Organ Donation and Islam: An Interview with Sheikh Jawid Akbari

May 20^th is known as the national day for organ donation in I.R. of Iran. For this occasion, ijtihadnet has interviewed Sheikh Jawid Akbari, a graduate of Hawza Seminary of Qom. He started his religious studies in Quetta of Pakistan where he studied the basics of Arabic grammar (Sarf & Nahv), logic and jurisprudence in Dar al-‘Ilm al-Ja’fari, a school founded and financed by the late Ayatollah Khoei – may his soul rest in peace.  However, in June 1994 he decided to move to Qom and continue his studies in al-Mustafa International University, formerly known as the International Centre for Islamic Studies. He did his Master’s degree in Islamic philosophy and attended four years of Dars-e Kharij (advanced Islamic studies) under prominent scholars such as Ayatollah Makarem Shirazi and Ayatollah Ja’far Subhani. For over ten years now, he has developed interest in jurisprudential studies and currently he is focusing on current legal issues such as abortion, cloning, gender reassignment surgery, in vitro fertilization, insemination, organ donation and so forth.

Sheikh Akbari, May 20^th is known as the day for organ donation. Would you proceed to tell us the different views of Muslim, Shia and Sunni jurists regarding this issue?

Your question is general, and the answer can be fairly general too. Speaking from a general perspective, organ donation is allowed in Islam even though there are some controversies about it especially within the Sunni denominations.  That is due, mainly, to the reason that some of the contemporary Sunni scholars base their verdicts on the rulings of some older generations of scholars who did not have sufficient knowledge of science and technology, and, therefore, their views were not completely formed based on all facts on the ground. Obviously, the more facts become available, the more conclusive becomes their opinion, and I believe, right now, the conclusion is that there is a stronger rationality in organ donation and thus saving someone’s life than there is in the general arguments put forth by a minority among Sunni scholars.

Let me give you an example, the fear that people generally have is that an organ is a gift of Allah which I have to keep intact and take with me to the next world. I have no right, whatsoever, to chop my organ off and give it to someone else. No matter what the reason, I will be held responsible for whatever I do to myself and my organs. There are people who ask themselves, can I donate my organ? What if I do that and on the Day of Judgment I arise without my organ? These are some questions which are completely irrational. Just think about it, if Allah has given you an organ, surely, He can recreate another one in your body if you need them on the Day of Judgment assuming that that resurrection on the Judgment Day is physical. What if you lost your organ because of a car accident and you died? Imagine your body was found but your head wasn’t. Does it mean you will be resurrected on the Day of Judgement without your head? That is obviously not the case. The whole argument is poor in rationality. The Quran says in the verse 32 of chapter 5 “And whosoever saves the life (of a human being), it shall be as if he has saved the life of all mankind.” If we put this into perspective, we shall understand that organ donation which helps save a person’s life overrules many other arguments presented in this regard. In fact, saving a person’s life take precedence over everything else.

Sheikh Akbari, there are some Sunni Muslims who oppose accepting artificial organs for the simple reason that it is a change in God’s creation. They say changing God’s creation is not allowed even if one wishes to get a simple tattoo on his arm. Now, speaking from a Shiite perspective, are we allowed to accept such organs?

Of course, we are. If you have problems with your hearts or eyes, you can go ahead and use those organs. Now-a-days, doctors can do everything; they remove the natural lenses and put artificial ones instead. When we have, for example, a broken bone, they put a metal screw inside, and we take it without questioning.  The same rule applies to other body parts which can be replaced by either a natural organ or an artificial one if they fail to function. The Shiite position is clear and consistent. You can take artificial body parts if they work on you. You can even take organs of an animal if they help you enhance your life.  Let’s also not forget that donating an organ and the operation to remove an organ is never tantamount to body mutilation provided that another person’s life depends on it. Also, to be honest, donating an organ does not mean that somebody is changing God’s creation. It does not mean that even from layman’s perspective. Some people argue that it is a kind of mutilation which is forbidden in Islam but it is not true to say that donating an organ amounts to mutilation of the body because the operations are usually carried out in the most dignified way.

You touched on transplanting animal organs and the fact that they can save lives if transplanted. That was a question I was going to lead to.  Now, are we, actually, allowed to use the organs of an essential impure animal like pigs if we need them?

Sure, it is permissible to take any animal’s organ and transplant it to a human body. It is said that pigs’ organs are often compatible with human organs. When it comes to saving human life, everything can be done to save it even if one has to use a pig’s organ. Saving and preserving a person’s life is necessary unless, otherwise, it is destined by Allah to take the soul back. But until then, the doctor or an ordinary person should do everything possible to help somebody live a good quality life. Of course, you yourself are responsible for taking good care of your life. You need to do everything you can to remain healthy and fit, to eat healthy and organic food, to exercise regularly in order to stay in shape. That is all you need to do. If you do so, your health won’t deteriorate so quickly. But if it did, and if, for example, your kidney or liver failed, you can take animal organs.

