery is performed in the most res pectable way and it is not considered to be disrespectful. This is the reason wh y many highly respected people of the community regard donating of organs as a m ark of merit, and they are not looked down upon. Secondly, there are cases where Shariah overlooks the sanctity that is attribute d to the body, such as in the case of saving another human. It is stated in Tuhfat al-Fuqaha: If a pregnant woman died and the child in her s tomach is still alive, her stomach will be cut open in order to take the child o ut, for in there is saving the live of a human, thus the sanctity of a human bod y will be overlooked. (Samarqandi, Tuhfat al-Fuqaha, 4/261 & Badaii al-Sanai). This is also based on the juristic principle: If one is confronted with two evils , one should choose the lesser of the two (al-Ashbah wa al-Nazair). c) As for a human not owning his body is concerned, Islam permits a human in cer tain situations to utilize his body. It is similar to the wealth which Allah Alm ighty has given a human, and he is permitted to utilize it (in a correct manner) and give it as a gift. If an individual is drowning or is in the midst of a burning flame, it is totall y permissible to go and save him. Similarly, it will be permissible to donate yo ur organ in order to save the life of a fellow human being. d) Almost all of the scholars give permission for the transfusion and donation o f blood in cases of need and necessity (see below), then why is there a differen ce in the issue of organ transplant. The surgical procedure of transplantation e nsures that one does not go thorough unnecessary mutilation of his body. It is s imilar to surgical treatment that is carried out on a living person for medicati

on purposes. In view of the above (according to this group of scholars), it will be permissib le to transplant and donate organs in order to save another persons life. However , this is subject to certain terms and conditions. The international Islamic fiqh academy (Majma al-Fiqh al-Islami) which consists o f a number of major scholars from around the globe researched this issue in Febr uary 1988, and after extensive research, issued the following verdicts: Note, that the resolutions of the Islamic fiqh academy have been published in Ar abic and translated in a number of languages. Below is the original Arabic text and its translation in English:

" .

: :

: : .

: : . Shariah Rulings 1) It is permitted to transplant or graft an organ from one place of a perso ns body to another, so long as one is careful to ascertain that the benefits of t

his operation outweigh any harm that may result from it, and on the condition th at this is done to replace something that has been lost, or to restore its appea rance or regular function, or to correct some fault or disfigurement which is ca using physical or psychological distress. 2) It is permitted to transplant an organ from one persons body to another, i f it is an organ that can regenerate itself, such as skin and blood, provided th at the donor is mature and fully understands what he is doing, and that all the other relevant shariah conditions are met. 3) It is permitted to use part of an organ that has been removed from the bo dy because of illness to benefit another person, such as using the cornea of an eye removed because of illness. 4) It is unlawful (haram) to transplant or use an organ on which life depend s, such as taking a heart from a living person to transplant into another person . 5) It is unlawful (haram) to take an organ from a living person when doing s o could impair an essential and vital function in his body, even though his life itself may not be under threat, such as removing the corneas of both eyes. Howe ver, removing organs which will lead to only partial impairment is a matter whic h is still under scholarly discussion, as is mentioned in resolution 8. 6) It is permitted to transplant an organ from a dead person to a living per son when his life depends on receiving that organ, or when vital functions of hi s body are otherwise impaired, on the condition that permission is given either by the person before his death or by his heirs, or by the leader of the Muslims in cases where the dead persons identity is unknown or he has no heirs. 7) Care should be taken to ensure that in all of the above situations where transplantation is permitted, no buying or selling of organs is involved. It is not permitted to trade in human organs under any circumstance. However, the ques tion of whether the beneficiary may spend money to obtain an organ he needs, or to show his appreciation, is a matter which is still under the research of the s cholars. 8) Anything other than the scenarios described above is still subject to sch olarly debate, and requires further detailed research in the light of medical re search and shariah rulings. And Allah knows best. (See: Qararat wa tawsiyat majm a al-fiqh al-Islami, P. 59-60). The Islamic Fiqh academy of India also discussed this issue, and one of their me mbers who is recognised as a renowned scholar Shaykh Ubaid Allah al-Asadi (Allah preserve him) compiled a very extensive article. The following are summarized po ints of some of the conditions mentioned in his article (that have not been ment ioned in the above resolutions): 1) There should be no other reasonable alternative availible in the view of experienced medical experts 2) All efforts should be made to avoid transplanting of a non-Muslims organ i nto a Muslim and vice versa. If this is not possible, only then the organ of a n on-Muslim may be used. 3) Only the organs of a dead person should be used. However, if that is not possible, then only will it be permissible to use the organ of a living person. In conclusion, the above are the two viewpoints of the contemporary scholars wit

h regards to organ transplant and donation. The stance of some scholars, however , is that they abstain from issuing any verdict altogether on this issue. My respected teacher, Shaykh Mufti Taqi Usmani is one of those who are reluctant to voice their opinion. In a writing of his which I have (and I have also heard this from him verbally), he states: After the compilation of the book Islams ruling on organ transplantation (by his est eemed father, the grand Mufti of Pakistan, Mufti Muhammad Shafi, in which he str ongly emphasised the impermissibility of organ transplantation, and which was al so endorsed by Shaykh Taqi, m), I read the various arguments in favour of organ transplantation, thus it has left me hesitant and uncertain in this matter. As s uch, I now abstain from issuing any verdict. Therefore, one may follow any of the above two viewpoints, as they are both from great scholars of Islam. If one acts on the view of permissibility, then it wou ld be advisable, as a precautionary measure, to seek forgiveness from Allah (ist igfar) and donate something in charity. And Allah knows best Muhammad ibn Adam al-Kawthari, UK www.daruliftaa.co.uk

Organ Transplant Muhammad Afifi al- Akiti, Belfast. 18 March 1996. All Praises belongs to Allah, who has lavished His favours on His servants, We S eek refuge in Allah, Most Exalted, from the evils of our own selves and from our wicked actions. Whomsoever has been guided by Allah, none can misguide him, and whomsoever has been misguided by Allah, none can guide him. I bear witness that there is no true God worth of being worship except Allah, alone, having no part ner. And I bear that Muhammad (s.A.w.) is His slave and His Messenger. To proceed: "O servants of Allah, seek treatment for your ailments, for surely He who has created the disease has also given a cure for it. Those who are knowl edgeable will be able to discover this cure." (Related by Bukhari) Aisha narrated that the prophet (s.A.w.) said: "Indeed the Believers would be h ardly pressed, and indeed every believer who is to suffer even from a sting or p ain, Allah would as a reward, erase one of his sins and increase his rewards a d egree." (Related by Ahmad,Ibn Sa d, al-Bayhaq & al-Hakim) The opinion among most Fuqaha (jurists) is that seeking medical treatment is eit her recommended (Mandub) or obligatory. There are many Ahadith which encourage t he Muslims to seek medical treatment. Therefore it is up to the patient to decid e whether or not if he wants to undergo organ transplant. In regards to the prohibition of violating and mutilating the dead, it has been narrated that a man was digging a grave and he stumbled on some bones, the Proph et of Allah (s.A.w.) said: "Breaking the bones of the dead is like breaking the bones of the living." (Rela ted by Ahmad, Abu Dawud & Ibn Majah) It is a general rule in Fiqh in which it is prohibited to violate, harm or mutil ate the dead body whether it is a Muslim or non-Muslim cadaver, as an act of rev enge, showing disrespect or doing so without any good reason. There are exceptio

