In the picture is a booklet issued by MUIS this year entitled “Organ Transplant in Islam: The Fiqh of Organ Transplant and Its Application in Singapore”. Its content is in Malay and English, and it can be downloaded from the MUIS website. It shall henceforth be referred to as “booklet” or “the booklet”.
This entry is my take on the issue of organ transplants in Singapore as it pertains to Muslims.
Don’t ask me, ask God!
I thought we’ve all agreed that our bodies don’t belong to ourselves, that our jasad (bodies, or physical selves) are but lended to us by Allah for the period when we are are dwelling on this Earth, so that we may prepare ourselves for The Afterlife.
But now they’re conjuring the idea that we somehow have ownership over our bodies—even after our deaths—by giving us the choice to opt-out of the organ donation scheme.
It doesn’t make sense.
- If our bodies don’t belong to us, why ask us for permission or, more precisely, give us permission to opt out?
- If our bodies belong Allah instead, why not they ask Allah for permission, or ask Allah whether He wants to opt our organs out of the scheme?
Why ask us?
After all, it has been claimed, “Those who need organs have a right to receive help from the community” (booklet, p. 44, emphasis added), so, what question is there left?
Why don’t they just proceed with their eager, honourable plight?
Or: are they actively seeking our explicit permission (in the form of a “pledge”) so that they may clear themselves from any potential blame?
Give me the facts and figures!
Another thing I don’t like about this whole issue is that, in the publications that I have come across e.g. past Berita Harian articles that I’ve read, the full 2-page feature in Berita Harian today (28th July 2007), and even that orange booklet in the photo above, there is a dire lack of facts and figures given about the success rates, cost and nature of organ transplants itself.
There are, however, more of the usual “the number of donors is insufficient” accompanied by the relevant figures, and such other claims as “there had also been a vast improvement in medical knowledge which showed an increase in the success rate of organ translants” (booklet, p. 42).
By “facts and figures on organ transplantation”, I don’t just want to know that the the success rates has improved. I expect to see
- the present rates being compared to past success rates, and the extent of the improvement
- the supply of local doctors who are trained in this area
- the cost of each organ transplantation surgery
- the affordability of organ transplantation vis a vis alternative treatments
- the affordability of organ transplantation to the various income groups, especially lower income groups
I am especially keen to see the money aspect being exposed, so as to establish confidence that when they say “Fatwa seeks to safeguard the interests and welfare of the community” (p. 50), they meant the whole community.
Another perspective that probably not many see—aside from the simplistic “more organ donors = more lives saved”—is that more organ donors means more business for the transplant surgeons, whereas a scarcity of organ donors means that they would run out of business, their years of training gone to waste, and less ‘resources’ for training surgeons of the future.
That the facts and figures have not been made obvious so far seems to suggest that there has been a deliberate attempt to withhold it from the public, or less likely but still worth mentioning, the ignorance of the jurisdictors themselves about its significance and relevance.
Al-Ma’idah verse 32
The merits of organ donation has been claimed to be found in the Quran, Al-Ma’idah, verse 32:
On that account: We ordained for the Children of Israel that if any one slew a person - unless it be for murder or for spreading mischief in the land - it would be as if he slew the whole people: and if any one saved a life, it would be as if he saved the life of the whole people. Then although there came to them Our apostles with clear signs, yet, even after that, many of them continued to commit excesses in the land.
(Yusuf Ali translation; emphasis added to part quoted in the booklet, p. 38)
It has been further claimed that “There is no doubt that organ transplant is in the same category as saving a life.” (booklet, p. 38, emphasis added to the booklet’s reference to the Quranic verse).
I am sorry to say, I have doubts about that. I declare that what I am saying in the next two paragraphs is out of my own capacity i.e. my own reasoning and appreciation of the verse.
Preceding verses 27 to 31 is the story about Habil and Qabil (Cain and Abel), the story about how Qabil murdered Habil. Verse 32 begins with “On that account”, enforcing the earlier context to itself. In my copy of the translation of the Quran, verses 27 to 32 fall under a heading “Kisah pembunuhan pertama dan besarnya malapetaka akibat pembunuhan”, the rough translation of which is “The story of the first killing and the severity of the calamity resulting from murder”. In my opinion, what this seems to suggest is that “saved a life” here particularly refers to saving a life from murder or killing.
