From: Kamal Mubarak MD <kmubarak@magnus.acs.ohio-state.edu>
Subject: RE: Transplantation
News-Software: VAX/VMS VNEWS 1.41    
Originator: Mughal@Romeo.Caltech.Edu (Asim Mughal -Moderator)
Organization: California Institute of Technology
Date: Thu, 23 Jul 1992 08:22:00 GMT


[Postmarked: 21 Jul 92 ]


For those of you who may have lost the string of arguments let me recap. Mr
G Houseini declared that:

           The ^ulama' based on the hadith of the prophet deduced
           that it is not permissible to donate organs whether to
           a Muslim or a non-Muslim. The hadith states that to break
           the Muslim's bone when dead is like breaking it while the
           Muslim was alive.
           Now, which one of you accept to break the bone of a Muslim
           alive?! No Muslim has the permission to accept such a
              sinful dead.

and that:

           Philosophically, no person "possesses" his organs to donate
           them. Allah did not give us the permission to use our
           bodies the way we wish. We are the care takers of our bodies.
           Allah is the possesser of everything. According to His
           permission we manage the things He possesses. If someone
           claims that Allah granted human beings the right to use
           their bodies in any way, let him/her bring the proof.

I happen to disagree with this viewpoint.  In the ensuing discussion I have
been told that I  only  have  a "long list of questions wrapped in a bag of
objections and  mockery".  It  has  been implied that I may be one of those
"people who just go by their 'intellect'" and there has been  some  mention
of how Iblis just went by his "intellect" and ended in grief.

Let me state from the beginnning that I participate in  this  newsgroup not
because I know the answer, but because I do not.  I am not given to writing
long discourses on the ontological and  cosmological  significance  of  the
angels and jinns.  Nor am I given to showing the proof of how  Islam is the
perfect and ultimate religion.  Let me  also  state  very  clearly  that  I
have never intended to mock anyone's beliefs. However, if anyone feels that
his or her beliefs are being mocked by my questions, then so be it.

First, let me accept my own mistake.  I had stated:

    And  the  animal  most suited for xenograft  transplants  is  the  pig,
    because  of  the  great similarity in physiology and immunology.

Since that statement, history has been  made  in transplantation.  A  liver
from a baboon has been transplanted into a human. True, it had been thought
for a long time that pig or cow maybe more suitable, but apparently not.  I
was in Chicago last weekend and spoke to Dr Suzanne Ilstad who is a surgeon
closely involved with this first-ever baboon-to-human liver transplant. She
told me that there are preformed antibodies in all humans against  pig  and
cow tissues which have prevented this.  (No, these antibodies  don't  arise
from eating pork and beef, they are preformed.) In any case, pig trials may
still be performed and we should hear about those some time.

Before I come to points of disagreement, let me start by issues that I hope
we will all agree on.  I will then move to more controversial ones.

A.  BLOOD TRANSFUSIONS

The simplest transplant is a blood transfusion. This allows red blood cells
and other blood products from one person to be placed in another. They only
survive from weeks to months and are eventually broken down.  I hope no one
considers this unIslamic.

As an aside, before transfusing someone any blood, does one  have  to  find
out whether the person who donated the blood (say, two weeks ago) is  still
alive?  I hope no one will say that if the donor has died, then the bag  of
blood must be buried with the deceased.

B.  AUTOTRANSPLANTS

No, this does not refer to Japanese cars made in America :-).  This implies
transfer of tissue from one part of the body to another, such as moving the
thyroid glands from the neck to the forearm so that if you have to  operate
again at least you do so on the forearm and not the neck.  There  are  many
other examples such as removing a muscle from the back and  placing  it  on
an infected bone on the leg to allow it to heal the infection.  Or  cutting
away a cancer from the jaw and then using  skin  muscle  and  the  shoulder
blade to make a new jaw. (This is not science fiction.  I  have  helped  do
such operations.  This is precisely  what  reconstructive  surgery  is  all
about.)

I hope no one considers this unIslamic.

C.  LIVING-RELATED AND LIVING-UNRELATED TRANSPLANTS

This is the kind of transplant when a first-degree blood relation (such  as
a brother or a mother) or an unrelated  person (such as a husband)  donates
an organ.  This is almost always a kidney transplant.  I hope no one  would
consider this unIslamic because of any "philosophic" disagreements like "we
do not really "possess" our organs and Allah does not give us permission to
use our bodies the way we wish."

Now suppose a husband is donating one of his kidneys to his wife whose life
is impossible without dialysis.  Suppose he dies as a complication from the
surgery.  (No, this is not hypothetical, this happens.)  Do we have to take
the kidney out of the wife and bury it with the husband? I hope no one will
suggest this absurdity.

