Organ Donation, Ethics, Organ Procurement

Currently with medical technology continuing to advance, the use of organ transplantation and the worldwide shortage of organs are increasing with the need of more clinical procedures requiring the use of organ transplantation. There are many barriers that exist within organ donation. For the British Muslim community, religious and cultural beliefs have been a major obstacle. In addition, it has long been known that British Muslims have a high percentage for refusal rates to donating organs. This thesis reviews the diverse opinions of Islamic scholars and British Muslims communities’ on the subject on organ donation in Islam. In addition, this thesis will attempt to offer a theological position on the issue of organ donation, by defining the Islamic opinion on organ donation in the context of Quran and Sunnah. By discussing philosophical and practical perspectives, this thesis will propose a better strategy for actively encouraging organ donation among British Muslims, and to make a more informed choice on the matter.

Cerrahideki gelişmeler ve bağışıklık sistemini baskılayan ilaçların kullanıma girmesi, transplantasyon tıbbının önünü açmıştır. Günümüzde kalp, böbrek, karaciğer, akciğer, pankreas, kornea, kemik iliği ve yüz gibi doku ve organların bağışı ve nakli mümkün hale gelmiştir. Transplantasyon tıbbı, yeni etik ve hukuki tartışma alanları yaratmıştır. Bu tartışmalarda tıp etiğinde genel kabul gören dört etik ilke, yararlılık, zarar vermeme, özerklik ve adalet, farklı boyutlarda yer almakta, zarar vermeme ve özerklik ilkeleri karşı karşıya gelmektedir. Organ bekleyenlerin sayısındaki dramatik artış, konu ile ilgili çözümsüzlüğün birçok kişinin ölümü anlamına geldiğini, toplumun değer yargılarına uygun çözüm bulunmasının önemli olduğunu göstermektedir. Çalışmada, dünyada var olan yöntemler tartışılmakta, temel etik ikilemler ele alınmakta ve etik perspektife uygun etkili bir çözüm yöntemi aranmaktadır.

Advances in surgery and the introduction of drugs that suppress the immune system have paved the way for transplantation medicine. Today, the donation and transplantation of tissues and organs (including heart, kidney, liver, lung, pancreas, cornea, bone marrow, and face) are feasible. Transplantation medicine has created new areas of ethical and legal discussion. In these discussions, four principles generally accepted in medical ethics – beneficence, non-maleficence, autonomy, and justice – have featured in their different aspects. In particular, the principles of non-maleficence and autonomy can collide. The dramatic increase in the number of people waiting for an organ shows that any deadlock on this subject means the death of many; hence, it is important to find a solution appropriate to the values held in society. In this study discussing current transplantation methods throughout the world, basic ethical dilemmas are addressed and effective solutions sought in accordance with ethical perspectives.

Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal injection (cessation of heartbeat, cessation of respiration, and dilated pupils) neither conform to current medical science nor to any standard of medical ethics. In practice, death is pronounced in China within tens of seconds after starting the lethal injection. At this stage, however, neither the common criteria for cardiopulmonary death (irreversible cessation of heartbeat and breathing) nor that of brain death (irreversible cessation of brain functions) have been met. To declare a still-living person dead is incompatible with human dignity, regardless of the processes following death pronouncement. This ethical concern is further aggravated if organs are procured from the prisoners. Analysis of postmortem blood thiopental level data from the United States indicates that thiopental, as used, may not provide sufficient surgical anesthesia. The dose of thiopental used in China is kept secret. It cannot be excluded that some of the organ explantation surgeries on prisoners subjected to lethal injection are performed under insufficient anesthesia in China. In such cases, the inmate may potentially experience asphyxiation and pain. Yet this can be easily overlooked by the medical professionals performing the explantation surgery because pancuronium prevents muscle responses to pain, resulting in an extremely inhumane situation. We call for an immediate revision of the death determination criteria in execution by lethal injection in China. Biological death must be ensured before death pronouncement, regardless of whether organ procurement is involved or not.

English intro: In 2020 I published a book on organ donation. It is published by Aarhus University Press. The book is in Danish and the website for the book can be found here: The book explores alternatives to the current danish opt-in model for organ donation. Specifically, it discusses the ethical permissibility of opt-out, mandated choice and priority rules. A chapter is dedicated to the role of the family and rejects the so-called family veto. The book recommends a change to an opt-out system, arguing that it is a) likely to bring about more organs for transplantation and b) consistent with proper respect for autonomy. If you have any questions about the book please write me on [email protected]

This study explores the meanings of organ donation, with emphasis on donating eyes and hearts, comparing people across gender and across two ethnic groups. Four focus group interviews were conducted with people living in the North of England: (1) five Muslim women of Pakistani origin, (2) five Muslim men of Pakistani origin, (3) nine white English women, and (4) eight white English men. The focus group interviews were analysed using grounded theory and a conceptual micro-model created for each group. The main finding was that the act of organ donation can be perceived as involving a personal cost. The Muslims of Pakistani origin related costs with their religious beliefs. In contrast, the white English associated costs with their distrust of the medical system. Women were concerned about the transmission of disease or of personality, whereas the white English men highlighted their personal rights. We conclude that the meaning of organ donation is more than about being and having a body. It is bound up in metaphors of embodiment, religious considerations, and moral judgement of scientific and medical conduct.

