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• Brain death is not 'complete death' in Islam: A global call for revising the legal definition of death in Islam
  Mohamed Y Rady
  Published on: 18 May 2017

• Published on: 18 May 2017

  Brain death is not 'complete death' in Islam: A global call for revising the legal definition of death in Islam

  • Mohamed Y Rady, Professor
  • Other Contributors:
    • Joseph L. Verheijde

  Brain death is not 'complete death' in Islam: A global call for revising the legal definition of death in Islam

  To the editor

  Dr Bedir and Professor Aksoy have made an important scholarly contribution addressing the validity and legitimacy of equating brain death with human death in the Islamic faith. This contribution has significance not only for the medical community of practicing physicians and h...

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  Brain death is not 'complete death' in Islam: A global call for revising the legal definition of death in Islam

  To the editor

  Dr Bedir and Professor Aksoy have made an important scholarly contribution addressing the validity and legitimacy of equating brain death with human death in the Islamic faith. This contribution has significance not only for the medical community of practicing physicians and health care providers worldwide but also to Muslim scholars and the global Muslim community in particular.

  Bedir and Aksoy concluded that all approaches towards the definition of the soul have been made "within the boundaries of the positivist perspective... [and thus], the diagnosis of brain death has been set forth with a pragmatic and Cartesian logic...[but] always neglecting one aspect of human life". [1] Their conclusion has far reaching practical implications for transplantation practice as now: "...it can be asserted that brain death is not absolute death according to Islamic sources; for in the patients diagnosed with brain death the soul still has not abandoned the body. Therefore, these patients suffer in every operation performed on them".[1]

  Professor Sachedina succinctly framed the fallacy of equating brain death with human death (http://people.virginia.edu/~aas/article/article6.htm )

  "....More importantly, the Qur'anic view of human person, the nafs [soul], that rejects the dichotomization of human personality into a body and mind, is at the root of theological debate on the relationship between life and death. As a nafs who dies through the divine decree any definition of this nafs's death must focus on the criteria that determines the death of the whole human rather than just a part of his biological existence. In other words, no definition of death that fails to take a living person, as seen in the Qur'an, can have a valid ground for acceptance in Islamic jurisprudence".[2]

  The same position , rejecting brain death as equivalent to human death, was recently echoed in other Abrahamic religions: Orthodox Judaism [3] and Christianity [4, 5].

  Brain death has been ingrained in western medical practice as a necessity for expanding organ transplantation practice over the past 40 years. Brain death is a utilitarian definition of death serving society's interests in organ donation and transplantation practice. This utilitarian definition of death also transgresses the theological definition of death in Abrahamic religions.

  The most obvious question to ask is: what is next? We recommend the following changes:

  First, the Resolution of the Pan-Islamic Council Jurisprudence on Resuscitation Apparatus (1986) [6] adopted a definition of death that is similar to the Uniform Determination of Death Act (1981) in the United States [7]. Based on this Resolution the legal definition of death in Islam was changed to:

  "[A]person is pronounced legally dead and consequently, all dispositions of the Islamic law in case of death apply if one of the two following conditions has been established: (1) there is total cessation of cardiac and respiratory functions, and doctors have ruled that such cessation is irreversible; (2) there is total cessation of all cerebral functions and experienced specialized doctors have ruled that such cessation is irreversible and the brain has started to disintegrate. In this case, it is permissible to take the person off the resuscitation apparatus, even if the function of some organs e.g., heart, are still artificially maintained".[6]

  This legal definition of death must be revised in Muslim countries so that human death is acknowledged as a singular phenomenon (not two types of death). This revision is necessary because of:

  (1) Scientific evidence proves that in "brain death" [8]:

  I. Some residual brain functions are retained in organ donors.

  II. Whole brain disintegration is not present in organ donors.

  III. Some of the ceased brain functions are reversible in organ donors.

  IV. The rest of the human body does not disintegrate in brain-dead persons.

  (2) Theological evidence from the interpretation of Islamic sources [1][2].

  The Muslim Law (Shariah) Council of the United Kingdom issued a declaration equating brainstem criteria of death with human death in 1995 [9]. The Medical Ethics Committee of the Islamic Medical Association of North America (IMANA) approved irreversible cessation of whole-brain function, including that of the brainstem, for cadaveric organ donation in 2005 [10]. The Muslim Councils in the United Kingdom and North America need to reevaluate current scientific and theological evidence and revise the definition of death to conform to the singularity of the process of human death in Islam.

  Second, medical publications should not misinterpret the reluctance of Muslims and their faith leaders to accept brain death and organ donation as simply a matter of "lack of education" and "lack of knowledge" about brain death [11-22]. The presumption of ignorance among those who adhere to Islamic faith teachings is unjustified. Muslims' primary source of knowledge about life, death and the soul is The Qur'an and The Hadith. The two sources are clear on defining life and death. When organs are procured from heart-beating donors, the surgery is the procedure that ends life.

  Third, the undergraduate and postgraduate medical education curricula should not misrepresent the neurological condition of "brain death" as "human death" to make organ donation and transplantation convenient in society. The medical profession is responsible for the integrity and accuracy of information in educational materials about brain death. Recent scientific advances have shed better light on brain death as a neurological condition that belongs to a continuum of neurological disorders affecting human consciousness.