ns to this general rule especially in the light when there is a Necessity (Darur ah). "The Fuqaha of the Maliki and the Hanbal schools state that it is impermissible to dissect a dead pregnant lady in order to retrieve the baby, as it is difficu lt to determine whether the baby is alive. Because of this uncertainty, it shoul d not be a cause to violate the sanctity of the dead. On the other hand, the Fuq aha of Shafi i allows this dissection to be carried out. Besides, to dissect a d ead body in order to remove valuable goods is allowed according to Jumhur except the Hanbal school." (Ad-Durr al-Mukhtar 3/246) Nowadays, it is possible for medical authorities to determine whether the baby i s alive or not when such cases arise. The uncertainty that some Fuqaha had, is t hus removed. In Fiqh al-Islam wa Adillatuh (7/3), the author concludes: "Based on the rulings which allows dissection on dead bodies in specific cases, therefore any dissect ion or operation done on the dead body due to a significant necessity is allowab le. Forexample, dissection for the knowledge of medicine and dissection in order to find the cause of death to convict criminals by which there are no other ave nues to come to the truth (al-Haq). These are based on the Shari ah principle of establishing justice ( Adil) in any ruling given by the court, inorder to avoid injustice (Dhalim) from happening to the innocent or to ensure the guilty not t o escape from the punishment as a result of his crimes. Even though such dissections are allowed, it should be done within necessary lim its withoutoverdoing it. Besides, the sanctity of the dead body has to be respec ted and handled properly.After the investigation, bits and pieces should be gath ered, the body should be closed by suturing itup and finally shrouding the body. It is also allowable to perform any organ transplant such as the human heart or the eye. This must bewith the condition that the donor is proven to be dead by a specialist in the field. This is because thepriority is given to the living. Th e success of recovering vision for a human is a wonderful gift and isdemanded by the Shara ." In al-Ifta , The Permanent Committee for Legal Rulings (Fataawa) in Saudi Arabia conclude the following regarding dissection on dead bodies: 1.Dissection to discover if there is a criminal act causing the death is sanctio ned. 2.Dissection to see if there is a contagious disease and to then conclude how to stop its spread is sanctioned. 3.Dissection for educational and training purposes is accepted. The following is another legal ruling about organ transplant. Wabillahit Taufiq, And the last of our prayer: "Glory to your Lord, the Lord of Honour & Power! He is better from what they ascribe to Him! Peace be upon the Messengers! Praise b e to Allah, the Lord of the worlds." (37:180-182) The Council which consists of scholars from all the major Muslim Schools of Law in Great Britain, together with three distinguished lawyers has considered the i ssue of organ transplant and resolved that: The medical profession is the proper authority to define the signs of death. Current medical knowledge considers brain stem death to be a proper definition o f death. The Council accepts brain stem death as constituting the end of life for the pur pose of organ transplant. The Council supports organ transplant as a means of alleviating pain or saving l ife on the basis of the rules of Shari ah. Muslims may carry donor cards.

The next of kin of a dead person, in the absence of a donor card or an expressed wish of the dead person to donate his organs, may give permission to obtain org ans from the body to save other people s lives. Organ donation must be given freely without reward. Trading in organs is prohibi ted. Organ Transplant Ruling: List of the Ulama and Scholars who participated during the consultation and the n approved the statement on Organ Transplant: 1.Dr M A Zaki Badawi Principal, The Muslim College, London Chairman, The Muslim Law (Shari ah) Council UK. 2.Dr Jamal Sulayman, Professor of Shari ah, The Muslim College, London. 3.Dr A A Hamid, Professor of Hadith, The Muslim College, London. 4.Dr Fazel Milani, Professor at The International College of Islamic Sciences Lo ndon. 5.Dr S M A Shahristani, Principal, The International College of Islamic Sciences London. 6.Moulana Abdul Hadi Umri, General Secretary, Jamia-te-Ahl-e-Hadith (UK). 7.Moulana Qamaruzzaman Azami, Chief Imam, North Manchester Central Mosque & Gene ral Secretary, The World Islamic Mission. 8.Mufti Mohammed Yunus President, The World Islamic Mission & Imam, Woking Mosqu e. 9.Mufti Mohammed Muniruzzaman, Imam, Munir-ul-Islam Mosque, Rochdale. 10.Dr Abdul Halim, Senior Imam, The Islamic Cultural Centre and London Central M osque, Regent s Park London. 11.Mufti Alauddin, Head Imam, Brick Lane Central Mosque, London. 12.Moulana Hafiz M Khalid, Head Imam, Sparkbrook Islamic Centre, Birmingham. 13.Moulana Mumtaz Ahmed, Imam of Bradford. 14.A A Bashiri Esq. Barrister-at-Law. 15.R Abdullah Esq. Barrister-at-Law. 16.Dr Safia Safwat, Barrister-at-Law. 17.Moulana M Shahid Raza, Director, Islamic Centre Leicester & Secretary, The Mu slim Law (Shari ah) Council UK. 18.Mr S G Syedain, General Secretary, Imams & Mosques Council UK. 19.Dr. Manazir Ahsan, Director of the Islamic Foundation Islam holds that Man consists of two essential elements, one material which is t he body, the other spiritual which is the soul. Life exists in the human body as long as the soul is joined to it, and it ceases when the soul departs from the body. "Who made all things good, which He created, and He began the creation of man fr om clay then He made his seed from a draught of despised fluid. Then He fashione d him and breathed into him of His Spirit, and He appointed for you hearing and sight and hearts. Yet small thanks do you give for it!" (32:7-9) Thus the cessation of life means the departure of the soul from the body: "Allah recalls souls at the time of their death, and those who have not died, du ring their sleep. Heholds on to anyone whom death has been decided for, and send s the others back for a specific period." (39:42) The soul is a mysterious thing and nobody has been able to discover its nature. Its presence in the body results in life which is observed by the movement and t he other conventional signs of life. The departure of the soul from the body res ults in death, which is associated with certain physical signs arrived at as a r esult of medical observations and knowledge.

The signs of death which the ancient medical doctors have listed are: lack of co nsciousness, loss of body temperature, cessation of pulse and breathing, glazing of the eyes, parting of the lips, sagging of the nose, and slackening in the mu scles of the hands and feet. The heart used to be considered as the centre of li fe in the body. When it stopped completely it was assumed that death occurred. B ut if it regained its functions through first aid practices life is assumed to h ave returned. The last five decades have witnessed a big leap in medical science bringing grea t benefits and skills which were unthinkable before. It is now possible to trans plant organs from one body into another, which would help the recipient to conti nue to live. The significance of the heart has also changed as it is no longer c onsidered the most important organ with regard to life and death. Medical opinio n now considers the brain to be the central and crucial part which controls the entire body and its functions. When it is damaged partially or totally the body will suffer either partial or total deterioration. As a consequence of the prese nt development in medical knowledge and skills a number of questions have arisen . These are: Is it allowed to remove an organ like the kidney from the body of a living perso n and transplant it into the body of a sick person whose life depends on it? Is it permissible to remove an organ from the body of a dead person to be used t o save the life of a living person? Is a person allowed to donate his body or part of it to be used after his death in saving the life of other people? Does Islam recognise the new definition of death that is brain stem death? If it does is it permissible to remove from brain stem dead persons organs for t ransplant while there are signs of body functions like heart beat temperature an d breathing? Before answering these questions it is important to note the following principle s of Islamic Jurisprudence (Usul-Fiqh): A person has the legal authority over his own body, attested by the fact that he can hire himself for work which might be difficult or exhausting. He may also v olunteer for war which may expose him to death. A person is forbidden from harmi ng himself or others (It is not legitimate in Islam to inflict harm on others or to suffer harm from them - Hadith). In case of Necessity certain prohibitions a re waived as when the life of a person is threatened the prohibition on eating c arrion or drinking wine is suspended. "He has only forbidden you what has died by itself, blood and pork, and anything that has been consecrated to something besides God. Yet anyone who may be force d to do so, without craving or going too far, will have no offence held against him; for Allah is Forgiving, Merciful." (2:173) Confronted with two evils a person is permitted to choose the lesser of the two, as in the case of a starving person whose life could be saved by either eating carrion or stealing from another person s food. He would be permitted to opt for the latter. Islam made it an obligation upon the sick to seek treatment. In the light of the above principles the Council is of the opinion that: 1. It is permissible for a living person to donate part of the body such as the kidneys to save the life of another, provided that the organ donated would not e ndanger the donor s life and that it might help the recipient. The Prophet (s.A.w.) says, "Whoever helps a brother in difficulty, God will help him through his difficulties on the Day of Judgement." 2. It is permissible to remove the organ of a dead person to be used to save the