Muslims in the UK face discord due to the clash of opinions on the ‘opt-out’ system to be introduced in April 2020. In this article, I share my opinion on how a careful re-examination of the fatawa that contribute to the prohibition of organ donation may provide a fresh perspective on how to advise on the new opt-out system.

In America it is forbidden to sell one’s organs or tissues for profit. Public policy gives no provision for financial compensation for a life-saving service like organ donation, but has no legal or moral sanctions against monetary recompense for offering one's bodily services for a non-essential treatment. In contrast, obtaining surrogate mothers, and egg donors for Assisted Reproductive Technologies [A.R.T.s] are provided for under U.S. law can be quite lucrative, marking a sharp distinction between the illegal and legal buying and selling of the body. This paper will explore the financial aspects of human collateral- selling the body for income- and consider laws that forbid financial compensation for life-saving procedures in juxtaposition to the ethical ramifications of a legal system that permits payment for non-lifesaving treatments.

Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison, but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide.

Background: Identification of potential organ donor is blocked by mixed
feelings of physicians, thus, negative experiences with death and the idea of “no objectification” of the human body become important.
Objectives: a) to explore life experiences of ICU physicians about death and diagnosis of brain death; and b) to collect their opinions about the uses of the cadaver.
Design, place and participants: Qualitative, prospective and descriptive research with intentional-saturated sampling. Data collection was based on in-depth interviews. ICU physicians from a Buenos Aires City Hospital were included.
Results: Death meant something stranger to physicians; it was represented as: clinical perception, cessation of brain functions, legally or practically defined. Brain death was an uncertain diagnosis conceived as a death’s moment, detected by clinical and ancillary methods. Under brain death, withdrawing of mechanical ventilator requires family agreement. Disposition of the corpse depends on the will of deceased, the family or doctors; if it is respected, it can be used as biological material. The cadaver should be donated because it is not a commodity; however, others think it could be sold for noble goals. Corpse has value per se, for the family and for the health system; there would not be benefits when it is viewed as a useful good. Procedures on a cadaver were seen as family’s aid and not as cruelty.
Conclusion: Death, although perceived previously to be diagnosed, was difficult to explain and it was denied among the physicians. Brain death was not unanimously considered an accurate diagnosis. The disposition of cadavers could involve their trade.

In December 2015, Wales became the first country in the United Kingdom to move away from an opt-in system in organ procurement. The new legislation introduces the concept of deemed consent whereby a person who neither opt in nor opt out, is deemed to have consented to donation. The data released by the NHS in July 2017 provides an excellent opportunity to assess this legislation in light of concerns that it would decrease procurement rates for living and deceased donation, as well as sparking an increase in family refusals. None of these concerns have come to pass, with Wales experiencing more registered donors, fewer family refusals and more living donations. Though, as the number of actual donors have dropped slightly from a high level, the situation must be monitored closely in the years to come.

In the effort to address the persistent organ shortage it is sometimes suggested that we should incentivize people to sign up as organ donors. One way of doing so is to give priority in the allocation of organs to those who are themselves registered as donors. Israel introduced such a scheme recently and the preliminary reports indicate increased donation rates. How should we evaluate such initiatives from an ethical perspective? Luck egalitarianism, a responsibility-sensitive approach to distributive justice, provides one possible justification: Those who decide against being organ donors limit the health care resources available to others. As such, a priority rule can be justified by a luck egalitarian approach to distributive justice. Furthermore, a priority rule inspired by luck egalitarianism is well equipped to avoid prominent criticisms of such a procurement system. Luck egalitarianism provides us with reasons to exempt people who are not responsible for their inability to donate from receiving lower priority, provide sufficient information about donation , and mitigate social and natural circumstances affecting people's choice to donate.

This paper will reflect on the related topics of biocapitalism and biocontrol as they are dramatized in Atwood’s The Heart Goes Last (2015), Holmqvist’s The Unit (2009) and Padmanabhan's Harvest (1997), works that share a number of topical issues. Amongst the most salient the question of citizens’ perceived freedom, diluted by biosurveillance and digital technologies, is powerfully articulated in these texts. While Atwood’s The Heart Goes Last can be seen as a dystopian comedy, Holmqvist’s The Unit as a biotechnological dystopia and Padmanabhan's Harvest as a tragicomedy, they all dramatize very serious topics such as organ trafficking and donation as well as the exploitation of weaker, poorer citizens.
A crucial question these narratives pose is the following, amongst others: is it possible that we are all living in a kind of panopticon, the prison system first described by Jeremy Bentham and then updated by Michel Foucault? Atwood’s The Heart Goes Last, whose narrative revolves around a prison, and Holmqvist’s The Unit, where the “dispensables” are imprisoned in a type of “gilded cage”, as are the destitute Indians in Harvest, go a long way towards suggesting that perceptions of freedom and unfreedom in contemporary societies can be undergoing profound changes. Indeed The Heart Goes Last can be read as a satirical twist on the current American trend of “for-profit prisons”, while some citizens in The Unit and Harvest, giving in almost willingly to their own captivity, become paradigmatic examples of the “precarious lives” discussed by Judith Butler and Giorgio Agamben.
These vexed, highly contentious issues will be discussed with recourse to recent theoretical work on the (political, digital, biotechnological) forces shaping society, often surreptitiously and with unexpected and unforeseen consequences, instantiating the pervasiveness and ubiquity of biopower in its many ramifications.