  Fourth, organ-donation websites and media campaigns should not misrepresent Islamic faith views on brain death and organ donation. The respect of religious diversity and beliefs about death and dying is a basic human right for all citizens.

  After all, truthfulness is among the most valued virtues by all religions including Islam

  Mohamed Y. Rady MD PhD FRCP (UK) FRCS (Eng) FCCM

  Professor, Department of Critical Care Medicine, Mayo Clinic, Phoenix, Arizona Adjunct Professor, Center for Biology and Society, School of Life Sciences, Arizona State University, Tempe, Arizona, USA

  Joseph L. Verheijde PhD MBA PT

  Associate Professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona

  Adjunct Professor, Center for Biology and Society, School of Life Sciences, Arizona State University, Tempe, Arizona, USA

  References

  [1] Bedir A, Aksoy S. Brain death revisited: it is not 'complete death' according to Islamic sources. J Med Ethics 2011; 37(5):290-4.

  [2] Sachedina A. Brain Death in Islamic Jurisprudence. Available from:[http://people.virginia.edu/~aas/article/article6.htm]).

  [3] The Lancet. Religion, organ transplantation, and the definition of death. Lancet 2011; 377(9762):271.

  [4] Tonti-Filippini N. Religious and Secular Death: A Parting of the Ways. Bioethics 2011[Article first published online: 24 March 2011] DOI: 10.1111/j.467-8519.2011.01882.x.

  [5] Verheijde JL, Potts M. Commentary on the Concept of Brain Death within the Catholic Bioethical Framework. Christian Bioethics 2010; 16(3):246-56.

  [6] Albar M. Islamic Ethics of Organ Transplantation and Brain Death. Saudi J Kidney Dis Transpl 1996; 7(2):109-14. Available from:[http://www.sjkdt.org/text.asp?1996/7/2/109/39509]

  [7] National Conference of Commissioners on Uniform State Laws. The Uniform Determination of Death Act 1981. 1981; Available from:[http://www.law.upenn.edu/bll/ulc/fnact99/1980s/udda80.htm].

  [8] Rady MY, Verheijde JL, McGregor JL. Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine. Resuscitation 2010; 81(9):1069-78.

  [9] Choo V. UK Shariah Council approves organ transplants. Lancet 1995; 346(8970):303.

  [10] IMANA Ethics Committee. Islamic Medical Ethics: The IMANA Perspective. JK-Practitioner: International Journal of Current Medical Science & Practice. 2005; 12(4):231-7 Available from:[http://medind.nic.in/jab/t05/i4/jabt05i4p231.pdf].

  [11] Ghorbani F, Khoddami-Vishteh HR, Ghobadi O, Shafaghi S, Rostami Louyeh A, Najafizadeh K. Causes of Family Refusal for Organ Donation. Transplant Proc 2011; 43(2):405-6.

  [12] Saudi Center for Organ Transplantation. Deceased heart beating donor and organ transplantation in Saudi Arabia. Saudi J Kidney Dis Transpl 2010; 21(2):379-83.

  [13] Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V. Religion and Organ Donation: The Views of UK Faith Leaders. 2010 Jul 9. [Epub ahead of print]. J Relig Health 201010.1007/s10943-010-9374-3 [doi].

  [14] Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V. Faith leaders united in their support for organ donation: findings from the UK organ donation taskforce study. Transpl Int 2010; 23(2):140-6.

  [15] Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V. 'Opting-in or opting-out?'--The views of the UK's faith leaders in relation to organ donation Health Policy 2010; 96(1):36-44

  [16] Mohsin N, Militsala E, Budruddin M, Al-Khawaldi H, Al-Dhuhli Y, Al-Rahbi Y, et al. Attitude of the Omani Population Toward Organ Transplantation. Transplant Proc 2010; 42(10):4305-8.

  [17] Heshmati BN, Tavakoli SAH, Mahdavi-Mazdeh M, Zahra S. Assessment of brain death of organ donors in Iran. Transpl Int 2010; 23 (5):e7 - e9.

  [18] Padela AI, Rasheed S, Warren GJW, Choi H, Mathur AK. Factors associated with positive attitudes toward organ donation in Arab Americans. Clin Transplant 2010[Published ahead of print 22 December 2010] DOI 10.1111/j.399-0012.2010.01382.x.

  [19] Oliver M, Woywodt A, Ahmed A, Saif I. Organ donation, transplantation and religion. Nephrol Dial Transplant 2011; 26(2):437-44.

  [20] Guden E, Cetinkaya F, Nacar M. Attitudes and Behaviors Regarding Organ Donation: a Study on Officials of Religion in Turkey. Journal of Religion and Health 2011[Published online 5 April 2011] DOI: 10.1007/s10943-011-9490-8.

  [21] Van Den Branden S, Broeckaert B. The ongoing charity of organ donation. Contemporary English Sunni fatwas on organ donation and blood transfusion. Bioethics 2011; 25(3):167-75.

  [22] Alghanim SA. Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Dis Transpl 2010; 21(1):23-30.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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