life of a sick person. 3. It is permissible for a person to donate his body or parts of it to be used a fter death to treat those who need transplants. So it is permissible for Muslims to carry a donor card. 4. In the absence of a donor card carried by the dead person it is sufficient to obtain the consent of the next of kin. 5. The proper authorities will act in lieu of relations if they are not known. Regarding brain stem death, the Council, having discussed the matter over a numb er of meetings with Doctors and specialists, and having studied the safeguards i nstituted by the Ministry of Health in Great Britain, went further and examined the research done by trustworthy Muslim Doctors and noted the following: If the heart stops beating then lack of consciousness and the cessation of breat hing will follow immediately. If however the person is helped by massage of the heart (CPR) or through the use of electric shock (defibrillation) within four or five minutes the heart may re start. If the flow of the blood to the brain ceased for more than a few seconds damage may occur, although some of the cells will remain alive for four or five minutes . On the other hand if the brain stem ceases to function it cannot be made to re start. After the brain stem is dead it is possible to preserve some organs functioning for a period from six hours to two weeks. The presence of pulse or movement afte r the death of the brain stem is not a sign of life. We know that a hanged or be headed person continues to have pulse and movement for a brief period. But they are not considered to be alive and it would not be possible to bring them back t o life. Based on the above the medical profession concludes that life ceases as a result of brain stem death. The Council is of the opinion that trustworthy Doctors are the proper and authen tic authority when it comes to defining the signs of death. After a thorough consideration regarding medical opinion and several edicts issu ed by different religious bodies, the Council arrived at the following conclusio ns: After trustworthy Doctors certify that the brain stem has died organs needed to save others lives might be taken from the body, and then the life support machi ne may be switched off. While the Council recognises the need for benefiting from the advances of medica l science in alleviating the suffering of the sick and saving lives, it wishes t o remind everyone especially Doctors of the following points: Human beings are the most honoured creature on earth. Their dignity in life and death must be maintained. "We have dignified the Children of Adam and transported them around on land and at sea. We have providedthem with wholesome things and favoured them especially over many of those whom We have created." (17:70) Human life is sacred. To terminate the life of one person is equivalent to the t ermination of the life of all humanity. Conversely the saving of one life is reg

arded as the saving of all humanity. "Whosoever kills any person without another soul being involved or for causing c orruption in the earth, it shall be as if he had killed all mankind and whosoeve r saves the life of one it shall be as if he had saved the life of all mankind." (5:32) The Council is of the opinion that human organs should be donated, and not sold. It is prohibited to receive a price for an organ. [Halal and Haram] [Mainpage] [What s New?]

Website: www.uktransplant.org.uk/.../islam_and_organ_donation/islam_and_organ_ d onation_2009.pdf Muslim scholars of the most prestigious academies are unanimous in declaring tha t organ donation is an act of merit and in certain circumstances can be an oblig ation. These institutes all call upon Muslims to donate organs for transplantation: the Shariah Academy of the Organisation of Islamic Conference (representing all Muslim countries) the Grand Ulema Council of Saudi Arabia the Iranian Religi ous Authority the Al-Azhar Academy of Egypt Organ donati on the gift of life Today more than 10,000 people in the UK need an organ transplant which could sav e or dramatically improve their lives. Most are waiting for a kidney, others for a heart, lung or liver transplant. Please join the NHS Organ Donor Register and tell family and friends about your wishes. Transplants save lives Information on Islam is available from: www.bbc.co.uk/religion Compiled by Rachel Howitt, Bradford Hospitals NHS Trust Produced by UK Transplant, April 2003. Updated by NHS Blood and Transplant 2009. Join the NHS Organ Donor Register Online at: www.organdonation.nhs.uk 4 by phoning 0300 123 23 23 -..: or text SAVE to 84118 Irk4 1 1 7, 4 p4 .,4 ;-4 I pi- i i 14211 :iri r.d-i 01 Blood and Transplant Islam and Organ Donation A guide to organ donation and Muslim beliefs e

NHS This leaflet available in Urdu, Gujarati, Punjabi, Bengali Organ donation Organ donation is the gift of an organ to help someone else who n eeds a transplant. Hundreds of people s lives are saved each year by organ trans plants. Organs that can be donated by people who have died include the heart, lu ngs, kidneys, liver, pancreas and small bowel. Tissue such as skin, bone, heart valves and corneas can also be used to help others. When can organ donation take place? Doctors and nurses are committed to doing ev erything possible to save life. Organs are only removed for transplantation once all attempts to save life have failed and after death has been certified by a doctor or doctors who are entirely independent of the transplant team. Most donated organs come from people who die from a severe brain injury and who receive treatment on a ventilator in an intensive care unit. The brain injury da mages vital centres in the brain stem which are essential to maintain life. No one can live once these centres have been destroyed. Tests can show conclusively when this has happened. In some circumstances, patients who die in hospital but are not on a ventilator may also donate. They are called non-heartbeating donors. Sometimes people who do not die in hospital can become tissue donors. Consent The consent, or lack of objection, of those closest to the patient is al ways sought before organs can be donated. This is why it is so important for peo ple to discuss their wishes with their loved ones. Donation is an individual cho ice and views differ even within the same religious groups. Many families who ag ree to organ donation have said that it helps to know some good has come from th eir loss. Care and respect The removal of organs is carried out with the greatest care and respect. The family can see the body afterwards and staff can contact a chaplai n or local religious leader if the family wishes. Islam and organ donation In 1995 the Muslim Law (Shanah) Council UK issued a fat wa (religious opinion) on organ donation. The council resolved that: the council supports organ transplantation as a means of alleviating pain or saving life on the basis of the rules of the Shariah Muslims may carry donor cards the next of kin of a dead person, in the absence of a card or an expressed wish to donate their organs, may give permission to obtain organs from the body to sa ve other people s lives. The fatwa is based on the Islamic principle of al-daru rat tubih al-mahzurat (ne cessities overrule prohibition). Normally, violating the human body, whether liv ing or dead, is forbidden in Islam but the Shariah believes this can be overrule d when saving another person s life. However there are also a significant number of Muslim scholars who believe that organ donation is not permissible and hold the view that this does not fall unde r the criteria of the Islamic principle of al-darurat tubih al-mahzurat (necessi ties overrule prohibition) due to other overriding Islamic principles. Both viewpoints take their evidence from the Qur an and the Ahaadith and therefo re individual Muslims should make a decision according to their understanding of the Shariah or seek advice from their local Imam or scholar. The Muslim Law Council UK fatwa draws on one of the basic aims of the Muslim fai th: saving life. "Whosoever saves the life of one person it would be as if he saved the life of a ll mankind." Holy Qur an, chapter 5:32 "Whosoever helps another will be granted help from Allah." Prophet Muhammed (pbu h) "If you happened to be ill and in need of a transplant, you certainly would wish that someone would help you by providing the needed organ." Sheikh Dr MA Zaki B adawi, Principal, Muslim College, London

website: http://www.isna.net/Leadership/pages/Islamic-Medical-Ethics.aspx

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In the name of Allah, Most Comassionate, Most Merciful Islamic Medical Ethics The position of Islamic Medical Association of North Amer ica On issues of Medical Ethics By IMANA Ethics Committee* List of Content: =========== Introduction of IMANA The need for Position Papers What is Islamic Medical Ethic s? The topics of our position A. The Care of Muslim patients B. The definition o f life and responsibility of Muslim physicians towards human life C The definiti on of death D. IMANAs position on: A Euthanasia, Mechanical life support, Living Will, case manager and Advance Directive. B Transplantation and Organ donation C . Assisted Reproductive Technology and Surrogacy D. Contraception and Terminatio n of Pregnancy (TOP) E The Genetic Research and Human Cloning. F .The Care of HI V patients G. Miscellaneous ethical issues. Appendix: Frequently asked questions and answers on medical ethics References from Holy Quran Recommended Resources Websites for Islamic Medicine and Medical Ethics Islamic Medical Association of North America (IMANA) =========================== ==============

In 1963, Muslim students studying in American colleges and universities organize d themselves into an association (Muslim Students Association). Four years later, in 1967, American Muslim physicians did the same and formed IMANA. MSA transfor med into the Islamic Society of North America (ISNA) and IMANA became a constitu ent body of ISNA. Since its inception in 1967, IMANA has dedicated itself to ser ving Muslim physicians, Muslim patients and the community at large on issues rel ated to Islamic Medicine nationally and worldwide. IMANA is also a member of the international Federation of Islamic Medical Associations (FIMA). Islamic Medici ne is defined as the art and science of practice of medicine by Muslim physician s and other health care providers in the service of humanity under Islamic guide lines as ordained by the divine book Quran and taught by Prophet Mohammad (peace be upon him). IMANA has headquarters in a Chicago suburb and regional chapters in many cities of USA. It is governed with By-Laws and an executive committee. I t has several operational committees including the medical ethics committee. For detailed information about IMANA, one can visit www.IMANA.org.