D.  CADAVERIC TRANSPLANTS

This is the term used  when  the  organs  from  a  dead person are used for
transplantation.  A typical story would run like this:

A 25-year-old male driving while intoxicated wearing no seat belt drove his
car into a tree.  He sufferred severe head injury and as a  consequence  is
brain-dead.  That is, his brain is without any blood  supply  and  activity
but the rest of his body still works.  His driver's license says DONOR  and
his family has no objections to using his organs to  save  somebody  else's
life.

If you can transplant a kidney from a live person  why  not  a dead person?
After all, according to Mr Houseini:

           The hadith states that to break
           the Muslim's bone when dead is like breaking it while the
           Muslim was alive.

And if you can transplant a kidney from a dead  person, then  why  not  the
liver, heart, pancreas, lungs, corneas, skin, tendons, bone, and  arteries.
I hope no one will raise the argument that by taking all these  organs  you
are killing a dead person!

E.  MISCELLANEOUS

Other  issues  such  as  animal  transplants, autopsies, and  fetal  tissue
research are related, but I will contain myself for the moment.

F.  THE EVIDENCE AGAINST TRANSPLANTS

Based on the above hadith Mr Houseini stated:

           Now, which one of you accept to break the bone of a Muslim
           alive?! No Muslim has the permission to accept such a
           sinful dead.

My answer to that is that I would!  For I have done so  myself!  A  typical
typical scenario may be as follows:

A 70-year-old female presents to the Emergency Room after having fallen  on
on an outstretched hand.  She has partially broken one of the bones of  her
wrist.  (A Colles' fracture for those medically inclined.)

The appropriate treatment  would  be  to  give the woman some sedatives and
painkillers  until  she  is  almost unconscious and then push the bone back
into  position. You can hear the bone crack!  It gets broken completely and
then can be realigned correctly. A plaster cast is then applied.

So many times one has to operate on bones that have healed incorrectly. One
has to break the bone and set it in correct position with plates and screws
so that the person can walk again.

So many times a fracture will not heal. One has to freshen up the edges and
then go to, say, the pelvis bone and break away pieces of perfectly  normal
bone so that these pieces of normal bone can  be  autotransplanted  to  the
fracture site to allow it to heal.  This is called bone grafting.

"Now, which one of you will accept to break the bone of a Muslim alive?!"

G. DEDUCTIONS

Mr Houseini had stated:

           The ^ulama' based on the hadith of the prophet deduced
                                                          ~~~~~~~
           that it is not permissible to donate organs whether to
           a Muslim or a non-Muslim.


This process of deduction escapes  me.  Is  this  some  process  that  mere
mortals like me can comprehend or only u'lama and the likes of Mr  Houseini
can understand it?

I will state once again.  I am ignorant of the Islamic teachings and stance
on the subject.  I am willing to provide any knowledge on this subject from
a medical point of view.  Is there anyone who will bring forth the  Islamic
perspective?

I have seen countless articles on this newsgroup arguing whether  Umar  ibn
AlKhattab (pbuh) was rightly guided or wrongly guided. I am sure this is of
a great deal of importance.  Now, will someone please tell  me  whether  my
own actions are rightly guided?

Wassalaam.

Kamal Mubarak, MD



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


Re : Abortion (MNN)

Dear Editor:

In a recent issue of MNN there was an article by Sheikh  A. M. Abdul  Akbar
which stated in no uncertain terms that abortion is unIslamic.  This  issue
has been discussed on soc.religion.islam at least twice.  My brother, Jamal
Mubarak, was involved in some of those discussions.  In his absence I  will
quote from his files:

Islam is more pro-choice than pro-life.  Of course the matter is not
as simple as that.  I was myself surprised to find this.  Rather than
say it all myself, I will simply quote.  My own comments are in curly
brackets.

Jamal Mubarak

----------------------------------------------------------------------

>From "Islam and Biological Futures--Ethics, Gender, and Technology" by
Munawar Ahmed Anees.  This is part of the "Islamic Futures and
Policy Studies" with the series editor being Ziauddin Sardar.  The book
is published in London and New York.  The London address is:

Mansell Publishing Limited
Artillery House,
Artillery Row,
London SW1P 1RT,
England

Chapter "The Inscrutable: an Excursus", page 164 onwards.  Excerpts
follow.  My own comments are in curly brackets.


"In the Muslim world abortion is not an issue, because there is little
partisan gain to be achieved.  One notable exception was the campaign
led by Jama'at Islami in the mid-1960's against the Muhammad Ayub Khan
regime's forced sterilization programme in Pakistan."

"Given these circumstances, it may be said without fear of philosophical
squabble that Islam permits abortion.  The question for Muslim women of
constitutional right to an abortion is an impertinence.  The approval of
abortion in accordance with the commands of the shari'ah makes any political
bargaining over procured abortion redundant.  The timely availability of
proper medical attention notwithstanding, this reproductive freedom enjoy-
ed by Muslim women may come as a big shock to radical feminists who hold
'legalized' abortion as one of their prime achievements."

