Religious views on organ donation

Many different major religious groups and denominations have varying views on organ donation of a deceased and live bodies, depending on their ideologies.[1] Differing opinions can arise depending on if the death is categorized as brain death or cease of the heartbeat.[1] It is important for doctors and health care providers to be knowledgeable about differentiating theological and cultural views on death and organ donations as nations are becoming more multicultural.[2]

General overview

Due to the recent advancements in medical technology, many religious and moral dilemmas have impacted biomedical ethics.[3] It is difficult to reach full consensus on organ donation within each religion.[4]

One of the main problems that has come from these advancements in the past few decades has been defining death, which leads to organ donation and transplantation controversy.[3] In 1968, Harvard medical school defined death as 'irreversible coma.'[5] It is important for healthcare practitioners to understand formal religious views on bioethics and organ donations in multicultural societies so medical advancements can still be aligned with religious views.[6][7]

Both receiving and donating organs is up to interpretation as there is no direct references to the process in religious texts.[8] Because of this, many scholars, religious authorities and individuals interpret the readings differently. All this allows for different views between religions as well as within major religions. Any religious processes and traditions that occur right after death also effect views on organ donation.[9]

Christianity

Christians generally support organ donation as an altruistic act and leaves the process as an individual decision. The Church of England has stated that organ donation is an act of Christian duty.[9]

Catholicism

Catholics believe the dead body is designed for resurrection and eternal life.[10] However, love and communion are key beliefs in Catholic religion and an organ donor's act is considered an act of self-giving and communion.[10] The New Testament suggests in the Gospel of Matthew 22:39, "Thou shalt love thy neighbour as thyself."[11] Pope John Paul II interpreted this Golden Rule in his quote,"We shall receive our supreme reward from God according to the genuine and effective love we have shown to our neighbor."[12] Pope Benedict XVI has owned a donor card since the 1970’s.[9]

Jehovah's Witnesses

Since Jehovah’s Witnesses are not allowed to accept external blood products, their view on organ donation is complicated by the medical procedure itself.[9] Jehovah’s Witnesses believe that organ donation with no transfusion of blood is an individual decision.[2]

Islam

The majority of Islamic religious leaders accept organ donation during life (provided it does not harm the donor) and after death in order to save life. Most religious leaders do not accept brain death as a criterion and consider cessation of all signs of life including heart beat as a precondition for declaring death.[13][14][15]

Despite this position by Islamic religious leaders, Muslims are oftentimes uncertain about whether or not Islamic tradition considers organ donation to be forbidden. This uncertainty stems from ambiguity caused by conflicting opinions among some Islamic leaders regarding this issue. Moreover, a lack of support along with a generally negative attitude toward organ donation and transplantation has been reflected in surveys of diverse Islamic populations. This overall negativity towards organ donation has resulted in low rates of participation in organ donation by practicing Muslims even in cases where donation would be considered permissible by religious leaders.[16][17]

Muslims believe that humans do not have ownership of their body or spirit, it is considered to be God's gift.[18][19] Judges of organ donation ethics question whether the noble act of donating an organ outweighs the desecration of a dead body.[6] Additionally, some Muslims believe that all body parts must be present on the Day of Judgement and organ donations would interfere with that testimony.[4]

Many Ayatollahs view organ donations differently. For example, Grand Ayatollahs Ali al-Sistani did not approve of posthumous organ donation, while Grand Ayatollahs Abu al-Qasim al-Khoei allowed donation of all organs after death as long as the body could still be recognizable.[6] Practicers of Shia Islam consider minor, regenerative organ donations different than major, non-regenerative organs.[7]

Some points of view that Muslims hold are based on the Prophet Muhammad’s teachings. The quote “Whoever helps another will be granted help from Allah in the Hereafter” has been interpreted by some Muslims in support of organ donation.[4]

In 1996, the United Kingdom Muslim Law Council declared that organ donation coincides with Islamic beliefs.[1]

Egypt

In recent decades, organ transplantation has become a major topic of disagreement in Egypt.[6] The Egyptian Parliament has not yet been able to develop an organ transplant program or any other laws concerning the subject.[7] Most of the opposition comes from the existence of a black market and organ theft that has tainted the view citizens have on organ donation.[6] Since Muslims believe organs belong to God, proponents suggest it is God who ultimately saves the patient and opponents suggest that one can not donate an organ that they themselves do not own.[6] Muhammad Metwali Al Shaarawy was a popular figure in Egypt whose quote, "How can you give a kidney that you yourself do not own?" influenced Egyptian views on organ donation.[6]