Need for Position Papers on Islamic Medical Ethics ============================= =========== Muslim Physicians, Ethicists, Imams and scholars are asked questions by Muslim a nd non-Muslim patients, physicians and institutions as to what is Islams position or opinion on certain medical dilemmas affecting the care and outcome of patien ts illness and life . Some of these issues, such as termination of pregnancy, are time honored situations while many such as transplantation, assisted reproducti on and euthanasia are products of advances in medical technology. Since these ar e new issues, Muslim physicians, have dire need for recommendations from guiding principles of Quran, the tradition of Prophet Mohammad (p)(ref: Quran 33:36) an d opinions of past and contemporary Muslim scholars. Thus, IMANA decided to make position papers which will be available to those who seek our position in order to pursue further reading on their own. The position papers are only suggestion s on behalf of IMANA and not to be considered a Fatwa (religious decree) which h as a legal binding. The members of ethics committee are not in a position to iss ue a Fatwa on any of the issues which we are writing on behalf of IMANA. However , from time to time, on need basis, we do consult Muslim scholars for their opin ion. The Position Papers will be revised from time to time as t new questions ar ise from advances in medical technology. The Position Papers are available to be read and downloaded from internet at www.imana.org at no cost.

Islamic Medical Ethics ================== Islam considers access to health care a fundamental right of the individual. In medicine, there are sometimes difficult decision making situations for choosing better options for the patients care. Thus, a physician at times has to decide fo r his /her patient in light of available knowledge, his/her experience, his/her peers and consensus of the community. In addition, a Muslim physician derives hi s /her conclusion from rules of Islamic laws (Shariah) and Islamic medical ethic s. The two main principles of Islamic Medicine are: 1) emphasis of sanctity of h uman life which derives from Quran 5:32 whosoever saves a human life, saves the l ife of the whole mankind, 2) emphasis on seeking a cure which derives from saying of Prophet Mohammad (p), seek cure as God has created no disease without creatin g a cure for it except for old age. The five goals of Islamic Shariah are protect ion and preservation of life, mind, private ownership, family and freedom of rel igion. Some of the rules of Islamic medical ethics are 1) Necessity overrides pr ohibition that is if there are certain items which are islamically prohibited, u nder dire necessity they can become permissible. 2) Accept the lesser of the two harms if both can not be avoided. 3) Public interest overrides the individual i

nterest. 4) Harm has to be removed at every cost if possible. Islamic Medical Et hics also upholds the four basic principles of biomedical ethics which are 1) Re spect for the autonomy, 2) Beneficence, 3) Nonmaleficence, and 4) Distributive J ustice. Thus, a Muslim physician has to make a decision not only based on his/her own kn owledge and experience, but as a Muslim in light of his /her Islamic teachings, in the best interest of his /her patient, whether Muslim or non Muslim .

4a: IMANAs Position on the Care of Muslim Patients (2) ========================== ================ IMANA has published a brochure entitled Guidelines for Healthcare Providers in Ca ring for Muslim Patients. (2). Those who wish to obtain a copy can call IMANA at (630) 932-0000 . It is also available on line at www.imana.o rg . All patients irrespective of their faith should be treated with human dignity an d respect. Muslim physicians are advised to treat all patients with loving care as if they are members of their own family. We suggest to all health care provid ers that they familiarize themselves with the basic teachings of Islam and Islam ic moral values. It is easier for a healthcare provider to deal with the patient if he /she understands the faith, values and culture of his/her patient. These are some of the specific guidelines for healthcare providers especially of other faith traditions for caring for their Muslim patients. 1. Muslim patients should be identified if possible as Muslim (or with religion Islam) in the registration information so as to prevent any mistakes happening u nintentionally in terms of violating dietary rules or privacy. 2. Their care providers should respect their modesty and privacy. Muslim patient s, particularly women may need a special gown to cover the whole body in order t o avoid unnecessary exposure during physical examination. Some examinations may be done over the gown. 3. Provide Muslim patient Islamically slaughtered (Dhabiha) meat. Muslim patient s should not be served any pork, pork products or alcohol in their meals. A Musl im patients family may be allowed to bring food from home meeting patients dietary restrictions. 4. Allow Muslim patients facility to perform Islamic prayers if they can... 5. Inform them of their rights as a patient and encourage n Islamic living will. (a sample of a living will is enclosed). 6. Take time to explain test procedures and treatment. Some of the recent immigr ant Muslims may have a language problem. Muslim women, can give consent themselv es for any treatment or procedure. 7. Allow their Imam (religious teacher) to visit them and pray for them. Priests of other faith traditions can pray for or with Muslim patients with their permi ssion, using non denomination words like God. 8. Autopsy is permitted if medically indicated or required by law. 9. Organ donation is permitted with some guidelines and encouraged. 10. Always examine a female patient in the presence of another female or a femal

e relative (except in medical emergencies). Especially for labor and delivery pr ovide the same sex healthcare provider, upon the request of the patient if feasi ble. Her husband is encouraged to be present during the delivery. 11. After death of a Muslim patient in a health care facility, allow the family and Imam to arrange for preparing the dead body for funeral under Islamic guidel ines. A corpse should be given the same respect and privacy as he/she was receiv ing while alive. Muslim relatives and friends of the dead are encouraged to stay in the room where dead body is kept to recite Quran. Muslim corpses are not emb almed.

4b: Definition of Life and the Responsibility of Muslim Physicians towards Human Life {34) ===================================================================== = Muslims believe that God is the Creator of life and life is a gift from Him (Qur an: 36:77-78). Muslims believe that all life is sacred and must be protected .Th e position paper extends the principles of medical ethics to the patient in a ve getative state. Until the death has been declared, the patient in a vegetative s tate is considered a living person and has all the rights of a living person. IM ANA holds the position that biological life begins at conception while human lif e begins when ensoulment takes place at 40 (or120 days according to other school of thought) after fertilization. The right of the fetus in Islam is similar to the rights of a mature human being, including right to life, right to inheritanc e, right of compensation when injured by willful acts and right to penalize assa ilants. The respect for life in Islam is common for all humans, irrespective of gender, age, race, color, faith, ethnic origin, financial status or productive stage of life.

4c: Definition of Death (24, 26, 33) ========================== IMANA has published a position paper on death in the Journal of Islamic Medical Association. (JIMA vol. 29, 1997) Permanent cessation of cardiopulmonary functio n, when diagnosed by a physician, is considered death. The concept of brain deat h is necessitated when artificial means to maintain cardiopulmonary function are employed. In those situations, cortical and brain stem death, as established by a specialist using appropriate investigations can be used. It should be the phy sician who should be responsible for making the diagnosis of death. Thus a perso n is considered dead when the conditions given below are met. 1. The physician has determined that after a standard examination, a persons card iopulmonary function has come to a permanent stop 2. A specialist physician has determined that after standard examination, the fu nction of the brain, including the brain stem, has come to a permanent stop, eve n if some other organs may continue to show spontaneous activity. 4d: IMANAs Position on Mechanical Life Support, Euthanasia and

and Vegetative State (8, 9, 11, 21, 27) ============================= Please refer also to the following versus in the holy Quran on the issue of life