"There is unanimous prohibition of abortion after the completion of the
fourth month of pregnancy.  Prior to the prescribed period, however,
fuqaha hold different views."

"'Classical views, as expressed by scholars of the four Sunni (orthodox)
schools and the dissident Shi'ite and Kharijite sects, on abortion before
the end of the the first four months of pregancy, fall into four basic
categories: unqualified allowance without need of an excuse; permissibility
if there is an excuse and disfavour if there is not; unqualified disfavour
in all cases; prohibition in all cases.'"

[Zayid, "Family Planning in Islam," p.9]

"According to a survey of Muslim jurists on the subject, Muhammad Salam
Madkur has observed that Hanafi scholars, such as Haskafi and Ibn Wahban,
have ruled that a woman is allowed to abort before the completion of four
months of pregnancy even without her husband's consent, although she should
have reason.  One reason often used is the existence of a nursing infant."

"The position of the Maliki school is not as lax as that of the Hanafi.
They hold that abortion should be prohibited even during the first forty
days of pregnancy, and they are unanimous in prohibiting it after ensoul-
ment.  Nonetheless, abortion at the preimplantation stage is permissible.
Al-Qurtubi, a Maliki scholar, indicates (al-Jami' li Ahkam al-Qur'an) that
it is admissible to dispose of the fertilized ovum while it is still in the
uterine tube and before it definitely assumes the form of a gastrula.  A
woman can get rid of it as long as it has not yet settled in the uterus.
He says: 'The sperm is not subject to any legal provision if it is discard-
ed by the woman after it settles in the womb.  At this stage it is as though
it were still part of the man in his loins.'

{I think there is a mistake here, it should be before rather than after.}

"Basim Mussallam {in "Sex and Society in Islam"} believes that most Maliki
jurists disapproved of abortion absolutely.  They sided with those who held
the view that the foetus is not a human being before ensoulment, but asserted
that since the predestination of the sperm, once it lodges in the uterus, is
ensoulment, it should not be trifled with: 'When the womb has retained the
semen it is not permitted for the husband and wife, or one of the them, or
the master [of the slave wife] to induce an abortion.  After ensoulment,
however, abortion is prohibited absolutely and is akin to murder.'

[See Muhammad ibn Ahmad ibn Juzaiy al-Kalbi (d. 740/1340), "Kitab al-Qawanin
al-Fiqhiyyah," Fez, Matba'at an-Nahda, 1935, p.212; vide Musallam, "Sex and
Society in Islam," pp.57-8.]

"Among Shafi'i scholars, opinions differ about the nature of the fertilized
ovum before the end of the forty days of pregnancy.  Some argue that the
zygote,
if eliminated, is not to be regarded as having been aborted or suffered
infanti-
cide, while others considered it forbidden.  Abu Bakr ibn Abi Sa'id al-Qurafi
is willing to allow forced birth in between zygote and the clot i.e., before
either of them begins to take shape as a gastrula.

"The verdict of Imam Abu Hamid Muhammad al-Ghazali ..." {Did not type this
one in.  Basically, it is that all abortions are like shades of grey.  The
sin becomes greater and greater as the pregnancy progresses.}

"Generally, the Shafi'i belief is that prohibition is inapplicable to the
pre-ensoulment period or before the end of forty days following conception.

"The Hanbali scholar, Muwaffaq ad-Din ibn Qudama al-Maqdisi (d. 620/1223),
is of the view that if a person bangs the abdomen of a pregnant woman and
causes her to abort, that person must compensate for the action.  Similarly,
a pregnant woman who aborts after using an abortive drug, must compensate for
her deed.  If abortion occurs during the gastrula phase and is attested by
the accoucheuse that it has a faint bearing of human form, then the repara-
tion would be in the form of a ghurra (indemnity).  Hanbali authors are
quite plain in cases where compensation must be made.  The Blessed Prophet
is reported to have granted a ghurra in the case of the fetus of a woman
from the clan of Hudhail.

"Commenting on the Shafi'i and the Hanbali juridical opinion on the subject,
Mussalam has observed that 'they agreed with Hanafis in their tolerance of
the practice, some putting an upper limit of 40 days for legal abortion,
others eighty days or 120 days.  The variety of legal regulations blurred
the exact religious attitude towards abortion.  Not only that, but given
the nature of Islamic Law, both Hanafi opinion [permission] and Maliki opinion
[prohibition] were deemed legitimate by all orthodox Muslims.'"

Wassalaam.

Kamal Mubarak.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I hope this solves my posting problems.  Thanks again, Asim.

Wassalaam.

Kamal Mubarak.