Government may place everyone on organ donor register
September 21st, 2007
The Government is considering placing all people on the organ donor register automatically unless they “opt out”. Currently only a quarter of Britons are on the register and the waiting list for organs is at a record high.
But a system of presumed consent – which operates in several other countries including Sweden and Austria – has proved controversial in the UK.
At present, the family has the final say unless a person has actively put themselves on the organ donor register or expressed their wishes.
The family does not have the legal right to veto or overrule those wishes even if they disagree.
Chief Medical Officer for England, Sir Liam Donaldson, backs changing the law to drive up donation rates but some critics have argued against it. Sir Liam’s Scottish counterpart, Harry Burns, has said the public is not ready for a system of presumed consent.
Today, Health Secretary Alan Johnson announced that the Organ Donation Taskforce – set up in 2006 to look at barriers to organ donation – would examine the issue in detail.
The taskforce will focus on the moral and medical issues around presumed consent, including whether the family of somebody who has died should be given the final say on organs for donation.
Mr Johnson said: “We know that around 8,000 people in the UK need an organ transplant but only 3,000 transplants are carried out each year.
“With more than 400 people dying every year waiting for a new kidney, heart, lung or liver, we need to do everything possible to increase organ donation.
“The Chief Medical Officer’s annual report helped put the idea of presumed consent into the public arena to be debated.
“This is a sensitive issue, but it is vital that all possible options for increasing the number of organs available for transplant are explored.”
Elisabeth Buggins, chair of the Organ Donation Taskforce, said: “I am very pleased that the taskforce has been asked to explore this incredibly important issue.
“We will establish a special sub group to take this work forward which will examine the complex medical, ethical, legal and societal issues.”
Earlier this year, it was revealed that the number of people waiting for organ transplant had reached a record high. UK Transplant said 7,234 patients were waiting at the end of March, up 8 per cent on the previous year.
Currently, more than 14.5 million people (around 24 per cent of the population) are on the organ donor register.
The British Medical Association (BMA) supports a system of presumed consent for organ donation for those over the age of 16, where relatives’ views are taken into account.
The Human Tissue Act 2004 states that no organs and tissue can be removed without the consent of the dead person or their relatives.
Adrian McNeil, chief executive of the Human Tissue Authority, said: “As we said in our statement in July 2007 in response to the Chief Medical Officer’s recommendation, any move to a system of presumed consent would require a change in the law.
“There would need to be extensive consultation and debate before that happened.”
[…]
The first thing that comes to mind is what are the religious implications; for example, what rules govern the 1.6 million Muslims in the UK once they are dead?
Internets say:
[…] Sheikh Ahmad Kutty, a senior lecturer and an Islamic scholar at the Islamic Institute of Toronto, Ontario, Canada, issues the following Fatwa:
“Organ donation is permitted in Islam if it is done within the permissible limits prescribed by the Shari`ah.
The following are the conditions scholars have stipulated for donation:Conditions associated with a living donor:
1. He/she must be a person who is in full possession of his/her faculties so that he/she is able to make a sound decision by himself/herself;
2. He/she must be an adult and, preferably, at least twenty-one years old;
3. It should be done on his/her own free will without any external pressure exerted on him/ her;
4. The organ he/she is donating must not be a vital organ on which his/her survival or sound health is dependent upon;
5. No transplantation of sexual organs is allowed.
Conditions associated with deceased donors:
1. It must be done after having ascertained the free consent of the donor prior to his /her death. It can be through a will to that effect, or signing the donor card, etc.
2. In a case where organ donation consent was not given prior to a donor’s death, the consent may be granted by the deceased’s closest relatives who are in a position to make such decisions on his/her behalf.
3. It must be an organ or tissue that is medically determined to be able to save the life or maintain the quality of life of another human being.
4. The organ must be removed only from the deceased person after the death has been ascertained through reliable medical procedures.
5. Organs can also be harvested from the victims of traffic accidents if their identities are unknown, but it must be done only following the valid decree of a judge.”
[…]
Hmmm and my emphasis.
The Muslim Religious Council initially rejected organ donation by followers of Islam in 1983; but it has reversed its position, provided that donors consent in writing in advance. The organs of Muslim donors must be transplanted immediately and not be stored in organ banks. According to Dr. Abdel_Rahma Osman, Director of the Muslim Community Center in Maryland, “We have no policy against organ and tissue donation as long as it is done with respect for the deceased and for the benefit of the recipient.”