and death. (Abdullah Yusuf Ali Translation) 1) 40:68 It is He who gives life and death and when He decides upon an affair, He says to it: Be and it is. 2) 3:145 No soul can die except by Gods permission, the term being fixed by writin g----- 3) 39:42 It is God who takes the soul of (men and women) at death, and those who die not during their sleep .Those on whom , He has passed the decree of death, H e keeps back ( from returning to life), but rest , He sends to their bodies. Ver ily in these are signs for those who reflect. 4) 29:57Every soul will have a taste of death. In the end, to Us, shall you broug ht back. 5) 10:56 it is He who gives life and Who takes it away and to Him shall you broug ht back. 6) 17:33 Nor take life which God has made sacred-except for a just cause IMANA believes that when death becomes inevitable, as determined by physicians t aking care of terminally ill patients, the patient should be allowed to die with out unnecessary procedures. While the patient is still alive, all ongoing medica l treatments can be continued. IMANA does not believe in prolonging misery on me chanical life support in a vegetative state. All of the procedures of mechanical life support are temporary measures. When a team of physicians, including criti cal care specialists have determined, no further or new attempt should be made t o sustain artificial support. Even in this state, the patient should be treated with full respect, comfort measures and pain control. No attempt should be made to withhold nutrition and hydration. In such cases, if and when the feeding tube has been withdrawn it may not be reinserted. The patient should be allowed to d ie peacefully and comfortably. No attempt should be made to enhance the dying pr ocess in patients on life support. Suicide and Euthanasia are prohibited in Isla m (Quran17:33). Muslim physicians are instructed to uphold the sanctity of human life. IMANA is absolutely opposed to Euthanasia and assisted suicide in termina lly ill patients by healthcare providers or patients relatives. IMANA recommends all Muslims to have a living will, advance directive and a case man ger for their care, to help physicians to know the wishes of patient, when he or she is unable to give directions (i.e. in a coma). A sample of such proposed li ving will is provided here which can be modified by the patient after consulting with family and attorney. (Ref: JIMA: Vol.29:1997).

Islamic Living Will and Advance Directive (a sample) =========================== ============= Declaration made this ________day of ______, 20__. I , a Muslim of sound mind , willfully and voluntarily make known my desires that my dying shall not be artif icially prolonged under the circumstances set forth below and I declare: If at a ny time I have an incurable injury, disease or illness certified in writing to b e a terminal condition by my attending physician, and my attending physician has determined that the use of life-prolonging procedures would serve only to artif icially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the provision of a ppropriate nutrition and hydration and the administration of essential medicatio ns and the performances of any medical procedure necessary( as determined by my physician) to provide me with comfort or to alleviate pain.

In the absence of my ability to give direction regarding the use of life-prolong ing procedures, it is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or su rgical treatment and I accept the consequences of the refusal. ____________ is my case manager to enforce my living will, if I am not physicall y able to give direction. I do not permit autopsy of my body unless my death occ urred in a suspicious manner or is required by the court of law. It is my desire that Muslims attending my dying process ensure that Islamic Shariah is practice d during preparation of my body for funeral. .My body be treated with grace and privacy and buried with Islamic guidelines under the directions of my Muslim fam ily, Imam or other qualified Muslims as soon as it is feasible. Signed--------------------------------------- Date---------------Place------------

---============================================================The declaring person has been personally known to me and I believe (him/her) to be of sound mind. I did not sign the declaring persons signature above for or at the direction of the declaring person. I am not a parent, spouse, or child of th e declaring person . I am not entitled to any part of the declaring persons estat e or directly financially responsible for his/her medical care. I am competent a nd at least eighteen (18) years of age. Witness (to the document) _________________________ Date________________ Witness (second) _______________________________ Date________________ 4e: IMANAs Position on Organ Donation and Transplantation (1) ============================================== We, at IMANA, understand that certain organs may fail in the human body while th e rest of the body may still be functional. The current state of medical knowled ge holds the view with scientific proof that if the diseased organs are replaced by healthy organs and if accepted, the body machine can continue to function ra ther than die because of one diseased organ. Islam instructs all Muslims to save life (Quran 5:32). Thus, on this basis, transplantation in general, both giving and receiving organs, is allowed for the purpose of saving life. This has to be done under the following guidelines: 1. The medical need has to be defined 2. The possible benefit to the patient has to be defined 3. Consent from the donor as well as recipient must be obtained. 4. No financial incentive to the donor or his relatives for giving his organs. (a voluntary gift may be permitted) 5. Any permanent harm to the donor must be avoided. 6. May not transplant sex organs (testicles, ovaries or) which would violate the sanctity of marriage.

7. There should be no sale of organs by any party. 8. There should be cost to the family of the donor for removing the organ. 9. Cadaver donation is permitted but only if specifically mention in that persons Will or in driving license. Blood Transfusion is permissible. Giving or receiving blood from people of other faith is permissible. 4f: IMANAs Position on Assisted Reproductive Technology (22, 23, 30) ==========================================

We believe infertility is a disease and desire for a cure by an infertile couple is natural. However, in Islam, for an action to be permissible all means of ach ieving that action are also to be pure. IMANA holds the position that all forms of assisted reproductive technology (ART) are permissible between husband and wi fe during the span of marriage using the husbands sperm and the wifes ovaries and uterus. No third party involvement is allowed. We believe in the sanctity of mar riage (Quran: 16:72) and that the death of one of the spouse terminates the marr iage contract on earth, thus frozen sperm from husband can not be used. Sperm, o va and embryo donation are not permitted. We also believe that surrogacy involvi ng a third person is not permissible, as we believe that it exceeds the boundari es of the marriage contract and lineage (Quran 58:2, 25:54). An infertile couple , if they can not find a permissible cure, can care for another child or someon e elses child as their own without giving legal adoption such as changing the nam e, inheritance etc. Use of infertility drugs is permissible. Additional embryo p roduced by IVF between husband and wife can be discarded or given for genetic re search.

4g: IMANAs Position on Contraception and Abortion (Termination of Pregnancy) (7) =========================================================== Islam prohibits sex and conception out of wedlock. For married couples, contrace ption for several reasons, including health of the mother, social or economic re asons etc, is permitted. Abortion is willful termination of pregnancy by artifici al means (drugs, chemicals, mechanical or surgical before the age of viability 2 3 weeks) for any reason. Chemical or mechanical means to prevent the formation o f zygote (fertilized ovum, which marks the beginning of human life) is not consi dered abortion. . We believe that life begins at conception and unless interrupt ed by disease or artificial means, the fertilized ovum will continue to grow and become a viable mature human being. Islam gives fetus the right to life. IMANAs position on abortion can be classified in three categories: Elective abortion of a viable fetus in a healthy mother is considered a serious crime, equivalent to murder and is prohibited. Abortion may be permitted if cont inuation of pregnancy may cause the pregnant woman to die or cause serious deter ioration of her health both medical and mental. The congenital conditions affect ing fetus in which abortions may be sought and may be permitted are lethal malfo rmations not compatible with extra uterine life such as bilateral renal aplasia, Trisomy 13, 18 and . But, even in these situations, it is preferable to do it b efore the 120 days of pregnancy. In non-lethal situations such as severe hydroce phaly, cervical spinal bifida, Downs syndrome, it may be permissible before 120 d

ays of pregnancy after consulting Islamic scholars and medical experts in the fi eld. Pregnancy occurring because of rape, war crimes, incest may be a cause to s eek abortion. In all cases, the recommendation should be made by a team of Islam ic scholars and medical experts in the field. Similarly, contraceptive methods w hich can lead to abortion are not allowed. . Prohibition of infanticide is menti oned in following verses in Quran 17:31, 6:151, and 60:12.

4h: IMANAs Position on Genetic Engineering and Human Cloning (16, 18, 29, 31)) == ============================================================== Genetic research and engineering to alter or delete diseased genes is allowed an d genetic research using stem cells from products of miscarriages or surplus ova after IVF procedures is permissible. However, to conceive in order to harvest a nd use stem cells and then abort the fetus is not permissible. We believe that e ach individual is born with unique qualities and genetic makeup .Islamically, a child should be born out of marriage between husband and wife and the lineage of the child should be maintained. (Quran 25:54). Therefore, Human Cloning is not permitted in Islam...

