Editor: Nasir Ahmad B.A. LL.B.Sept 2016

IN MEMORY OF JALAL-UD-DIN AKBAR IBN-I ABDULLAH, SACRAMENTO, CALIFORNIA

Vol. No. 11, Issue No. 9

RELIGIOUS AND CULTURAL VIEWS ON ORGAN DONATION AND ORGAN TRANSPLANTATION

ADEEBA ALI

(This paper was done for Extended Project Qualification. It is somewhat similar to AS Level (first year of A Levels). The head was Miss Elaine Neal, the librarian of the school, who is currently pursuing her Ph.D. The supervisor was Miss Nicola Pittaway, Biology teacher for A Levels.A summary of this paper was presented at the monthly meeting held at the Lahore Ahmadiyya Centre at Wembley, London. She is now studying Microbiology at the Hertfordshire University. Our young speaker is daughter of Mr. & Mrs. Mustaq Ali. Both are actively engaged in inter-faith activities. Bro. Mustaq is general secretary of the UK Jama’at. – Ed)

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Introduction ������������������������������������������������������������������������������������������������������������������������������������3

Brief history of organ transplantation ...................................................................................... 5

Advantages and disadvantages of organ transplantation ......................................................... 5

Religious Views of Organ Donation and Transplantation .......................................................... 6

Christianity ������������������������������������������������������������������������������������������������������������������������������ 6

Judaism ����������������������������������������������������������������������������������������������������������������������������������� 8

Hinduism ��������������������������������������������������������������������������������������������������������������������������������� 9

Islam ������������������������������������������������������������������������������������������������������������������������������������� 10

Cultural Views of Organ Donation and Transplantation .......................................................... 12

Black African Americans �������������������������������������������������������������������������������������������������������� 12

BAME (Black, Asian and Ethnic Minorities) ���������������������������������������������������������������������������� 13

Conclusion ............................................................................................................................. 14

WHAT IS ORGAN DONATION AND TRANSPLANTATION?Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). Transplantation is necessary because the recipient’s organ has failed or has been damaged by disease or injury. Organ transplantation is one of the great advances in modern medicine. Unfortunately, the need for organ donors is much greater than the number of people who actually donate. Every day in the United States 18 people die waiting for an organ and more than 117,000 men, women, and children await life-saving organ transplants.

What organs and tissues can be transplanted?Organs and tissues that can be transplanted include:1. Live, 2. Kidney, 3. Pancreas, 4. Heart, 5. Lung, 6. Intestine, 7. Cornea, 8. Middle ear, 9. Skin, 10. Bone, 11. Bone marrow, 12. Heart valves and , 13. Connective tissue.

Does it disfigure the body?Donation does not disfigure the body or change the way it looks even in a casket. Every donor is treated with great care and dignity during the donation process, including careful reconstruction of one’s body. Donation as a rule does not delay funeral plans.For organ donation, surgery lines are fully covered by all clothing except for a low cut or v-neck top. Skin donation takes skin from the back and legs and is not visible with clothing. A stand-in plastic bone is used to allow the shape of the legs and arms to remain the same for bone donation. For eye donation, a plastic cap is placed over the eye to maintain the shape of the closed eyelid.

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PageCONTENTS

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Introduction

“If you save a life it is as though you have saved the whole of humanity.”1 Never has there been a statement of such a profound nature that has influenced my life. If as human beings we all thought like this, wouldn’t this world be a better place to live?

Organ donation and organ transplantation are ways of emulating this verse. There are two types of organ donation: live donations, where one living person donates an organ to another, and do-nations from bodies of the deceased to living recipients.2 There are several types of organ trans-plants: autograft, allograft, isograft, xenotransplantation, split transplants, domino transplants, ABO-incompatible transplant, and transplants in obese individuals.3

1 The Holy Qur’an, 5:32

2 McManus, J. (2015). Hospitals urge Muslims to donate organs [online]. Available from: http://www.bbc.co.uk/news/uk-3315532. [Accessed: 9th December 2015.]

3 Wikipedia. (2016). Organ transplantation [online]. Available from: https://en.wikipedia.org/wiki/Organ_transplantation. [Accessed: 12th December 2015.]

Figure 1 this image shows that Spain has the highest organ donor rate; 36 organ donors per million

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It has been reported by the International Registry in Organ Donation and Transplantation (IRODT) that there are 71 countries in worldwide organ donation and transplantation activity as of 2013.4 Statistics from IRODT show that Spain has the highest organ donor rate in the world (see figure 1). This is thought to be as a result of Spain implementing the opt-out system.

The Telegraph reported that in the UK there are around 21 million people who are registered as organ donors.5 Despite this, in 2014, 429 patients died while on the active waiting list for an organ transplant in the UK due to a shortage of donors6 (this is shown in figure 2). U.S statistics state that an average of 22 people die each day waiting for transplants that cannot take place because of the shortage of donated organs.7

With the advance in technology, the great scientific minds, and the altruistic characteristics within us, why are there people dying due to a shortage of organ donors?