[…]
and finally:
A. 5. This question is very much debated by the jurists (Fuqaha’) in recent years. It is a matter of ijtihad and some jurists consider it permissible while other prohibit organ donation and transplantation. The Supreme Council of Ulama’ in Riyadh (as per their resolution no. 99 dated 6 Dhul Qi’dah 1402) has allowed both organ donation and organ transplantation in the case of necessity (idtirar). They use the principle of Maslaha and the principle that every thing is permissible unless it is forbidden. According to these jurists, the organ can be taken from the body of a living person with his/her consent and approval and also from the body of a dead person. In the case of a living person, the jurists have stipulated that this donation should not deprive him/her of vital organs. It should also not cause risk to his/her normal life. The Fiqh Academy of the Muslim World League, Makkah also allowed organ donation and transplantation in its 8th session held between 28 Rabi’ul Thani – 7 Jumadal Ula, 1405. The Fiqh Academy of the Organization of the Islamic Conference in Jeddah during the year 1408 and the Mufti of Egypt Dr. Saeed al-Tantawi also allowed the use of the body organs of a person who has died in an accident, if the necessity requires the use of any organ to cure a patient, provided that a competent and trustworthy Muslims physician makes this decision.
It is important to note that most of the Fuqaha’ have allowed the donation of the organs only. They do not allow the sale of the human organs. Their position is that the sale of human organs violates the rules of the dignity and honor of human being and so it is haram. Some jurists suggest that because people have become too materialistic and it may not be possible to find a free organ, so under necessity one can purchase the organs, but a Muslim should never sell his/her organs.
Some Egyptian as well as Indian and Pakistani jurists do not permit organ donation or transplantation. They argue that our bodies are Allah’s trust (‘amanah) with us and we do not own our bodies. So as it is haram to commit suicide, it is also haram to give away part of one’s body. But this does not seem to be a strong argument. Allah owns every thing and every thing that we have is a trust from Allah, but Allah allowed us to use things for our benefit and to give them to others for their benefit. Suicide is a termination of life for no purpose and it is haram according to the specific rules of the Shari’ah, but organ donation or transplant is for the benefit of oneself or others and there is no rule of the Shari’ah that forbid it.
[…]
Fascinating…internets led me to this tract about sperm donation in the Middle East, starting with Israel:
This focus on the “local moral” is found in another award-winning book on the topic of IVF. Titled Reproducing Jews: A Cultural Account of Assisted Conception in Israel, this book by medical anthropologist Susan Martha Kahn (2000; see also her article in this special issue) takes us into the often arcane world of Jewish Halakhic law, where male rabbis legislate on the appropriate uses of IVF for their followers. Kahn carefully describes how these rabbinical debates and decisions affect the actual practice of Israeli IVF. For example, third-party donation of gametes, including sperm donation, is allowed, since Jewishness is seen to be conferred through the mother’s side, particularly through the act of gestating and birthing the baby. However, most conservative rabbis prefer that non-Jewish donor sperm be used, to prevent adultery between a Jewish man and a Jewish woman and to prevent future genetic incest among the offspring of anonymous donors in this small, intermarrying country. Furthermore, debates have revolved around whether surrogacy should be allowed for infertile couples, using single or married surrogates. Generally speaking, single Jewish women are preferred as surrogates, both to avoid the implications of adultery for married surrogate women and to confer Jewishness through a Jewish woman’s gestation of the fetus. Finally, because the Jewish state is pronatalist—with the state subsidizing up to six cycles of IVF or up to the birth of two IVF children for any given Jewish patient—rabbis have generally been permissive when it comes to single career women, as well as lesbian Jewish mothers, conceiving children through assisted conceptive means.
Kahn’s fascinating and frankly funny book details the sometimes dizzying rabbinical arguments regarding morally appropriate and inappropriate reproduction. In so doing, the book bespeaks the importance of local religious moralities in the contemporary world of Israeli assisted conception. There, doctors in many clinics serving orthodox Jewish patient populations attempt to practice IVF according to the moral dictates set forth by religiously conservative rabbis. The IVF laboratories in these clinics are full of orthodox women called maschigots, who literally peer over the shoulders of laboratory technicians to make sure that the correct sperm and correct eggs are being united—so as not to produce a mamzer, or an illegitimate child. In her book, Kahn is explicit in stating that the American consumer model of free-market reproductive medicine has yet to take hold in Israel, with its concern over religious guidelines. Nonetheless, Israel’s relative permissiveness over the use of donor gametes, surrogacy, and single and lesbian motherhood stands in stark contrast to the Muslim Middle East, including both neighboring Egypt and Lebanon, where I have conducted my own ethnographic research on IVF.