Iran

In Iran, an Islamic ruling nation, laws have been passed in which monetary compensation for kidney donation is legal under regulation.[20]

Judaism

Like Islam, the body requires burial within 24 hours of death and any unnecessary interference with the body should be avoided. The Jewish Law, Halakha, discusses the moral obligation (mitzvah) of saving one's life, which many scholars and rabbis consider to outweigh the consequences of interfering with one's body.[21]

Mishnah Sanhedrin 4:5
“It was for this reason that man was first created as one person [Adam], to teach you that anyone who destroys a life is considered by Scripture to have destroyed an entire world; and anyone who saves a life as if he has saved an entire world.”

This quote[22] represents pikuach nefesh, which is the term used in Jewish Law for saving one’s life and overrides any other regulations in Jewish law that would prohibit organ donations.[21]

Jewish medical ethics takes a unique approach. It encourages live organ donation, such as kidney transplant, partial liver lobe (Adult/Child) transplant and the like, when two basic conditions are met, firstly, that the operation does not (significantly) endanger the life of the donor, and secondly, that the recipient's life will be saved through this donation. However, opinions are divided on the issue of organ donations which will permanently end the donor's heart beating, in a case when the donor is brain dead. According to one school of thought,[23] the definition of death is indicated by irreversible cessation of heart beat. Hence, this view does not allow vital organs to be removed from a brain dead patient, as stopping the heart from beating is, in their view, tantamount to killing. Conversely, the other school of thought[24] (which include many Orthodox rabbis and Israel's Chief Rabbinate) the determination of death is based on brain function irrespective of a beating heart. Therefore, according to their view, removing vitals organs from a brain dead patient for the sake of saving a life, is in fact permissible, and even encouraged.

As a result of these two orthodox schools of thought, Orthodox Jewish ethics remains divided over key death-related policies. Tactically, opponents to the brain death criterion have requested waivers from state law, as a matter of religious freedom, so as to continue relying on traditional indicators.[23][24] Meanwhile, proponents of the brain death criterion, such as Halachic Organ Donor Society have been active in advocating organ donations and transplants either at brain death or even at cessation of heart beat, where donation of corneas and skin is still medically possible.

Israel

Israel used a committee of medical and religious authorities in order to create laws regarding organ donation. Two laws were enacted in 2008. First, the Brain-Respiratory Death Law states conditions that determines the conditions necessary to determine brain death. It also allows for both brain death and cease of the heartbeat as acceptable deaths. Second, the Organ Transplantation Law, fully implemented in 2012, addresses the legality and ethics of organ donation in Israel. The law states that organ trade and donor compensation are illegal.[20]

A nonprofit NGO called Matnat Chaim was created in Israel in order to promote live-donor kidney transplantation. Their goal is to be in accordance with Jewish law and states that the act is considered a laudatory one.[20]

Only about 10% of the Israeli population owns an organ donor card.[9]

Buddhism

The spiritual consciousness remaining in the body after death leads to discrepancy on organ donation in the Buddhist community. Issues with defining a diagnosis of brainstem death also provides contradictions in organ donation views.[9]

According to Buddhism, it is a great Merit to donate one's own flesh for the sake of another. The lord Buddha is also believed to be sacrificed himself by jumping into a fire in order to nourish a lost and starved villager in woods, in a previous life as a rabbit.[25] This bodhisattva value of compassion is also expressed through organ donation by putting another person’s wellness above one’s own. Donations made based on monetary or societal motivation are not valued by Buddhists.[26][2]

A person’s spiritual consciousness continues through the path of the bardo and rebirth after death. Some believe that since physical organs are useless after death, donating them is an act of great compassion. Other’s believe that in order to ensure positive rebirth, the dying individual should not be disturbed. However, organs have to be harvested right after death is declared in order to be useful. All these considerations allow for differentiating views depending on the individual.[26]

The choice of making the donation has to be made by the donor him/herself according to Buddhism. It's not clear brain death is a form of death according to Buddhism. But if it considered as death, in which case one cannot make decision oneself, it's a good deed for one who died and also for the ones involved in decision making and contributing. Buddhists believe in the value of compassion, in which actions such as organ donation can be used to overcome the sufferings of life.[27][3]

Buddhism generally accepts brainstem death and the irreversible ability for respiration as a valid criteria for death of a human being.[3] A living body or a dead body in Japanese culture is considered to be the permanent carrier of the soul.[27] This belief has made it hard to develop a unanimous agreement on brain death in Japan.

