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.

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.

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.

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?

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?

(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 :)

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 :)

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 :)

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 :)

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.