4i: IMANAs Position on the Care of HIV Patients (20) ============================ ============ HIV infection, in addition to being associated with Homosexuality is also known to be acquired through heterosexual acts, as well as I.V. drug use, blood transf usion and child birth. While Islam is opposed to homosexual life style, IMANA is not opposed to the care of HIV patients. In fact, it instructs Muslim physician s to care for HIV patients with the same degree of compassion as they would for other patients. We do not discriminate against any patient on the basis of their lifestyle. We do advise healthcare providers to take precautions for themselves while taking care of HIV patients.

4j: Miscellaneous Issues ================== a. Birth control methods between husband and wife: IMANA approves of all methods of contraception between husband and wife which ar e not harmful, are reversible and are not abortificient. Prophylactics, withdraw al methods or oral contraceptives are allowed. However permanent measures such a s tubal ligation , vasectomy, morning after pill and certain forms of IUD are no t permissible. b. .Examination of opposite sex: This is allowed in the presence of a third person of the same sex as the patient . In case of a minor, one of the parents presence is desirable. Only necessary ex amination needs to be done. Pelvic examination must be done using gloves. IMANA encourages but does not mandate same sex health care provider. Medical or nursin g students may be allowed during examination of a female patient, but only with her prior consent and in the presence of a female nurse or relative. Drug Research: Double blind drug research or using placebos is allowed, but the patient must be informed and consent must be taken. Worsening of the disease whi le in drug research, either due to placebo or an ineffective dosage of the drug must be carefully monitored and the trial should be ended for the safety of the

patient.

5: Frequently asked Medical Ethics Questions (Answers provided by Hassan Hathout , MD, PhD) ===================================================================== ==== Q1. Can Muslim patients take medicines which may contain alcohol or pig by- prod ucts? A. No, Muslims should not take these medicines unless they are life saving drugs and no substitute is available. (One school believes that when pork has c hanged chemically, it is not haram or najs- illegal and impure). Q2. I am 3 mont hs pregnant and doing fine. Can I fast during Ramadan? A. It is preferable that you utilize God s granted exemption and do not fast. Your baby is dependent on y ou for his or her nutrition and hydration. Why do you want him or her to fast wi th you? Q3. Is use of placebos in clinical trial endorsed by Muslim Ethicists? A . Yes, but make sure that the protocol is fully explained to the patient and by delaying the treatment, no worsening of his medical condition takes place nor hi s life is endangered. Q4. While fasting can a Muslim patient have a blood test ( venous draw) or check his glucose with a finger stick? A. Yes, if it is a medica l necessity. Q5. While fasting can a Muslim patient take tablets, injections, in halers or patches? A. The general rules are: (1) Sick patients are exempt from f asting. (2) Any medicine of nutritional value or taken with water will break the fast. (3) Patches and inhalers can be used. Q5. on Separation of conjoined twin s, one dependent on the other, which one to save? A. It is a difficult situation . The emphasis should be to save both lives and one cannot be sacrificed over th e other. However, if one has to do so, the twin who cannot function on its own a nd acts as a vestigial organ of the other, may have to be sacrificed during the process of separation. Q6. Should a female patient only seek a female Gynecologi st? A. If available, same sex health care providers are encouraged but, if not a vailable and in life saving situations, "necessity overrides the prohibition" a rule of Islamic Sariah. Q7. Can a female Physician do genital/rectal examinati on of male patients? A. Yes, but in the presence of a male nurse or male relativ e of the patient. The answer to the previous question also applies here. Q8. Sho uld Muslim Physicians care for AIDS patients? Is this endorsing homosexuality? A . We do not discriminate other patients because of their lifestyle (smokers, alc oholics, over eaters etc) nor should we do so for AIDS patients. We should care for them as we care for any patient, taking all the necessary precautions to pro tect ourselves. By the way, not all AIDS cases are due to homosexuality. Q9. Sho uld Muslim OB/GYN Physicians perform abortion, vasectomy or tubal ligation? A. S uch procedures are prohibited in Islam except to save the life of the mother. Mu slim Physicians also may not perform them (even on patients of other faith) unle ss medical necessity. Q10. We are getting married and can not afford to have chi ldren, as both of us are still students. What contraception measures are allowed ? A. All contraception measures between married couples for a valid reason and w ith consent of both are permitted if they are not irreversible (sterilization/tu bal ligation), abortifacient (RU 486, IUD) or may be harmful (oral contraceptive s). That leaves only abstinence, condoms and the withdrawal method. Q11. My wife can not conceive. Can she use her ovum and my sperm to be fertilized in her sis ter s uterus? A. No. Surrogacy is not permitted in Islam. (some jurist disagree with this opinion) Q11. We got married 3 months ago. My husband is in a coma aft er an auto accident and is expected to die soon. I love him very much. Can I sav e his sperm to have his baby after his death? A. No. After his death, his sperm can not be used. All methods of assisted reproduction are allowed between husban d and wife only during the intact span of marriage. Q12. I am pregnant and expec ting delivery soon. Should I request my husband be present but no other male att endant during labor? A. Yes. You can make such a request. Q13. My friend is in t he hospital. He is to have a major operation and will require blood. Is blood tr ansfusion allowed and should we select the donor? A. Yes. Blood transfusion is a llowed. Blood is routinely screened for HIV and other diseases. It would be nice

if you could find a relative of your friend to match and donate his or her bloo d. Q14. At what stage of pregnancy does the termination become abortion, after 1 20 days or before? A. According to Imam Ghazali School of thought, life begins a t conception, but other Islamic Jurists may have different opinions and allow te rmination of pregnancy before 120 days for a valid reason. Q15. Is post-mortem ( autopsy) of a dead body allowed? A. Yes, but only as a medico- legal necessity t o ascertain the cause of death. Q16. What should be done to the products of misc arriage? Should they be destroyed or buried? A. Preferably they should be handle d with the same respect as another death and be buried if possible. (there is no need for funeral prayer). Q17. After a massive brain hemorrhage, my mother is i n a coma and is on artificial life support. Her physician says there is no hope of her surviving and wants to pull the plug. We love her very much. What should we do? A. Islam does not encourage prolonging misery in a vegetative state and p atients should be allowed to die naturally when nothing more can be done. You sh ould agree with the medical decision, maybe seek second opinion, but insist that hydration and nutrition be maintained until death. Q18. Question from a medical student: "As a Physician, when I find out that my patient has a terminal illnes s and will die very soon, should I tell the truth to my patient and his family a s soon as I know it myself? A. You should always tell the truth but do not be do gmatic about it. You can explain the diagnosis and natural history of the diseas e process but do not give a time limit as you do not know for sure when the pati ent will die. Q19. My grandfather never took care of his diabetes. Now he has de veloped gangrene in his foot. Doctors recommend amputation to save the rest of h is leg. He refuses. What should we do? A. You should talk to him again and again that God entrusted him with care of his body and if he does not do what doctors recommend, his condition may worsen and he will be questioned about it on the D ay of Judgment in addition to having additional suffering in this life. Q20. My sister, who is pregnant, found out the baby has the congenital defect, Down s sy ndrome. Should she abort the fetus or carry it to term and spend her life caring for a disabled child? A. Carry to term. There is extra reward in going through this test from God in caring for such a child. Q21. For a patient who has cancer with bone metastasis and is in constant pain, is it better that he takes strong pain killers all the time or be in pain and remember God? A. He should take pai n killers as God does not want him to suffer. In severe pain he may not have the strength to remember God. Q22. I am on a heart transplant waiting list. Should I accept a heart from a criminal or an atheist? A. Yes, and pray that God change s your new heart to adopt it to your pious body. Q23. Should the pregnancy resul ting from rape be continued to term or aborted? A. Carried to term unless the li fe of the mother is in danger. Why commit another crime? Q24. Is patient s auton omy (i.e. right to not seek treatment) equal to planned suicide? If so, should i t be allowed? A. Patient s autonomy involves a sound mind while suicide decision is made in severe depression. One can refuse treatment because of side effects, but to kill yourself is against the will of God. Q25. I am a Muslim female medi cal student who does hijab (head cover). How can I scrub before surgery without removing my head cover and pulling up sleeves? A. You should do Masah (wadu) ove r the head cover, or remove in the presence of a female co-worker only. Q26. Is gene therapy and genetic manipulation to cure diseases allowed? Can we use embry onic stem cells for this? A. To seek cure for a disease is mandatory. Thus, gene therapy is allowed and stem cells from spontaneously miscarried embryos can be used. However, it is wrong to conceive or create an embryo just to harvest cells and then destroy it. Q27: If God is the Healer, then why should I take medication? A: It is not the Will of God that you suffer. You should take the medicine then pray to the Healer that it works and He heals you through that medicine. When Pr ophet Muhammad got ill, he took medicine and has advised us the same. References from The Holy Quran (A. Yusuf Ali Translation; Amana Corp)