Many Buddhists in Eastern Asia adopt the Confucian taboos that are against destruction or disfiguring the human body. Because of this view, many countries in East Asia have low rates of organ donation.[26]

Because Hawai’i has a large Asian population, these cultural and religious ideals can be reflected in their participation in organ donation. As a state, they have the lowest rate of organ donations compared the rest of the United States.[26]

Tibetan Buddhists believe the spirit may remain in the body until about a week after death, therefore organ donation can be seen as interfering with the next rebirth.[1] Pure Land Buddhism is a branch of Mahayana Buddhism that is against organ donation. They believe that the soul should be able to leave peacefully towards the path of rebirth. Since the soul takes time to depart from the physical body, they believe the body should not be disturbed immediately after death is declared.[28] In Korea and Taiwan, organ donation is successfully adopted.[26]

Hinduism

In Hinduism, the physical integrity of the body after death is not considered important.[2] Hindu values reincarnation and prolonging life which allows for many individuals to agree with organ donation.[9]

Life after death is a strong belief of Hinduism and is an ongoing process of rebirth. It is a perpetual circle of birth and rebirth of the soul, so the physical body is insignificant. This could be seen as reflecting positively on the concept of organ donation and transplantation in Hinduism.[29] Other Dharmic faiths hold similar views.

Jainism

In Jainism, compassion and charity are considered to major virtues. Organ donation has been widely supported by the Jain community leaders and monks.[30] It has been reported that in Mumbai, 85-90% of all organ donations including eye donations, are by Jains and Gujaratis (a significant fraction of them are Jain in Mumbai).[31] Gujarat has had considerable success with the eye donation program due to a significant population of the Jain community, which considers eye donation as a sublime form of charity.[32]