Research has shown that there are several reasons as to why this shortage exists. The most poignant reason is the belief that it will be violating religious and scriptural views. However, it is hard to find

4 IRODaT. (2014). INTERNATIONAL REGISTRY in ORGAN DONATION and TRANSPLANTATION [online]. Available from: http://www.irodat.org/img/database/grafics/newsletter/IRODaT%20Newsletter%202013%20.pdf. [Accessed: 14th December 2015.]

5 NHS Choices (no date; last reviewed 2014) How organ donation works. [Online.] Available from: http://www.nhs.uk/Conditions/organ-donation/Pages/donationprocess.aspx. [Accessed: 14th December 2015.]

6 Knapton, S. (2015). Organ donation crisis threatens hundreds of lives. The Telegraph. [Online.] 20th July. [No pagination.] Available from: http://www.telegraph.co.uk/news/health/news/11749503/Organ-donation-crisis-threatens-hundreds-of-lives.html. [Accessed: 14th December 2015.]

7 US Government Information on Organ and Tissue Donation and Transplantation. (No date.) The Need Is Real: Data. [Online.] Available from: http://www.organdonor.gov/about/data.html. [Accessed: 14th December 2015.]

Figure 2 graph showing the decrease in donors from 2013-2015

http://www.telegraph.co.uk/news/health/news/11749503/Organ-donation-crisis-threatens-hundreds-of-lives.html

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a reference in any holy scripture that categorically forbids the act of organ donation. According to Organ Donation NHS, all major religions of the world agree and encourage organ donation.8

If all major religions agree with organ donation, then what is preventing religious people from donat-ing their organs? The British Journal of Anaesthesia published an article of a study in the UK which suggested that “cultural issues are an important influencing factor when making a decision about or-gan donation.”9 In the UK, 66% of Black, Asian and some Ethnic Minority (BAME) communities refuse to give permission for their loved ones’ organs to be donated, compared to 43% of the rest of the population.10 As a result, on average, BAME communities will wait a year longer for a kidney trans-plant than a white British patient and many may die while waiting for an organ to become available.11

For the past 100 years organ transplantation has shown that it can save lives and offer a better qual-ity of life for patients. The question that arises therefore is whether religion and culture influence organ donation.

8 Organ donation NHS (no date). What does my religion say? [online]. Available from: https://www.organdonation.nhs.uk/about-dona-tion/what-does-my-religion-say/. [Accessed: 14th December 2015.]

9 Randhawa.G. (2012). Death and organ donation: meeting the needs of multiethnic and multifaith populations. British Journal of Anesthesia. Volume 108 (S1), 2012, pp. i88-i91.

10 Colnbrook Community Association. (2013). Black, Asian and Minority Ethnic communities [online]. Available from: http://www.coln-brookcommunityassociation.org.uk/organ-donation-black-asian-and-minority-ethnic-communities/. [Accessed: 14th December 2015.]

11 Ibid.

Figure 3 showing the process of a domino transplant

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Brief history of organ transplantation

Organ transplantation was first conceptualised in 1902 by Dr Alexis Carrel.12 Since then, there has been a huge uptake in organ transplantation for the improvement of lives in several countries of the world.

This pioneering procedure led to organs such as the kidney, liver and the heart being transplanted in 1954, 1963 and 1967 respectively.13

With improvements in technology and research, the UK had its first domino transplant (see figure 3) carried out by Sir Magdi Yacoub at Harefield Hospital in 1987.14 In 1971 kidney donor cards were in-troduced in the UK.15 This gave people the choice to donate their kidneys after they had passed away.

Scientists did not stop at only transplanting internal organs. The first partial face transplant was performed in 2005 in France on a woman whose face had been gnawed away by her dog,16 and the world’s first full-face transplant was performed in 2010 in Spain; this procedure took a total of 24 hours and required a team of 30 medical staff.17

12 NHS choices. (No date. Last reviewed 24th February 2015.) NHS history of donation [online]. Available from: http://www.nhs.uk/Tools/Pages/transplant.aspx. [Accessed: 18th January 2016.]

13 Ibid.14 Ibid.15 Ibid.16 Lanchin, M. (2012). Isabelle Dinoire: Life after the world’s first face transplant [online]. Available from: http://www.bbc.co.uk/news/

magazine-20493572. [Accessed: 18th February 2016.]17 Govan, F. (2010) Spanish man who had world’s first full face transplant speaks. The Telegraph [online]. 26th July [no pagination]. Available

from: http://www.telegraph.co.uk/news/health/news/7910582/Spanish-man-who-had-worlds-first-full-face-transplant-speaks.html. [Accessed: 18th February 2016.]