and now Sunni Islam:
Sunni Islam and IVF
IVF was first practiced in the Sunni Muslim world, with clinics opening in the mid-1980s in Egypt, Saudi Arabia, and Jordan, all Sunni-majority countries. The Grand Shaikh of Egypt’s famed religious university, Al Azhar, issued the first widely authoritative fatwa on medically assisted reproduction on March 23, 1980. This fatwa—issued only two years after the birth of the first IVF baby in England but a full six years before the opening of Egypt’s first IVF center—has proved to be truly enduring in all its main points (Inhorn 2006a). In fact, the basic tenets of the original Al-Azhar fatwa on IVF have been upheld by other fatwas issued since 1980 and have achieved wide acceptance throughout the Sunni Muslim world. Sunni Islam, it must be emphasized, is the dominant form of Islam found in the Middle Eastern region and throughout the Muslim world. Between 80 and 90 percent of the world’s Muslims are Sunni, and more than 90 percent of Egypt’s citizens are Sunni Muslims, the rest being predominantly Coptic Christian.The degree to which these official Sunni Islamic fatwas on IVF have affected the actual practices of the Middle Eastern medical profession is also quite striking. For physicians, the dominant Sunni religious opinion on IVF has been made known to the Middle Eastern medical community through the writings of Gamal I. Serour, one of three founding members of the first Egyptian IVF center and the director of Al-Azhar’s International Islamic Center for Population Studies and Research. In article after article (Serour 1992, 1994, 1996; Serour and Omran 1992; Serour, El Ghar, and Mansour 1990, 1991; Serour, Aboulghar, and Mansour 1995), Serour has spelled out the main points of the Sunni Islamic position on medically assisted conception, as follows:
- Artificial insemination with the husband’ssemen is allowed, and the resulting child is the legal offspring of the couple.
- In vitro fertilization of an egg from the wife with the sperm of her husband followed by the transfer of the fertilized embryo(s) back to the uterus of the wife is allowed, provided that the procedure is indicated for a medical reason and is carried out by an expert physician.
- No third party should intrude into the marital functions of sex and procreation, because marriage is a contract between the wife and husband during the span of their marriage. This means that a third party donor is not allowed, whether he or she is providing sperm, eggs, embryos, or a uterus. The use of a third party is tantamount to zina, or adultery.
- Adoption of a donor child from an illegitimate form of medically assisted conception is not allowed. The child who results from a forbidden method belongs to the mother who delivered him/her. He or she is considered to be a laqit, or an illegitimate child.
- If the marriage contract has come to an end because of divorce or death of the husband, medically assisted conception cannot be performed on the ex-wife even if the sperm comes from the former husband.
- An excess number of fertilized embryos can be preserved by cryopreservation. The frozen embryos are the property of the couple alone and may be transferred to the same wife in a successive cycle, but only during the duration of the marriage contract.
- Multifetal pregnancy reduction (or so-called selective abortion) is only allowed if the prospect of carrying a high-order pregnancy (i.e., twins, triplets, or more) to viability is very small. It is also allowed if the health or life of the mother is in jeopardy.
- All forms of surrogacy are forbidden.
- Establishment of sperm banks is strictly forbidden, for such a practice threatens the existence of the family and the “race” and should be prevented.
- The physician is the only qualified person to practice medically assisted conception in all its permitted varieties. If he performs any of the forbidden techniques, he is guilty, his earnings are forbidden, and he must be stopped from his morally illicit practice.
interesting…
and finally:
Muslim IVF patients use the term “mixture of relations” to describe this untoward outcome. Such a mixture of relations, or the literal confusion of lines of descent introduced by third-party donation, is described as being very “dangerous,” “forbidden,” “against nature,” “against God”—in a word, haram, or morally unacceptable. It is argued that donation, by allowing a “stranger to enter the family,” confuses lines of descent in patrilineal Islamic societies. For men in particular, ensuring paternity and the “purity” of lineage through “known fathers” is of paramount concern (Inhorn 2006b). As one Sunni Muslim man, a high school biology teacher, summarized the problem:
The most important thing is that we are Muslims. If there is faith in carrying out this operation using sperm from the husband and ova from the wife, then this is okay. We cannot accept what happens in the West. We heard some women “hire the womb” of another woman, or take sperm. According to our religion, this is called ikhtilat in-nasab, “mixing relations.” We consider it some kind of zina, prostitution. Because there are many hadiths from the Prophet Muhammad that confirm this. If you put your sperm in another woman besides your wife, you go to hell. This is adultery. There is a hadith on adultery. “If you put your sperm in another woman other than your wife, you are going to commit a sin.” People asked the Prophet, “How?” He said, “If you put it in your wife, you are going to be rewarded from Allah.” They said, “Yes.” He told them, “But this is also the case if you put it in the wrong womb. You are going to have punishment.”
In addition to the consequences of mixed bloodlines and adultery, bringing such donor children into the world is considered unfair to the children themselves, who would never be treated with the love and concern parents feel for their “real” children. Such a child could only be viewed as a bastard—an ibn haram, literally “son of sin.” Thus, a child of third-party donation starts life off as an “illegal” child. The child is deemed illegitimate and stigmatized even in the eyes of his or her own parents, who will therefore lack the appropriate parental sentiments (Inhorn 2006b). As one Sunni Muslim IVF patient stated
:
And so on, from PubMed
That was a major digression, but worth it.
Essentially, this goes right back to wether or not a person is the property of the state or not. When you are dead, the state is trying to confiscate your body and then use it as it sees fit. They already do everything they can to steal your property after you die, so why not steal your body also?
Like the screengrab above from THX-1138, what will happen in the end is that they will compel you to have your health actively monitored and store the results in a database (a decedent of the NIR) so that they can then harvest your body parts on demand while you are still alive or under certain conditions, i.e., if you are a freshly executed criminal.