5:32 On that account, We ordained for the children of Israel that if anyone, slew a person unless it be for murder or for spreading mischief in the land, it woul d be as if he slew the whole people; and if any one saved a life, it would be as if he saved the life of the whole people. Then although there came to them our messengers with Clear signs, yet, even after that, many of them continued to com mit excesses in the land. 33:36 It is not fitting for a believer, man or woman, when a matter has been deci ded by Allah, and His messenger, to have any option about their decision. If any one disobeys Allah and His messenger, he is indeed on a clearly wrong path. 17:33Nor take life which Allah has made sacred except for just cause. And if anyo ne is slain wrongfully, we have given his heir authority (to demand Qisas or to forgive): but let him not exceed bounds in the matter of taking life; for he is helped (by the law). 58:2 If any men among you divorce their wives by Zihar (calling them mothers), th ey cannot be their mothers. None can be their mothers except those who gave them birth. And in fact they use words (both) iniquitous and false, but truly Allah is One that blots out (sins), and forgives (again and again). 25:54 It is He who has created man from water. Then haws He established relations hips of lineage and marriage, for your Lord has power (over all things). 42:49-50 To Allah belongs the dominion of the heavens and the earth. He creates w hat He wills (and plans). He bestows (children) male or female according to His will (and plan), or He bestows both males and females, and He leaves barren whom He will, for He is full of knowledge and power. 17:31Do not kill your children for fear of want We shall provide sustenance for th em as well as for you. Verily the killing of them is a great sin. 60:12 O Prophet! When believing women come to you to take the oath of fealty to y ou, that they will not associate in worship any other thing whatever with Allah; that they will not steal; that they will not commit adultery ( or fornication); that they will not kill their children ; that they will not utter slander, inte ntionally forging falsehood; and that they will not disobey you in any just matt er. Then receive their fealty, and pray to Allah for the forgiveness (of their s ins), for Allah is Oft-Forgiving, Most Merciful.

Recommended Resources ===================== 1. FIMA Year Book 2002- Published by Federation of Islamic Medical Associations 2. The Guidelines for Health Care Providers When Dealing with Muslim Patients, J IMA, 1998, vol: 30, 44-45. 3. International Ethical Guidelines for Biomedical Research involving Human Subj ects( An Islamic Perspective)- prepared by Islamic organization for Medical Scie nces-2004 4. Islamic Law Ruling on Certain Medical Questions- The Argument and Supporting Evidence. Osama Muhammad Al-Abd, Ph.D. 5. Shahid Athar- Islamic Perspectives in Medical Ethics- from Islamic Perspectiv e in Medicine (ATP 1993) 6. Abdul Fadl Mohsin Ebrahim- Biomedical Issues- an Islamic Perspective (Islamic

Medical Association of South America) 7. Abdul Fadl Mohsin Ebrahim Abortion, Birth Control and Surrogate Parenting (AT P 1989) 8. Shahid Athar- Ethical Decision Making in Patient Care in Health Concerns for Bel ievers (KAZI 1995) 9. Faroque A. Khan Religious Teachings and Reflections in Advance Directive- Reli gious Values and Legal Dilemmas in Bioethics: An Islamic Perspective Fordham Urb an Law Journal- November 2002. 10. Fazlur Rahman Health and Medicine in Islamic Tradition (Crossroad Publication 1987) 11. Abul Fadl Mohsim Ebrahim ICU Ethical Dilemmas The Islamic Medical Association of South Africa- 2004 12. Hassan Hathout- chapter on Medical Ethics in Reading the Muslim Mind (ATP 1995 ) 13. Code of Medical Ethics- AMA 2000-2001 14. Jonsen, Siegler and Winslade- Clinical Ethics McGraw Hill 1992 15. Islamic Code of Medical Ethics Kuwait Document published by International Org anization of Islamic Medicine -1982, revised 2004. 16. Dr. Muzzamil Siddiqi and Imran Siddiqi PhD. An Islamic Perspective on Stem Ce ll Research- published in Pakistan Link 2001. 17. Wahaj Ahmed in Islamic Ethics in Medicine- Book in print. 18. A.F. El-Hazmi MD. in Ethics of genetic counseling Annals of Saudi Medicine, vo l.24, 2, March- April 2004. 19. Kamyar M. Hedayat .MD and Raya Pirzadeh Issues in Islamic Biomedical Ethics: a Primer for the Pediatrician Pediatrics vol. 108 No.4, October 2001. 20. Peter B. Gray HIV and Islam. Social Science &Medicine 58(2004) 1751-1756. 21. Care at the End of life and Euthanasia, Medical Ethics Committee IMANA. JIMA 1997; 29:100-101. 22. Hathout , M: Surrogacy , An Islamic Perspective; JIMA 1989,21:157-60 23. Fadel, HE The Islamic Viewpoint on new Assisted Reproductive Technologies- For dham Urban Law Journal 2002: xxx (1) 147-157. 24. Death: Medical Ethics Committee, IMANA, JIMA 1997, 29:99. 25. Athar, S.Contemporary issues in the practice of Internal Medicine. JIMA 1996:2 8, 1995-7. 26. Ahmed, WD An Islamic view of Death and Dying. JIMA 1996; 28:175-7. 27. Islam and Euthanasia Guest Editorial: JIMA 1994; 26:152-4. 28. Ahmed, WD Ethics Committee Commentary on Gene Therapy JIMA; 1993 .25: 25-8

29. Ahmed , AJ :Gene Therapy Promises and Issues ; JIMA 1993, 25 :25-9 30. Fadel , HE Assisted Reproductive Technology ;An Islamic Perspective JIMA 1993 ;25, 14-9 31. Fadel, HE, Cloning The role of Muslim scientists and scholars, Editorial JIMA 1997; 29:51-3. 32. Fadel, He Antenatal diagnosis of fetal malformations: achievements, pitfalls, and diagnostic dilemmas JIMA 1998; 30, 99-101. 33. Yaseen,MN: The End of Human Life in the Light of The opinion of Muslim Schol ars and Science JIMA 1991;23:74-81 34. Yaseen, MN. The Inception of Human Life in the Light of the statement from th e Holy Quran and Sunnah and the opinion of Muslim Scholars JIMA, 1990; 22:159-67.