Figure 4 image showing John McCafferty at Harefield Hospital

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Advantages and disadvantages of organ transplantationSince its inception, organ transplantation has seen many successes and failures. Many have raised concerns as to whether organ transplants are safe, moral or ethical. For example, there have been many cases of people selling their organs for money to the rich. This is not a new phenomenon as poverty has led to this illegal trade throughout South Asia.18

Longevity is a benefit of transplantation. The Guinness World Records in 2013 recognised John McCafferty (see figure 4) as the world’s longest surviving heart transplant patient. This was published in the bulletin “What’s New?” by the Royal Brompton and Harefield NHS Foundation Trust. John McCafferty’s heart transplant was carried out by Sir Magdi Yacoub in 1982 at Harefield Hospital. He was told that he had five years to live. However, his life was prolonged for 33 years.19

Dr Chris Barry is a transplant surgeon in America and as a result of his profession he is a passionate and vocal advocate for transplant and organ donation awareness.20 His TEDx talk “Giving the Gift of Life through Organ Donation” has influenced tens of thousands to consider registering to become organ donors. In this video Dr Barry stated that 19 people die every day on the organ transplantation waiting list (resulting in 6,935 deaths each year). He also stated that a single person could save up to eight people’s lives by donating their organs, and 50 people could be saved through tissue donation, for example, tendons, cornea and skin, from just one individual.21

However, there are some disadvantages of donating organs. For families, it is a distressing time when their loved one who is dying has opted to donate their organs.22

One of the major risks of organ transplantation is rejection.23 To prevent the body’s immune sys-tem attacking the transplanted organ, immunosuppressive drugs are prescribed to the patient.24 However suppressing the immune system can lead to the body becoming less resistant to infection, thus increasing the likelihood of infectious diseases.

Another potential risk is that of transmitted diseases as a result of organ transplantation. The Centers for Disease Control and Prevention in 2013 confirmed that a rabies death was caused by an organ transplant from an infected donor.25 However, the transmission of diseases are highly unlikely due to current scientific advances in technology of screening organs.26

18 Mustafa, S. (2013). The Bangladesh poor selling organs to pay debts [online]. Available from: http://www.bbc.co.uk/news/world-asia-24128096. [Accessed: 20th March 2016.]

19 What’s New? (2016). Tributes paid to longest surviving heart transplant patient.20 Barry, C. (no date). Transplant and Organ Donation Awareness [online]. Available from: http://www.livercancergenomics.com/.

[Accessed: 23rd February 2016.]21 TEDx Talks. (2012). Giving the Gift of Life through Organ Donation [online]. [Accessed 23rd February 2016.] Available

from: https://www.youtube.com/watch?v=UigBNjBLByc.22 OCCUPY THEORY. (2015). Organ Donation Pros and Cons List [online]. Available from: http://occupytheory.org/organ-donation-

pros-and-cons-list/. [Accessed: 23rd February 2016.]23 Busse, P. (2013). Transplant rejection [online]. Available from: https://www.nlm.nih.gov/medlineplus/ency/article/000815.htm.

[Accessed: 23rd February 2016.] (Update.)24 Tortora. G, Derrickson. B (ed.) (2006). PRINCIPLES OF ANATOMY AND PHYSIOLOGY. 11th ed. [no place]: John Wiley & Sons,

Inc. G35.25 Centers of Disease Control and Prevention. (2013). Human Rabies Due to Organ Transplantation [online]. Available from: http://www.

cdc.gov/rabies/resources/news/2013-03-15.html. [Accessed: 23rd February 2016.]26 Tomasulo, A. (2013). Organ Transplant Leads to Rabies Infection and Death [online]. Available from: http://www.healthmap.org/site/

diseasedaily/article/organ-transplant-leads-rabies-infection-and-death-31813. [Accessed: 23rd February 2016.]

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Religious Views of Organ Donation and TransplantationChristianityThere are several denominations within Christianity, and all encourage organ donation. In Catholicism it is strongly encouraged as the current Pope, Pope Francis, has stated that “organ donation is a tes-timony of love for our neighbour.”27 In addition, the previous Pope, Pope Benedict XVI, had a donor card. However, it was announced by the Vatican that Pope Benedict XVI’s body parts could not be donated as they belonged to the Church.28

There are several verses in the Bible to suggest that organ donation is allowed. For example “Do to others as you would have them do to you” (Luke 6:31),29 and “Love your neighbour as yourself” (Matthew 22:39)�30

Reverend Dr John Wilkinson, author of Christian Ethics in Health Care, stated that “the first eth-ical principle on which organ donation and transplantation may be justified is that of love for one’s neighbour.”31

In addition, the Methodist Church, UK, stated, “The Methodist Church has consistently supported organ donation and transplantation in appropriate circumstances, as a means through which heal-ing and health may be made possible.”32

The former Archbishop of Canterbury, Rev. Rowan Williams, released a poem promoting organ do-nation called ‘Host Organism’.33

Jehovah’s Witnesses are a non-Trinitarian denomination of Christianity.34 Their doctrine, introduced in 1945, stated that blood should not be received or donated.35 This doctrine is based on the follow-ing verses: “For the life of a creature is in the blood…” (Leviticus 17:11),36 and “Instead we should write to them, telling them to abstain … from blood” (Acts 15:20).37

27 Independent Catholic News. (2014). Pope Francis: ‘Organ donation is a testimony of love for our neighbour’ [online]. Available from: http://www.indcatholicnews.com/news.php?viewStory=25737. [Accessed: 23rd February 2016.]

28 Oliver, M, Ahmed, A et al. (2012). Donating in good faith or getting into trouble. Religion and organ donation revisited. World J Transplant. Volume 2 (5), October 2012, pp. 69-73.

29 Bible gateway (no date). Luke 6:31 [online]. Available from: https://www.biblegateway.com/passage/?search=Luke+6:31. [Accessed: 23rd February 2016.]