References

  1. 1 2 3 4 Oliver, Michael; Woywodt, Alexander; Ahmed, Aimun; Saif, Imran (1 February 2011). "Organ donation, transplantation and religion". Nephrology Dialysis Transplantation. 26 (2): 437–444. doi:10.1093/ndt/gfq628.
  2. 1 2 3 4 Oliver, M.; Woywodt, A.; Ahmed, A.; Saif, I. (20 October 2010). "Organ donation, transplantation and religion". Nephrology Dialysis Transplantation. 26 (2): 437–444. doi:10.1093/ndt/gfq628.
  3. 1 2 3 4 Keown, Damien (2001). Buddhism and bioethics (1st (Great Britain) ed.). Basingstoke [u.a.]: Palgrave. ISBN 0312126719.
  4. 1 2 3 Sharif, Adnan (September 2012). "Organ Donation and Islam—Challenges and Opportunities". Transplantation Journal. 94 (5): 442–446. doi:10.1097/TP.0b013e31825f4474.
  5. ↑ Matis, Georgios; Chrysou, Olga; Silva, Danilo; Birblis, Theodossios (2012). "Brain Death: History, Updated Guidelines And Unanswered Questions". The Internet Journal of Neurosurgery. 8 (1).
  6. 1 2 3 4 5 6 7 Brockopp, edited by Jonathan E.; Eich, Thomas (2008). Muslim medical ethics : from theory to practice. Columbia, S.C.: University of South Carolina Press. ISBN 9781570037535.
  7. 1 2 3 Atighetchi, Dariusch (2007). Islamic bioethics : problems and perspectives. [Dordrecht]: Springer. ISBN 1402049617.
  8. ↑ Randhawa, Gurch; Brocklehurst, Anna; Pateman, Ruth; Kinsella, Suzannah; Parry, Vivienne (9 July 2010). "Religion and Organ Donation: The Views of UK Faith Leaders". Journal of Religion and Health. 51 (3): 743–751. doi:10.1007/s10943-010-9374-3.
  9. 1 2 3 4 5 6 7 Oliver, Mike (2012). "Donating in good faith or getting into trouble Religion and organ donation revisited". World Journal of Transplantation. 2 (5): 69. doi:10.5500/wjt.v2.i5.69.
  10. 1 2 Boyle, Kevin D. O'Rourke, Philip (1993). Medical ethics : sources of Catholic teachings (2nd ed.). Washington, D.C.: Georgetown University Press. ISBN 0878405402.
  11. ↑ "Matthew 22". www.lds.org.
  12. ↑ Pope John Paul II (June 20, 1991). "Many Ethical, Legal, and Societal Questions Must be Examined at Greater Depths". Vatican Press: 12–13.
  13. ↑ Al-Mousawi, M; Hamed, T; Al-Matouk, H (December 1997). "Views of Islamic scholars on organ donation and brain death". Transplantation Proceedings. 29 (8): 3217. doi:10.1016/S0041-1345(97)00876-2. PMID 9414684.
  14. ↑ Khan, Faroque (1986). "The Definition of Death in Islam: Can Brain Death Be Used as a Criteria of Death in Islam?". Journal of the Islamic Medical Association. 18 (1): 18–21. doi:10.5915/18-1-4731. Retrieved 2010-06-13.
  15. ↑ Moazam, Farhat (September 2006). Bioethics and Organ Transplantation in a Muslim Society: A Study in Culture, Ethnography, and Religion. Indiana University Press. pp. 32ff. ISBN 978-0-253-34782-4.
  16. ↑ Padela, A. I.; Curlin, F. A. (2013). "Religion and disparities: Considering the influences of islam on the health of american muslims". Journal of Religion and Health. 52 (4): 1333–45. doi:10.1007/s10943-012-9620-y.
  17. ↑ Rasheed, S. A.; Padela, A. I. (2013). "The interplay between religious leaders and organ donation among Muslims". Zygon. 48 (3): 635–654. doi:10.1111/zygo.12040.
  18. ↑ Moazam, Farhat (2006). Bioethics and organ transplantation in a muslim society : a study in culture, ethnography, and religion ([Online-Ausg.] ed.). Bloomington [u.a.]: Indiana Univ. Press. ISBN 9780253347824.
  19. ↑ Sachedina, Abdulaziz (2009). Islamic biomedical ethics : principles and application. Oxford: Oxford University Press. ISBN 9780195378504.
  20. 1 2 3 Rabinowich, Aviad; Jotkowitz, Alan (7 September 2017). "Altruism and Religion: A New Paradigm for Organ Donation". Journal of Religion and Health. 57 (1): 360–365. doi:10.1007/s10943-017-0488-8.
  21. ↑ "Mishnah Sanhedrin 4:5". Sefaria.
  22. 1 2 Bleich, J. David (1991). Time of death in Jewish law. Z. Berman.
  23. 1 2 See Moshe Tendler's elucidation of Rabbi Moshe Feinstein's responsa
  24. ↑ "Sutta Pitaka: The Jātaka Tales". Archived from the original on November 3, 2009.
  25. 1 2 3 4 5 Tsomo, Karma Lekshe (2006). Into the jaws of Yama, lord of death : Buddhism, bioethics, and death. Albany: State Univ. of New York Press. ISBN 0791468321.
  26. 1 2 Bourgeault, Daisak Ikeda, René Simard, Guy (2003). On being human : where ethics, medicine, and spirituality converge. Santa Monica, Calif.: Middleway Press. ISBN 0972326715.
  27. ↑ Tai, Michael Cheng-Tek (March 2009). "An Asian Perspective on Organ Transplantation". Tzu Chi Medical Journal. 21 (1): 90–93. doi:10.1016/S1016-3190(09)60017-3.
  28. ↑ http://www.bbc.co.uk/religion/religions/hinduism/hinduethics/organdonation.shtml
  29. ↑ Maitri Porecha, Gurus' discourse: Donate organ, save life, DNA Aug 7, 2013
  30. ↑ Ratan Sharda Positive Side of Religion, News Bharati, 4/22/2013
  31. ↑ Sunil Shroff Legal and ethical aspects of organ donation and transplantation Indian J. Urol. 2009 Jul-Sep; 25(3): 348–355.
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