Some web sites on Islam, Islamic Medicine and Medical Ethics www.Islamicmedicine.org www.Islamonline.net www.Islamfortoday.com www.islam-usa. com www.imana.org www.IIIM.org www.islamicity.org www.ima.org.za www.fima.org.pk *IMANA Ethics Committee Shahid Athar, MD, Chair Members Wahaj D. Ahmed, MD A.R.C. Amine, MD Hossam E. Fadel, MD Malika Haque, MD Faroque A. Khan, MD Hussain F. Nagamia, MD Hasan Shanawani, MD Hassan Hathout, MD, PhD (advisor) Published by and copy right Islamic Medical Association of North America 101 West 22nd Street, Suite 106 Lombard, IL 60146, USA Web page: www.IMANA.org E -mail: HQ@IMANA.org Phone #: (630) 932-0000 Fax#: (630) 932-0005 (Initial draft as of 11/1/04) (5th revision 3-26-05) Home : Membership : Services : Islam : Donate : Conferences : Interfaith : L

Website: www.uktransplant.org.uk/ukt/.../fact.../general_religious_lflet-2005.pd f 0 iti E ,_ 0, NHS 11) Organ C donation and 10,1 religious perspectives

What is the NHS Organ Donor Register? Facing up to the death of a loved one is hard. Having to make a decision about o rgan donation, and being unsure what that person would have wanted, can cause ex tra distress. The best way to make sure your family and friends never find themselves in this situation is to talk to them now. No two people are alike even if they share a religion. So, please, talk to your family and register your wishes so they know what you would have wanted after yo ur death. The NHS Organ Donor Register is a nationwide confidential list of people who are willing to be donors if the time ever comes. To find out more about organ donation and to join the NHS Organ Donor Register: Call the Organ Donor Line: .., ... 60 60 400 or visit www.uktransplant.org.uk See also our more detailed series of leaflets on organ donation and religious pe rspectives available on the website. Produced by UK Transplant, Fox Den Road, Stoke Gifford, Bristol BS34 8RR 0 UK Transplant reprinted February 2005 34749/0/U KT 1 Every year hundreds of people die while waiting for a transplant and many other s lose their lives before they even get on to the transplant list. There is a serious shortage of organs and the gap between the number of organs d onated and the number of people waiting for a transplant is increasing. Some people are not sure whether their religion would prevent them from agreeing to donate their organs after their death - yet all the major religions in the U K support the principles of organ donation and transplantation. It is important that people from all backgrounds donate organs, as there is a mu ch better success rate when transplants are carried out within the same ethnic g roup. Black and Asian people are three times as likely to need a kidney transpla nt than white people, so there is an even greater need for more black and Asian donors. This leaflet has been written by the NHS with the support of religious leaders o f Buddhism, Christianity, Hinduism, Islam, Judaism and Sikhism. What is organ donation? Organ donation is the gift of an organ to help someone e lse who needs a transplant. Hundreds of people s lives are saved each year by th e generosity of organ donation. Organs that can be donated by people after death include the heart, lungs, kidneys, liver, pancreas and small bowel. Tissue such as skin, bone, heart valves and corneas can also be used to help others. Doctors and nurses are committed to doing everything possible to save life and o rgans are only removed for transplantation once all attempts to save life have f ailed and the patient has died. Most donated organs come from people who die whi le on a ventilator in an intensive care unit, after having suffered a severe bra

in injury. Organ donation and religion All the major religions of the UK support the princi ples of organ donation and transplantation. However, within each religion there are different schools of thought, which means that views may differ. All the maj or religions accept that organ donation is an individual choice. This leaflet offers a brief guide to religious viewpoints regarding organ donati on. If you have any doubts, you should discuss them with your spiritual or relig ious leader. Buddhism and organ donation There are no injunctions in Buddhism for or against organ donation. The death process of an individual is viewed as a very important time that shoul d be treated with the greatest care and respect. In some traditions, the moment of death is defined according to criteria which differ from those of modern West ern medicine, and there are differing views as to the acceptability of organ tra nsplantation. The needs and wishes of the dying person must not be compromised b y the wish to save a life. Each decision will depend on individual circumstances . Central to Buddhism is a wish to relieve suffering and there may be circumstance s where organ donation may be seen as an act of generosity. Where it is truly th e wish of the dying person, it would be seen in that light. If there is doubt as to the teachings within the particular tradition to which a person belongs, expert guidance should be sought from a senior teacher within t he tradition concerned. When he discovered a monk sick and uncared for, the Buddha said to the other mon ks, "Whoever would care for me, let him care for those who are sick". Mahavagga VIII.26.1-8 Kucchivikara-vatthu * Christianity and organ donation The Christian faith is based upon the revelation of God in the life of Jesus Chr ist. Throughout his life Jesus taught people to love one another and he proved h is love for the world upon the cross. It seems in keeping with this that Christi ans consider organ donation as a genuine act of love and a way of following Jesu s example. This act of love then becomes part of a Christian discipleship or fa ith journey that is motivated by compassion to help someone else and demonstrate s a sense of social responsibility. Sacrifice and helping others are consistent themes in Christianity, which teache s the principle of seeking for others what you hope others would do for you. Ena bling life to be lived as fully as possible is consistent with the teaching of t he Son of God, Jesus Christ: "...freely you have received, freely give" Matthew, chapter 10:8 Christians should be encouraged to help others in need. Discussing organ donatio n with family and friends is a responsible and thoughtful act. *The Monk with Dy sentery. Translated from the Pali by Thanissaro Bhikkhu. Hinduism and organ donation There are many references that support the concept of organ donation in Hindu sc riptures. Daan is the original word in Sanskrit for donation meaning selfless gi ving. In the list of the ten Niyamas (virtuous acts) Daan comes third.

Life after death is a strong belief of Hindus and is an ongoing process of rebir th. The law of karma decides which way the soul will go in the next life. Organ donation is an integral part of the Hindu way of life, as guided by the Ve das. That which sustains is accepted and promoted as Dharma (righteous living). Scientific treatises form an important part of the Vedas - Sage Charaka deals wi th internal medicine while Sage Sushruta includes features of organ and limb tra nsplants. "...it is said that the soul is invisible.., knowing this you should n ot grieve for the body." Bhagavad Gita, chapter 2:25 Islam and organ donation In 1995 the Muslim Law (Shariah) Council UK issued a fatwa (religious opinion) o n organ donation. The council resolved that: the council supports organ transpla ntation as a means of alleviating pain or saving life on the basis of the rules of the S hariah Muslims may carry donor cards the next of kin of a dead person, in th e absence of a card or an expressed wish to donate their organs, may give permissi on to obtain organs from the body to save other people s lives. The fatwa is based on the Islamic principle of al-daru rat tubih al-mahzurat (ne cessities overrule prohibition). Normally, violating the human body, whether living or dead, i s forbidden in Islam - but the Shariah believes this can be overruled when savin g another person s life. However there are also a significant number of Muslim scholars who believe that organ donation is not permissible and hold the view that this does not fall unde r the criteria of the Islamic principle of al-darurat tubih al-mahzurat (necessi ties overrule prohibition) due to other overriding Islamic principles. Both viewpoints take their evidence from the Qur an and the Ahaadith and therefo re individual Muslims should make a decision according to their understanding of the Shariah or seek advice from their local Imam or scholar. The Muslim Law Council UK fatwa draws on one of the basic aims of the Muslim fai th: saving life. "Whosoever saves the life of one person it would be as if he sa ved the life of all mankind." Holy Qur an, chapter 5:32 Judaism and organ donation In principle, Judaism supports and encourages organ donation in order to save li ves (pikuach nefesh). This principle can sometimes override the strong objections to any unnecessary interference with the body after death, and the requirement for immediate burial of the complete body. As all cases are different, Jewish law requires consultation with a competent Ra bbinic authority before consent is granted. For more information please contact the Office of the Chief Rabbi, or another co mpetent Halachic authority. "One who saves a single life it is as if he has save d an entire world." Pirke D Rav Eliezer, chapter 48 Sikhism and organ donation

Sikh philosophy and teachings place great emphasis on the importance of giving a nd putting others before oneself. It also stresses the importance of performing noble deeds and there are many exa mples of selfless giving and sacrifice in Sikh teachings by the ten Gurus and ot her Sikhs. Sikhs believe life after death is a continuous cycle of rebirth but the physical body is not needed in this cycle - a person s soul is their real essence. "The dead sustain their bond with the living through virtuous deed." Guru Nanak, Guru Granth Sahib, p 143 Acknowledgements UK Transplant would like to thank the following organisations f or their help in researching and producing this leaflet: The Bradford Teaching Hospitals NHS Trust, The Bradford Interfaith Resource Cent re, The Buddhist Society, The Church of England, College of Health Care Chaplain s, Council of African & Afro-Caribbean Churches (UK), Hindu International Medica l Mission, Hospital Chaplaincies Council, The Inter Faith Network for the UK, Th e Methodist, Baptist & Catholic Churches, Muslim College London, Muslim Law (Sha riah) Council UK, National Council of Hindu Temples UK, The Network of Buddhist Organisations (UK), Network of Sikh Organisations UK, Office of the Chief Rabbi UK, University College London, World Council of Hindus. 1 Lfl C> 0 N C CO rl... N N