30 Bible gateway (no date). Matthew 22:39 [online]. Available from: https://www.biblegateway.com/passage/?search=matthew+22%3A39&version=NIV. [Accessed: 23rd February 2016.]

31 Howard, A.B. (no date). What the Bible Says About Organ Transplants [online]. Available from: http://www.christianliferesources.com/article/what-the-bible-says-about-organ-transplants-417. [Accessed: 23rd February 2016.]

32 Organ donation NHS (no date). Christianity. [Online.] Available from: https://www.organdonation.nhs.uk/about-donation/what-does-my-religion-say/christianity/. [Accessed: 23rd February 2016.]

33 Armitstead, C. (2013). Rowan Williams releases poem promoting organ donation [online]. Available from: http://www.theguardian.com/books/2013/jul/11/rowan-williams-poem-organ-donation-host-organism. [Accessed: 23rd February 2016.]

34 Wikipedia (no date). Jehovah’s Witnesses [online]. Available from: https://en.wikipedia.org/wiki/Jehovah%27s_Witnesses. [Accessed: 27th February 2016.]

35 Wikipedia (no date). Development of Jehovah’s Witnesses doctrine [online]. Available from: https://en.wikipedia.org/wiki/Development_of_Jehovah%27s_Witnesses_doctrine. [Accessed: 27th February 2016.]

36 Bible gateway (no date). Leviticus 17:11. [Online]. Available from: https://www.biblegateway.com/passage/?search=Leviticus%2017:11. [Accessed: 27th February 2016.]

37 Bible gateway (no date). Acts 15:20. [Online]. Available from: https://www.biblegateway.com/passage/?search=acts+15%3A20&ver-sion=NIV. [Accessed: 27th February 2016.]

https://www.biblegateway.com/passage/?search=Matthew+22:39&version=NIVhttps://en.wikipedia.org/wiki/Jehovah%27s_Witnesses

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In 1967 a Jehovah Witnesses’ document stated that “… removing the organ and replacing it directly with an organ from another human … is cannibalistic.”38 This is a clear indication that organ donation and transplantation were not permissible.

However, despite not donating or receiving blood, they do allow organ transplantation only if the blood is removed from organs and tissues before being transplanted.39

This statement was changed in 1980 to the following: “While the Bible specifically forbids consuming blood, there is no Biblical command pointedly forbidding the taking in of other human tissue… It is a matter for personal decision.”40 Thus, the first published case of transplantation of a Jehovah’s Witness was in 1986 in California.41

JudaismThere are specific concerns regarding organ donation amongst Jewish scholars and Rabbis. According to an article entitled “Religious aspects of organ transplantation”, when a member of the Jewish faith dies, it is important that they be buried within twenty-four hours.42

Rabbi Shumuly Yanklowitz is an Open Orthodox Rabbi and an author.43 He presented on “ELI Talks”, which is a twelve-minute presentation online on “Inspired Jewish ideas.”44 His topic was, “How Far Will You Go to Give? Judaism and Organ Donation”, and he addressed some of the common concerns with regard to organ donation in the Jewish community. The common concerns are as follows: firstly, the emotional attachment to the body; secondly, superstition – ayin ha-ra (evil eye) – the belief that if one talks about death it will bring about death; thirdly, the treatment of the corpse.45

Jewish law has three prohibitions, which are: nivul hamet (desecration of the body) – a law based on Deuteronomy 21:22-23, which states that if a criminal is put to death by hanging “... but thou shalt surely bury him that same day.” Rabbis interpret this verse to mean that mutilation or mistreatment of the deceased is a violation of the scriptural law; halanat hamet (delay of the burial of the body); and hannat hamet (prohibition of benefiting from the corpse).46 As a result of the above, this has led some Jewish scholars to disagree with deceased donation.

The definition of death has been debated by many Jewish scholars.47 The Talmud describes death as the “departure of the soul”; however, this cannot be observed or measured.48 The traditional Jewish

38 Quotes-Watchtower (no date). Organ Transplants [online]. Available from: http://www.quotes-watchtower.co.uk/organ_transplants.html. [Accessed: 27th February 2016.]

39 The Gift of a Lifetime (no date). Religion and Organ and Tissue Donation [online]. Available from: http://www.organtransplants.org/understanding/religion/. [Accessed: 27th February.]

40 Quotes-Watchtower, op. cit.41 Bramstedt, A.K. (2006). Transfusion contracts for Jehovah’s Witnesses receiving organ transplants: ethical necessity or coercive

pact? Journal of Medical Ethics. Volume 32 (4), April 2006. Pp. 193-195.42 Oliver, M, Ahmed, A et al, op. cit, pp. 69-73.43 Wikipedia (no date). Shmuly Yanklowitz [online]. Available from: https://en.wikipedia.org/wiki/Shmuly_Yanklowitz. [Accessed: 29th

February 2016.]44 ELI Talks (no date). About ELI talks [online]. Available from: http://elitalks.org/about-eli-talks. [Accessed: 29th February 2016.]45 Yanklowitz, S, Rabbi (no date). How Far Will You Go to Give?: Judaism and Organ Donation [online]. Available from: http://elitalks.

org/how-far-will-you-go-give-judaism-and-organ-donation. [Accessed: 29th February 2016.]46 Ibid47 Podcast featuring Rapoport, C, Rabbi, Bratton, M, Reverend et al. (2009). Jewish, Christian and secular contributors discuss the

religious and philosophical issues in organ donation [online]. Available from: http://www.bbc.co.uk/religion/religions/judaism/jew-ishethics/organs.shtml. [Accessed 29th February 2016.]