This is further corroborated by the manner in which verse 32 ends: “Then although there came to them Our apostles with clear signs, yet, even after that, many of them continued to commit excesses in the land” — the “excesses” here referring to the killing or murder of innocent people — as well as Verse 33, which continues to speak about “The punishment of those who wage war against Allah and His Messenger, and strive with might and main for mischief through the land”.
Get me some real life-saving!
But, even if you disagree with how I interpret the Quranic verse, I’m sure it’s hard to disagree with me that there are greater problems that deserve more attention.
The only useful data I can obtain from the booklet is that in Singapore, there are 500 people on the organ transplant waiting list, and 24 people die each year while waiting for a transplant. International statistics on organ transplant is scarce on the Internet, perhaps signifying the divisions among the international community about the whole issue.
What I know, however, is that:
- “1.8 million children die every year as a result of diseases caused by unclean water and poor sanitation. This amounts to around 5000 deaths a day.” (WaterAid)
- “More than 200,000 people have died in the four-year conflict in Darfur and over 2.5 million have been displaced from their homes.” (Amnesty International)
- At least 65000 civilians have been killed in the war in Iraq since 2003 (Iraq Body Count)
What happened to these? Don’t these people deserve more attention, if one is honestly concerned about “saving a life”?
I look forward to the day they take out the organs of those jurisdictors when they die.
Related:
- Singapore Muslims in donor ruling (BBC News)
14 Comments
sori bro I dun exactly agree with your point on how more organ means more income for transplant surgeon.. these surgeons do not carry out transplantatin on a daily basis 9 to 5 and 5 days a week kind of operation. transplantation is a sub-specialty of surgery, their bread and butter is still your typical operations and other many procedures if you are interested to find out abt.less organs does not mean less income for them it just means they(bear in mind they are surgeons and they do general surgey) will carry on with their routine procedures and operations while those with organ failures such as renal, heart etc hope against all hope for a second chance while their body function slowly fail and deteriotes. And seriously if you are really interested to find out the success rate and all the what nots try to turn to the web for answers, surely a man of your intelligence and speciality in computers would not have much trouble in digging out the figures. FYI most hospitals here and i mean public hospitals do publish their studies and success rates no kidding… Do read widely and understand the current situation before passing a generalised comment.
Hi Hanis, interesting perspective from you.
On my remark on the transplant surgeons, I do admit that it was a generalised comment, not backed by any hard facts whatsoever.
However, I do not think I would be wrong to say that not all doctors who do general surgery can do such a specialised, high-risk operation such as an organ transplantation, and the doctors who __can__ do it would be more experienced and relatively few. It is more of these few I am talking about, than any GS doctor. The relative scarcity of these doctors, coupled with the speciality and high risks of this procedure, leads me to also imagine (emphasise: imagine) that its cost would be higher.
To relate a personal experience, I just had a hemorrhoidectomy done in November, and the charge for the surgical procedure alone before govt subsidy was already $768. ($768 just to remove a small pile; plus 2 nights of hospitalisation and some medicines, added up to $1.4k.)
$768 just to “take out”. A transplantation is a “take out and put in someone else’s”. And the thing you “take out” is a vital organ, not a teeny-weeny growth.
From this, I imagine (emphasise: imagine) that an organ transplantation would cost much more, primarily since the procedure is so special. And, what about post-op care, i.e., all the extra consultations with the specialist doctor: they definitely don’t cost as little as a walk-in consultation for flu. And, in the case of complications, even more consultations.
But anyway, my actual point was rather simpler:
1. More organs = more transplants possible = more business (with regards to transplants).
2. Less organs = less transplants possible = less business (with regards to transplants).
At the extreme,
3. Absolutely no organs = no transplants possible = no business (with regards to transplants).
If (3) actually happened, and it can happen for discrete periods of time, of course those _transplant_ surgeons can carry on their work with such other things like hemorrhoids, but well, just no transplants. (I hope we all know that we’re talking about human organ transplants; about the other types e.g. pig to human, I don’t know.)
Again, if (3) actually happened, the situation would be quite sad for those doctors who do know how to do transplants—it’s like a writer without pen and paper, or a computer programmer without a computer, in the sense that you don’t have the resources to apply the skills you know. That is, in that narrow sense, “training gone to waste”.