It is hard to imagine that a lot of people die on a daily basis because of an organ failure; he dies waiting for an organ to be transplanted. Many deaths are preventable if an organ, artificial or natural, is transplanted. Donating an organ is an act of charity and its continuous charity, and it is permissible with some criteria, and they should be taken into consideration by the donor irrespective of whether he wants to donate his organ during his lifetime or after his death.

What are the main reasons of those who consider organ donation as prohibited? How do you evaluate these reasons?

Yes, just as I hinted, a minority of non-Shiite Muslims views organ donation as a mutilation and desecration of the body. The mindset that is there normally has its roots in some general principles within the Islamic literature. Anyways, to factorize the main reasons, I would mention these:

1. Donating an organ causes substantial harm to the donor’s body. Islam does not allow inflicting harm upon one’s body.
2. Donating an organ and the operation to remove it mutilates the body. Mutilation of a human body is forbidden because it is considered to be desecration of the human body.
3. Donating an organ and its transplantation to the recipient’s body amount to changing God’s creation. Changing God’s creation is a satanic and despicable action.
4. Organ donation is degrading and often leads to shame and humiliation of the organ donor.
5. In the event that the recipient is non-Muslim, it is forbidden for a Muslim to donate his organ.

So, these are some of the arguments presented by those who subscribe to prohibition of organ donation, but as Shia scholars have ruled there is no objection in donating an organ as its medical benefits outweigh religious considerations. However, when it comes to ‘substantial harm’ as one of the causes of prohibition, there is no doubt that all Muslim scholars see eye to eye with one another that an organ may be donated provided that it does not lead to substantial harm or damage to the donor’s health system. In Islam it is prohibited to harm oneself to the point of substantial bodily harm.  If it actually does, it is not permissible. As for the last case in which a Muslim may want to donate his organ to a non-Muslim, it has been a controversial issue even among Shiite scholars. Most of the existing grand religious authorities do not allow it exercising precaution and saying, it is not permissible to donate one’s organ to a non-Muslim as a recommended precaution.They have expressly stipulated in their verdicts that if a Muslim’s life depends on the organ, it is permissible to donate it. Obviously, we understand from their answers and from the term “Muslim” that non-Muslims are excluded.

Is it permissible to sell one’s body organ not to only to save somebody’s life but also to use the proceeds to meet his daily expenses? You often come across people who are willing to sell their organs. What is your take on that and what do the Shiite jurists say in this regard?

As per the fatwa of all contemporary Shia jurists, if removing the organ does not endanger the life of the donating individual, there is no objection to his selling an organ to save the life of a person who is in dire need of it. However, if the removal of an organ from a donor would precipitate his death, it is not permissible even if that person may be terminally ill or may have suffered brain death. If a person’s body is removed after his death, his prior permission is required; otherwise it is absolutely not permissible to remove his organ.

Do your family members have a say after your death when it comes to donating your organs? What if a person makes a will before his death directing his heirs to donate his organs?

Again, I would say that the validity of such a will is a matter of question and controversy. According to supreme leader, Grand Ayatollah Khamenei (may he live long), the enforceability of such a will cannot be ruled out insofar as the removal of the parts from the body does not amount to disrespect to the dead body. If that is absolutely the case, there is no objection to enforcing the will.

However, Grand Ayatollah Sistani is of the view that the validity of such a will is a matter of ishkal or question. That is to say, the heir cannot go ahead acting according to the will and thus severing his organ. Is it okay to go against the will in this matter? It seems from the fatwa issued by Grand Ayatollah Sistani that there would no objection if one simply ignores the will and acts against it. The heirs’ guardianship is limited to bathing, shrouding and burying the dead body as well as to choosing the place of his or her burial. To be frank, they do not have ownership of his body parts so as allow a surgeon to cut through his body and take out the organ.

Sheikh Akbari, you said in one of your answers that the permissibility of donating an organ is contingent on whether or not it leads to substantial bodily harm. Now, the question is what constitutes substantial bodily harm?

Well if donating an organ leaves a person disabled or precipitates his death, it is not permissible. A person cannot donate his organ if it is highly likely that he will end up suffering problems that are normally unbearable. A person has no right to disfigure himself even if he can still live on with it. For example, it is inquired in late Imam Khomeini’s Farsi Islamic law manual entitled Istifta’at vol.2, p.43 whether a woman can donate one of her eyes to her husband who is blind. The answer given to the question is, “It is not permissible in the said case.”

Indeed, what constitutes substantial harm, and what doesn’t is a matter of debate and contention. There is no consensus among scholars when it comes to the manifestations of substantial bodily harm.

That brings us to the end of this interview. All that remains is for me to thank you very much for the enlightening answers you gave to our questions on organ donation. I really appreciate that.

You are welcome.