48 Fink, R, Rabbi (no date). Halachic Aspects of Organ Transplantation [online]. Available from: http://www.hods.org/wp-content/up-loads/2015/08/Halachic-Aspects-of-Organ.pdf. [Accessed: 29th February 2016.]

https://www.jewishvirtuallibrary.org/jsource/Bible/Deutertoc.htmlhttps://www.jewishvirtuallibrary.org/jsource/Bible/Deuter21.html

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definition of death requires that all brain, respiratory and cardiac output has ceased.49 However, some believe death occurs when the whole brain, including the brain stem, dies, and others believe it is when the heart alone ceases.

Goses is a Halachic term that describes a person who is gravely ill and likely to die within 72 hours.50 Jewish law prohibits any interference with the Goses to prevent acceleration of death. In addition, there is “reluctance to intervene medically with the Goses to prevent death” solely for the purpose of taking their organs.51

In Israel, where 75% of the population are Jewish, only 10% of the population have an organ donor card.52 In 2008 the Israeli government implemented two laws to try to alleviate this issue; firstly, a definition of time of death; and secondly, to award a range of benefits to live donors.53 However, some Haredi Jewish communities responded to this law by introducing anti-donor cards which read “I do not give permission to take from me, not in life or in death, any organ or part of my body for any purpose.”54

Regardless of these concerns and prohibitions, many Jews and Rabbis read the following verse and believe it supercedes all the above: “Whoever destroys a soul, it is considered as if he destroyed an entire world … and whoever saves a life, it is considered as if he saved an entire world” (Mishnah Sanhedrin, 4:9; Yerushalmi Talmud, Tractate Sanhedrin 37a).55 In addition, Pikuach Nefesh describes the principle in Jewish law that the preservation of human life overrides virtually any other reli-gious consideration.56

HinduismHindus constitute more than one sixth of the world population, with one billion followers.57 Hindus believe in transmigration of the soul and in reincarnation. Hence the physical integrity of the dead body is not viewed as vital. In the Rigveda, the word “daan is the original word in Sanskrit for do-nation, meaning selfless giving.”58 The president of the National Council of Hindu Temples and am-bassador for peace, Mr Om Parkash Sharma MBE,59 stated “organ donation is in keeping with Hindu beliefs as it can help to save the life of others.”60

49 Oliver, M, Ahmed, A etal, op. cit, 69-73.50 My Jewish Learning (no date). Euthanasia: A Jewish View [online]. Available from: http://www.myjewishlearning.com/article/euthana-

sia-a-jewish-view/. [Accessed: 1st March 2016.]51 Ibid.52 Oliver, M, Ahmed, A etal, op. cit, pp. 69-73.53 Ibid.54 Ibid.55 Goodreads (no date). Mishnah Sanhedrin 4:9; Yerushalmi Talmud, Tractate Sanhedrin 37a. quotes [online]. Available from:

https://www.goodreads.com/author/quotes/14110064.Mishnah_Sanhedrin_4_9_Yerushalmi_Talmud_Tractate_Sanhedrin_37a_. [Accessed: 2nd March 2016.]

56 Oliver, M, Woywodt, A et al. (2010). Organ donation, transplantation and religion, Oxford Journals [online]. 26 (2). Pp. 437-444. Available from URL: http://ndt.oxfordjournals.org/content/early/2010/10/20/ndt.gfq628. [Accessed: 2nd March 2016.]

57 Wikipedia (no date). Demographics of India. [Online]. Available from: https://en.wikipedia.org/wiki/Demographics_of_India. [Accessed: 2nd March 2016.]

58 Organ donation NHS (no date). Hinduism. [Online]. Available from: https://www.organdonation.nhs.uk/about-donation/what-does-my-religion-say/hinduism/. [Accessed: 2nd March 2016.]

59 Universal Peace Federation (no date). In Memoriam: Mr Om Parkash Sharma MBE [online]. Available from: http://www.uk.upf.org/ambassadors-for-peace/ambassador-for-peace-news/294-mr-om-parkash-sharma-mbe. [Accessed: 2nd March 2016.]

60 Organ donation NHS, Hinduism, op.cit.

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There are many deities within Hinduism, but Ganesha is the most worshipped in the Hindu panthe-on�61 Ganesha is also known as the “elephant god” as he has the head of an elephant. This is seen as the earliest depiction of xenotransplantation within Hinduism.62

Consequently, organ donation and organ transplantation are encouraged in Hinduism.