I appreciate your advice for me to “read widely”. In fact, I have already gotten the figures on the success rates myself even before I wrote this piece, which was how I understood its importance. But that’s only after the tedium of using my “intelligence and speciality in computers”—if I actually had those.
However, I would like to clarify that the lack of data that I was bickering about is particular to the literature that has been targeted to the Muslim community; that was why I mentioned “Berita Harian” (twice) and “the orange booklet” as my examples—go take a look at them. After all, as I have mentioned at the very beginning, this piece is my take on the issue as it pertains to Muslims, not, um, men of intelligence or speciality in computers.
By the way, how nice it would have been if those publications I mentioned cited some data from those hospital studies you were talking about.
But alas, nothing.
In the spirit of benevolence, perhaps you might share with all of us here, the URLs to some of those hospital studies :)
I was hoping that you would take the initiative to find out abt the info yourself as it would be more satisfying rather than be told, but alas here’s a 20 min gooogle on Singapore studies
http://www.sma.org.sg/smj/3902/articles/3902a1.html
The medical cost of liver transplants in NUH does not include the doctor’s professional fees or other capital or training costs. As such, it is an underestimation of the true cost. In USA(15) and the Netherlands(16), the reported cost of liver transplants are significantly higher (US$223,000 and US$125,000 respectively). In a Royal Free study from London(17), the cost of medical care is also higher for a chronic cirrhosis patient compared to a liver transplant patient in the first 6 months (£3,795 versus £1,964). Further to this, a cost-effective study from USA suggested that liver transplant is more cost-effective than the treatment of acute leukaemia(18). Singapore’s charges are therefore reasonable and lower than the West.
http://www.sma.org.sg/smj/4707/4707e1.pdf
The future of liver transplantation in Singapore
http://www.sma.org.sg/smj/4707/4707a1.pdf
Liver transplantation in Singapore 1990-2004
FYI Iran has a very successful rate of renal transplantation due to the high number of organ donorsorgan donors… makes you wonder rite a not so well-developed country with a muslim populous could achieved so much….
Is there anyway you think our small but able muslim community able to emulate them :)
I was hoping that you would take the initiative to find the info yourself cos i believe satisfaction and joy is derived from the process of learning. But alas here it is anw a random 20 min google pardon me if can’t find more cos i’ve to catch up with my work
http://www.sma.org.sg/smj/3902/articles/3902a1.html
The medical cost of liver transplants in NUH does not include the doctor’s professional fees or other capital or training costs. As such, it is an underestimation of the true cost. In USA(15) and the Netherlands(16), the reported cost of liver transplants are significantly higher (US$223,000 and US$125,000 respectively). In a Royal Free study from London(17), the cost of medical care is also higher for a chronic cirrhosis patient compared to a liver transplant patient in the first 6 months (£3,795 versus £1,964). Further to this, a cost-effective study from USA suggested that liver transplant is more cost-effective than the treatment of acute leukaemia(18). Singapore’s charges are therefore reasonable and lower than the West.
http://www.sma.org.sg/smj/4707/4707e1.pdf
The future of liver transplantation in Singapore
http://www.sma.org.sg/smj/4707/4707a1.pdf
Liver transplantation in Singapore 1990-2004
Fyi Iran has a higher no. of organ donors and a very laudable success rate of renal transplant.. makes you wonder doesn’t it if our community can emulate them :)
I feel extremely reluctant to belabor on this but anyway, here it goes: I’ve already found the relevant information myself even before I wrote this article, and my criticism was largely targeted to the failure of the Malay press and MUIS to include that sort of information in their publications, as far as I have read.
(Whew, I shall mention no more of that.)
That said, thank you for taking your time to post all that valuable info. I am sure my readers here will find them useful in some way :)
Heehee. Its the first time I see Hanis commenting on an issue so passionately! Hahaha. In any case, just a gentle word of advise: try not to be too personal when you comment on people’s entries. Its Hirman’s opinion on this issue and if you want to debate about it, pick out the juicy bits and challenge him. It would be more fruitful exercise for both of you guys!
