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Aksoy applied Islam principles for ethically justifying and endorsing
obligatory cadaveric organ donation for transplantation. "That maxim means
that when there is no other way to save a life, forbidden means become
permitted; this includes the removal of organs from a cadaver ".
The most fundamental questions that Aksoy has not asked or answered:
(1) Are transplantable organs removed from the truly...
(1) Are transplantable organs removed from the truly dead or from
living human beings arbitrarily defined as dead?
(2) Are the medical criteria of neurological determination of death
(heart-beating donation) or cardio-respiratory determination of death (non
-heart-beating donation) scientifically consistent with human death? [2,
If organs are procured before true death, the act of procuring organs
is the proximate cause of death of the person.
Scientific evidence has undermined the biological concept of brain
death for declaring human death . In the 2008 report, the US President
's Council on Bioethics replaced the term "brain death" with "total brain
failure" . The report cited series of scientific and clinical studies
undermining the biological rationale equating the concept of brain death
with human death (see page 56 Table 2: Physiological Evidence of Somatic
Integration). In stead, the Council postulated a novel philosophical
rationale equating this irreversible neurological condition as human death
and justifying continuation of cadaveric organ donation. Similarly, the
validity of the newly developed criteria for circulatory-respiratory
determination of death in the context of organ donation has also been
Current worldwide practice of cadaveric organ procurement is
inconsistent with the legal standard of death set forth in the Uniform
Determination of Death Act of 1981. In the 1986 Resolution of the Pan-
Islamic Council Jurisprudence on Resuscitation Apparatus in Amman, Jordan,
Muslim scholars adopted a Western definition of death. However, this
Council failed to address the scientific flaws and the arbitrary nature of
this definition designed solely for the purpose of permitting cadaveric
organ donation. This omission potentially has sociocultural consequences
. The Council was also aware that the Quran include many verses from
which signs of life can be inferred. "Then He fashioned him in due
proportion, and breathed into him the Ruh [soul] (created by God for that
person), and He gave you hearing (ears), sight (eyes) and heart. Little is
the thanks you give! (Sura As-Sajda 32: 9) ". The dual interconnectedness
of functions and capacity to function of both the heart and the brain in a
human being are consistently emphasized throughout the Quran verses.
Advocates of cadaveric organ donation commonly cite the following
verse from the Quran: "if anyone killed a person -not in retaliation of
murder, or (and) to spread mischief in the land - it would be as if he
killed all mankind, and if anyone saved a life, it would be as if he saved
the life of all mankind (Sura Al-Maeda 5:32) ".
Advocates of organ donation emphasize that the act of saving a single
human life is of paramount value to saving the whole of mankind. What the
scholars should be emphasizing about this verse, however, is that its
warning about, and condemnation of, the active termination of life or the
killing of another human being has priority over the commendation for
saving one. Killing a human being for organs to save another life is not
When Aksoy and others affirmed that cadaveric organ donation should
be a social obligation and that "the community is under a collective
obligation to find the right organs for transplantation in order to
preserve the lives and health of its sick members", it is imperative to
ask these two fundamental questions:
First, is society willing to embrace "utilitarian homicide" in
medical practice by sanctioning procuring organs for transplantation, even
when the determination of death is uncertain, to save the lives of others?
Defining death arbitrarily to allow procuring transplantable organs from a
dying person is not different from other forms of active medical
termination of a human life (eg, euthanasia), except that the former
appears to be successfully veiled by a utilitarian ideology .
Second, does the claim of collective responsibility and obligation in
the context of organ procurement apply when current scientific evidence
proves that organ donors are not dead but "close enough to death"  to
justify proceeding with surgical removal of transplantable organs, which
is turn, becomes the proximate cause of death?
Mohamed Y. Rady, MD, PhD
Professor of Medicine, College of Medicine, Mayo Clinic
Consultant, Department of Critical Care Medicine
Mayo Clinic Hospital, Mayo Clinic, Phoenix, Arizona, 85254, United States
Joseph L. Verheijde, PhD, MBA
Associate Professor of Biomedical Ethics, College of Medicine, Mayo Clinic
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix,
Arizona, 85254, United States of America
1. Aksoy S: Some principles of Islamic ethics as found in Harrisian
philosophy. J Med Ethics 2010, 36(4):226-229.
2. Rady MY, Verheijde JL: Islam and end-of-life organ donation.
Asking the right questions. Saudi Med J 2009, 30(7):882-886.
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donation. Letter and Authors reply. Saudi Med J 2009, 30(11):1491-1493.
4. Verheijde J, Rady M, McGregor J: Brain death, states of impaired
consciousness, and physician-assisted death for end-of-life organ donation
and transplantation. Med Health Care Philos 2009, 12:409-421.
5. Controversies in the determination of death. A White Paper of The
Presdient 's Council on Bioethics [http://www.bioethics.gov/]
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7. Delimiting death. Nature 2009, 461(7264):570.
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Organ Donation for Transplantation: New Questions and Serious
Sociocultural Consequences. HEC Forum 2009, 21 (2):175-205.
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Enforcement of presumed-consent policy and willingness to donate organs as
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reinforcing ideology in pluralistic societies. Health Policy 2009,
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