IslamIn Islam there are many denominations; however, Sunni and Shi‘a are the two largest groups. Within both these groups of Islam there are differences of opinion with regards to organ donation. Some Sunni Islamic scholars do not believe that organ donation is permissible in Islam.63 Such is the opin-ion of Mufti Zubair Butt, a Sunni Islamic scholar and hospital chaplain, who was featured on the BBC Radio 4 programme “Beyond Belief”. He stated that “We as humans do not own our bodies, we are caretakers of our bodies” and “organ donation can be seen as mutilation of the body.”64

A document published by the Islamic Religious Council of Singapore entitled “Organ Transplant in Islam” contains many fatwas about organ donation and transplantation since 1973.65 In 1973, a fat-wa stated that kidney and other organ donations were prohibited.66 However, in the search to find a cure for kidney disease this ruling was overturned in 1986 and now it supports the use of organ donation and organ transplantation as it saves lives.67

61 Wikipedia (no date). Ganesha [online]. Available from: https://en.wikipedia.org/wiki/Ganesha. [Accessed: 2nd March 2016.]62 Sundar, S. (no date). “Xenotransplantation” Animal Organs to save Human Lives The Risks, Benefits and Future Prospects [online].

Available from: http://www.indiandoctors.com/paper/158.php3. [Accessed: 4th March 2016.]63 Organ donation NHS (no date). Islam [online]. Available from: https://www.organdonation.nhs.uk/about-donation/what-does-my-reli-

gion-say/islam/. [Accessed: 4th March 2016.]64 BBC Radio 4-Beyond Belief. (2013). Organ Donation [online]. Available from: http://www.bbc.co.uk/programmes/b0383lp6/.

[Accessed: 4th March 2016.]65 Majlis Ugama Islam Singapura (Islamic Religious Council of Singapura) (no date). Organ Transplant in Islam - The Fiqh of Organ

Transplant and Its Application in Singapore [online]. Available from: http://www.officeofthemufti.sg/documents/Muis%20kidney%20book%20ENG.pdf. [Accessed: 4th March 2016.]

66 Ibid.67 Ibid.

Figure 6 image showing that Muslims are more likely to oppose organ donation compared to other faiths

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In 1989, the Rector of Al-Azhar University, Dr Muhammad Syed Tantawi, passed a fatwa which states: “Live organ donations are permissible by consensus of jurists … taking organs from the body of a dead person to transplant to someone who needs it, whether to save his life or to cure him, is permissible….”68

Sayyid Muhammad Rizvi is a Shia scholar.69 He published a review article on the opinion of several Shia scholars on organ donation and organ transplantation. With regards to live donation the late Ayatullah al-Khu’i stated that donation of minor organs is permissible, such as of the skin, bone-mar-row and blood, as they can regenerate.70 However, kidneys were classed as major organs and were not allowed to be donated from the living.

Ayatullah Sistani allowed the donation of all organs as long as “the person donating was not made handicapped.”71

Ayatullah Khamenei allowed deceased donation as long as the body was not mutilated, so donation of internal organs is permissible.72

The Qur’an states: “If you save a life it is as though you have saved the whole of humanity” (5:32), and in a hadith the Prophet Muhammad (pbuh) stated: “Whosoever helps another will be granted

68 Islam, Z.Md. (no date). Organ Donation and Transplantation Issues in Islam and Present Situation. Journal of Law, Policy and Globalization. Volume 22, 2014, p. 102.

69 Wikipedia (no date). Muhammad Rizvi [online]. Available from: https://en.wikipedia.org/wiki/Muhammad_Rizvi. [Accessed: 4th March 2016.]

70 Rizvi, M, S. (no date). Islamic Views on Organ Donation & Transplantation [online]. Available from: http://www.al-islam.org/articles/islamic-views-organ-donation-transplantation-sayyid-muhammad-rizvi. [Accessed: 4th March 2016.]

71 Ibid.72 Ibid.

Figure 7. This image shows that individuals from Pakistani and Bangladeshi backgrounds are less open to organ donation compared to other ethnic groups

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help from Allah.”73 These statements clearly portray the importance of saving a life in Islam, thus a reasonable inference can be made that individuals have the discretion to decide whether they want to donate their organs or not.

A study funded by the Wellcome Trust into attitudes towards biomedical issues in the curriculum of UK secondary schools found the following:1. A science teacher stated that “Most Muslims would only consider transplantation from another

Muslim.” The school had reported that there were issues with religion telling students one thing and wider culture suggesting otherwise.

2� Xeno-transplantation could raise issues if organs originate from pigs, as the consumption of pork is forbidden in Islam.

Qualitative research has confirmed that many religious people strongly believe that their religion prohibits organ donation. However, in many cases it was shown to be assumed rather than known to be the case. Sixty-eight percent of Christians and 81% of Muslims say they don’t know how their religion views organ donation.74 During my research I did not come across any religious teaching which explicitly forbids organ donation.

Mrs Parveen Awan, a Pakistani Muslim woman featured on BBC Radio 4, told the story of her son who was born with a condition that caused acute kidney failure.75 In the interview she was asked if she was aware that some Muslims disagree with organ donation. Her response was “I didn’t even know there was an issue regarding organ donation in Islam.” As a result of her personal hardship due to the non-availability of organ donation, Parveen has started to raise awareness within her community in Blackburn. Interestingly, Parveen raised the issue that she had to wait a very long time for a kidney as not many people from her ethnic group are on the organ donor register.76

This begs the question: Are religious beliefs the only factor that is influencing individuals to donate their organs and undergo transplants, or does culture play an important role as well?