Heehee. I don’t have any statistics on this but I have an general opinion on this issue. Its the fact that many Malay/Muslims have conservative perspectives on this issue of Organ Transplants. To some, its the emotional trauma they have to go through when you loved one’s organs is being removed. I for one may opt out in the future (once the legislation goes through in Parliament), to respect my Mum’s wishes who adamantly refuses to allow such an act.
I can understand what Hirman is tryng to say though. That the booklet and the Berita Harian article, being devoid of the relevant facts and figures to substantiate the general issues behind Organ Transplants, is not enough to convince him of the need for Organ Transplants to include Muslims.
But just a thought - why is it only now that they want to include Muslims? Is it because of the increase in people Opting Out after the news of the families fighting over whether or not the surgeons had the right to remove the organs of their loved one? Or are there simply not enough donors that they want to increase the numbers to include the 14% of Malay/Muslims in Singapore?
Oh and yes! I love the title of your entry! Very punny I might add. Hahahaha.
hi hirman, long time no see, how are u?
Forgive me if i’m wrong, but from the booklet, it seems that they are cherrypicking verses from the Quran that serve their purpose, giving interpretations of their meanings for their own ends. Why discredit the “god owns my body” theory now?
Also, the booklet mentions that rulings in matters of Syariah can be changed to suit social conditions of the times. What about polygamy and the gender-biased distribution of assets of deceased muslims? Social conditions have no doubt changed and such outdated practices have litte relevance in society today, where in some families, the women are the (sometimes sole) breadwinners.
any thoughts?
oh, and in case you’re wondering, I was going to opt in, but it looks like i wont have to.
Yup my bad i sincerely apologize if it came out to aggresively but i felt i just had to speak out on that small part….
Btw the present system ensure that for our muslim communty, the right still lies with the patient whether he’s alive or not should he already opted out hence the surgeon will and shall not remove the organ. I admit i was as sceptic as anyone of you in this issue of transplant act however i’m thinking of opting in myself after talking to some of the people who are suffering from organ failure and looking at their predicament.
@ Libertas:
Actually, I feel that sufficient facts and figures should be included in mass publications targeted to the Malay/Muslim community so that the people can make a more informed decision on the issue. The lack of facts and figures, especially of the types that I have mentioned above, seems to suggest a lack of transparency of the relevant authorities on the issue, in an apparent rush to enlarge the pool of _potential_ donors in the shortest time possible.
Firstly, why the rush? Donating one’s organ is something new to most people, and so is, as you mentioned, the prospect of having a loved one’s organs being (I hate to use this word) harvested. The idea is itself so alien already. As such, people need time to think through it.
As far as I could follow, there were 2 khutbah Jumaat whose content was blatantly in support of Muslim organ donations, and then, as if executing a carefully planned procedure, BAM!, the MUIS declaration that Muslims can be included in HOTA.
Personally, I’m not comfortable with that. It really appears to stem out of a mantra of “do marketing, then make the sale”. There was very little time for the airing of opinions, and I was not informed of any public survey, in the spirit of seeking a fair community opinion, before the declaration was made.
Secondly, in the true spirit of charity, how can there be a system of ‘presumed permission’ that is imposed by a party other than the donor and the donee? Let’s extend this principle to another scenario, for example, A is rich, B is poor, and C _presumes_ that A upon his death donates his money to B. Who is C to do that?
Toss in religion, i.e., God G owns your body. A is the current possessor of an object O that belongs to G. B, due to a condition bequeathed by G himself, is in need of O. Upon A’s death, C presumes that B donates O to A, or worse, C claims that A has the _right_ to receive O from B. But we all know that O belongs to G, so again, who is C to say?
In a true act of charity, A would give what he has rightfully earned to B, without any third-party involvement—case closed. A will reap the rewards for his good deed, whereas B will receive A’s gift with full acknowledgement of A’s sincerity. This, no doubt, runs contrary to a system of ‘presumed permission’ that is enforced by a third party.
Thirdly, using my previous analogy, why is C so eager to intervene? Is C acting in the interest of B? If you were B, would you want to receive O from A, when O does not belong to A? Even if O _does_ belong to A, would you want to receive, in full moral conscience, O for which A has not given any explicit permission to give to you, after being given ‘permission’ from C?
If the answers to the last two questions are ‘no’, then, might C have some other vested interests in being so eager to facilitate the transaction between A and B? Would there be _any_ gain in advantage by C, and if yes, has these gains been fully elucidated to both A and B?