Cultural Views of Organ Donation and TransplantationBlack African AmericansThere is a shortage of organ donors in the United States. More than 123,000 men, women and children currently need life-saving organ transplants and every ten minutes another name is added to the national organ transplant waiting list77. The Journal of the National Medical Association stated that “historically African Americans donate their organs at a much lower rate than white people.”78

According to findings issued in the American Journal of Kidney Diseases, “at every transplant center in the nation, African Americans are the least likely to receive a kidney from a living organ donor.”79 The study had compiled data from all 275 transplant centers in America and it showed that “facilities

73 Organ Donation NHS. Islam, op. cit.74 OPTISISA Research. (2014). BAME Organ Donation 2014 [online], p. 6. Available from: http://www.odt.nhs.uk/pdf/NHSBT_BAME_

Organ_Donation_2014_Final_report.pdf. [Accessed: 11th March 2016.]75 BBC Radio Four – Beyond Belief. op. cit.76 OPTISISA Research, p. 22, op. cit.77 Donate life America (no date). Statistics [online]. Available from: http://donatelife.net/statistics/. [Accessed: 15th March 2016.]78 Minniefield, J, W, Yang, J et al. (2001). Differences in attitudes toward organ donation among African Americans and whites in the

United States [online]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594069/. [Accessed: 15th March 2016.]79 National Kidney Foundation. (2012). African Americans Least Likely to Receive a Living Kidney Donation [online]. Available from:

https://www.kidney.org/news/newsroom/nr/racial_transplant. [Accessed: 15th March 2016.]

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serving predominantly African American populations had even higher rates of living donor trans-plant disparities.”

Data obtained by the National Kidney Foundation portrayed that 92,000 people are waiting for a kidney in the US, and over one-third of these are African Americans. This is due to African Americans having a greater predisposition to diabetes, kidney disease and high blood pressure. These illnesses often lead to failure of a vital organ, thus there is a greater need for donations.80

This raises the question of why is there such a shortage of African American organ donors. In 1995 JET Magazine had published an article entitled “Why More Blacks Do Not Donate Organs”. The arti-cle stated that in 1993 there were “554 black people who died and their organs were used to help others, compared to 3,802 white people who donated their organs after they had died” (reported by the United Network for Organ Sharing).81 The question was then asked to experts and organ donors, “Why won’t more Blacks donate their organs?”

Dr Rodrick Stevenson stated that “some Blacks don’t donate organs because they believe they have to go to Heaven with everything they came with.”82 As a result of such misconceptions, Dr Clive Callender founded MOTTEP to educate ethnic minority groups on organ donation.83

Racism and distrust in the medical system were key issues with regards to why African Americans do not donate their organs. Dr Callender stated that “Blacks don’t donate organs because they feel that…all of their organs will go to Whites.”84

The “Tuskegee Syphilis Study” involved experimentation on 600 African American men. Of these, 399 had syphilis and 201 did not.85 The men were told that they were being treated; however, they were given placebos, when penicillin was the known treatment.86 Other cases that have led to the mistrust in the medical system are mysterious deaths of young African American teens, whose or-gans have been harvested.87

All the above reasons lead to the issue of a shortage of organ donors from African Americans.

BAME (Black, Asian and Ethnic Minorities)There is a shortage of organ donations amongst the Black and Asian Minority Ethnic community in the United Kingdom. The reasons for this are not too dissimilar to the US. In 2014, OPTIMISA Research published a document entitled “BAME Organ Donation 2014” for NHS Blood and Transplant (NHSBT), a special health authority that manages all types of organ donation from across the UK.88

80 Ibid.81 JET Magazine. (1995). Why More Blacks Do Not Donate Organs [online]. Available from: https://books.google.co.uk/books?id=_TwD

AAAAMBAJ&pg=PA15&dq=Why+More+Blacks+Do+Not+Donate+Organs&hl=en&sa=X&ved=0ahUKEwiLy-iz2ZbMAhVIshQKHcfGDGQQ6AEIHDAA#v=onepage&q=Why%20More%20Blacks%20Do%20Not%20D. [Accessed: 20th March 2016.]

82 Ibid.83 Ibid.84 Ibid.85 Centers for Disease Control and Prevention (no date). US Public Health Service Syphilis Study at Tuskegee [online]. Available from:

http://www.cdc.gov/tuskegee/timeline.htm. [Accessed: 24th March 2016.]86 Wikipedia. (no date). Tuskegee syphilis experiment [online]. Available from: https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment.

[Accessed: 24th March 2016.]87 Taylor, V, A. (no date). Are Black People’s Organs Being Stolen For Profit? [online]. Available from: http://kulturekritic.com/2015/05/

news/are-black-peoples-organs-being-stolen-for-profit/. [Accessed: 27th March 2016.]88 OPTIMISA Research. (2014). BAME Organ Donation 2014 [online], p. 5. Available from: http://www.odt.nhs.uk/pdf/NHSBT_BAME_

Organ_Donation_2014_Final_report.pdf. [Accessed: 29th March 2016.]