Iffy, iffy, iffy. Nowadays, we speak of biomedical research as being a multi-billion dollar industry. And then, just round the corner, there’s HOTA’s brother, the Medical Therapy, Education and Research Act (MTERA), which has been certified ‘halal’ as well. It is said that HOTA and MTERA complement each other. See some connection? You decide.
Whatever the decision is, I fall back to the knowledge that our bodies belong to God. It has been given to us to use, and everyone has one. In that broad sense, the ‘distribution of bodies’ is fair already. All illnesses come from God, but we must not forget that a portion of these has also been caused by our own careless actions, usually from our malconsumption of food (e.g. fatty foods, alcohol) and drugs (e.g. cigarettes, anabolic steroids).
It is also a blunt, inescapable fact that everyone’s hearts will stop beating at some point in time. Does that necessitate a heart transplant for everyone, in order to ’save their lives’? In this sense, does everyone have a right to a second heart, or a third kidney? And within a system of ‘presumed permission’? Hmm.
Serious questions aside, funny of me to say this, but I love the title too! I accidentally said it when I was talking to my brother about the issue.
@ Andee:
I am fine, alhamdulillah, thank you :) I hope you’re good too. Let’s meet together sometime, before you fly off.
Answering your question, the justification made for the change in stand is that ‘keadaan darurat menghalalkan yang haram’, in the same sense that you can eat swine when there is no other food.
The tension lies in ‘darurat’ (emergency), i.e., what is considered ‘darurat’? Let’s say a rough approximation is that a life and death situation is an emergency. Would it still be an emergency if there are other factors involved besides life and death? Would it still be an emergency if we have time to deliberate upon it, even drafting out laws regarding it? If it is a true life and death situation, why not leave the ultimate decision to the judgement call of the parties involved, in the manner that the abovementioned man has to decide for himself to finally eat the swine?
More on ‘menghalalkan yang haram’, might we one day legitimise a market distribution of organs, on the grounds that it can make the distribution more efficient? After all, the money that is raised from, for instance, a bidding system can be channeled into R&D and infrastructure that will facilitate further organ transplants, no? That’s for the ‘greater, common good of everyone’, no? Again, very iffy if that were to happen, but I wouldn’t be surprised if it does.
(’Greater, common good of everyone’: that was how the rule against allowing tudungs in schools was justified. Apparently, letting children expose their aurat was for the ‘greater, common good of everyone’.)
On the cherrypicking of verses, I have the same feeling as you that they are doing just that, but it is unfortunate that I don’t have the authority to say much with forceful certainty. In fact, I was expecting to receive a lot of flak for my interpretation of the verse above, from imams or ustazs who stumble upon my writing. Luckily, none (so far), haha.
A good thing that you mentioned about polygamy and the distribution of estate of a deceased.
On the former, although polygamy is not relevant today, I believe that the rules that allow for it are right, and if there were a situation where the rules must be applied, the rules must be observed on very strict grounds.
For example, in the past, polygamy was rightfully used to protect women, where many women were widowed by their husbands who died in wars, and women used to depend on their husbands. In the case of the Prophet (s.a.w.), some of his marriages were not consummated, but were merely symbolic gestures to establish relations between tribes. Obviously, these do not apply today, but the rules are in place if the situation should recur.
On top of that, the man must seek permission from his wife to marry a second wife (very hard), and upon entering a polygamy, the man has to shoulder the burden of ensuring that his wives are treated fairly (even harder).
On the latter, I very much agree with the mainstream view i.e. that men should receive a larger portion, on the grounds that the burden of responsibility in the Afterlife will lie heavier on men, who are heads of families. God has chosen that men be accountable for their families, and behind that there is His Wisdom.
As a general view, I think that it always appears on the surface that Islam is somewhat gender-biased, but if one takes into account and has faith in the responsibilities of each gender (as assigned in Islam) and the corresponding rewards and punishment in the Afterlife, one would find that Islam’s treatment towards both genders is balanced.
hm, interesting points. i do think, however, that we differ in some of our views. i’ve elaborated further on my blog.
http://news.bbc.co.uk/2/hi/americas/6925289.stm
A transplant surgeon in the US has been charged with attempting to hasten the death of a disabled man in order to harvest his organs.
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