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Their research showed that there is a shortage of suitable organs and a large number of patients are on the transplant waiting list. Patients from BAME (Black, Asian and Minority Ethnic) communities are more likely to need an organ transplant.89 Patients from a BAME community will wait a year longer to receive a kidney transplant. As a result, “a quarter of those on the waiting list are from a BAME background, which represents just 12% of the UK population.”90

Due to their findings they interviewed 684 individuals from the following ethnic groups: Bangladeshi, Indian, Pakistani, African and Black Caribbean. The individuals were of similar age, ethnic and reli-gious background. The researchers discovered that there are a number of religious and cultural barriers within the BAME communities towards organ donation.91

The study also showed that “some first generation migrants are also influenced by their perception of organ donation in their home country”92 such as selling their organs for money and organs being harvested after death without consent. In addition, many older generations believe that they should leave the world the way they entered. Seeking the advice from those with greater knowledge, for example, a faith leader,93 can impact decisions about organ donation, as they are likely to be influ-enced by these “respected sources”.

The BAME report found that customs and traditions are very important within BAME families and communities. This is particularly evident for those born outside of the UK, where traditions are upheld to ensure that heritage is not lost and that family history is passed on through generations.94

Finally, the OPTISMA document suggested that the notion of death is believed to be taboo in Islam. However, nothing could be further from the truth, as it is believed that discussion of death makes one more aware that they will have to experience it one day, so it should be spoken about freely.95

ConclusionMy research has shown that no religious scripture directly forbids organ donation or organ transplan-tation. Lack of religious information and disagreement between religious scholars has contributed largely to the shortage of organ donors especially amongst ethnic minorities.

The ethos of all faiths points towards saving lives. This act of altruism is greater than all the concerns that religious people may have with regard to organ donation and transplantation. Ironically, this has not filtered down from the leaders to the followers.

All major religions of the world encourage organ donation and transplantation. There is no dispute that there are some concerns within each faith, especially the Abrahamic religions, regarding de-filing of God’s creation, defining death and timing of burial. However, there is a general perception among all faiths that saving a life is greater than all the other misconstrued concerns. Thus the overall conclusion with regard to religion is that organ donation and transplantation is acceptable, as long as it is to save a life.

89 Ibid.90 Ibid.91 Ibid. p. 14.92 Ibid. p. 20.93 Ibid. p. 25.94 Ibid. p. 25.95 Ibid.

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blessings of Allah be on him). LOVE also generates peace and happiness in the society. Follow the commandments of ALLAH and His Messenger, the Holy Prophet MUHAMMAD and earn an ever-lasting life here in this world and in the Hereafter. May Allah bless you all.

Ahmad Nawaz, Hayward, California I have just finished reading the February 2013 issue of the HOPE Bulletin dedicated to the memory of the late Br. Akbar Abdullah. I must say that your team has worked very hard to collect facts about the life and contributions made by our late Br. Akbar. The formatting of the Bulletin and photographs have made it very impressive and visual. Br. Akbar deserved such a beautiful dedication. I wish to congratulate you for making the Bulletin more than just a news bulletin. The brief life history of the Holy Prophet Muhammad (sas) by our new sister in the fold of Islam, Christiane Backer, is very impressive and shows how his Perfect Example has inspired her thoughts and behaviour. I am sure her book “From MTV to Mecca” must be worth reading. Thanks for introducing the autobiography of a highly popular figure in the Western media, who, by her own study, has adopted Islam, and is facing challenges with firm faith and conviction.

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In the US, shortage of organs among African Americans has been fuelled by mistrust between the rich and the poor and largescale government experiments which left the African American popula-tion to suffer.

Culture is largely influenced by religion and tradition. To overcome religious bias to transplantation one study suggested creating awareness on such controversial issues as part of the school curriculum.96

With an increase in the need for organs, many organisations have been set up to raise awareness about organ donation, especially among ethnic minorities, in the hope of eradicating the shortage.

Recently the co-founder of the African Caribbean Leukaemia Trust, Beverly De-Gale, featured on BBC Breakfast News where she shared her story of losing her son to leukaemia. Many who have lost a loved one due to a shortage of either blood, stem or organ within ethnic minority communities have begun to campaign and raise awareness of this predicament. Could this shortage of organs result from apathy or a sheer ‘don’t care’ attitude as it is not affecting me or my family? This question still remains to be answered.

In conclusion, patients can have a good quality of life with an organ transplant and improvements in medical therapy. This is evident from the longevity of many transplant patients. So all the informa-tion we have today points to good outcomes for patients. The question remains whether we would want a second chance of life if we were ill and thus would we give a second chance of life if needed?

96 The Science and Technology Group, Institute of Education, University of London. (2001). The teaching of social and ethical issues in the school curriculum, arising from developments in biomedical research.

autograftIntroductionBrief history of organ transplantationAdvantages and disadvantages of organ transplantationReligious Views of Organ Donation and TransplantationChristianityJudaismHinduismIslamCultural Views of Organ Donation and TransplantationBlack African AmericansBAME (Black, Asian and Ethnic Minorities)Conclusion