the current practice of organ transplant in malaysia

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THE CURRENT PRACTICE OF ORGAN

TRANSPLANT IN MALAYSIA

By

Dr. Basri bin Ibrahim al-Hasani al-Azhari

Senior Lecturer,

Department of Sharicah, Faculty of Islamic Contemporary Studies

Universiti Darul Iman Malaysia (UDM),

21300 K. Terengganu, Malaysia

[email protected]

ABSTRACT

This study intends to understand the current practise of organ transplantation in Malaysia. Facts and relevant information are obtained directly from the individuals concerned such as the specialists, donors, recepients, medical centres and the Ministry of Health. Results of this research suggest that the issue of organ donation and transplantation is important to the present day Muslims and the majority of ulama agree that organ transplantation is permissible, but strict enforcement of the rules and regulations is required before it can be carried out. Their decision is based on ijtihad jama

ci. The organ transplantation practised in Malaysia is not

against the rules and regulations drafted by ulama.

KEY WORDS: organ transplantation, donors, recipients, ijtihad jamaci, regulations

mailto:[email protected]

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INTRODUCTION

Medical treatment in terms of donation and transfer of organs which is widely in practice today was not practiced during the Rasulullah’s (pbuh) time. The closest resemblance was in terms of replantation of detached organ back into its original place. As an example, Rasulullah (pbuh) once put back an eyeball of a sahabah by the name of Qatadah bin Nucman back into the eye socket, after it was yanked out while he was fighting in Badar war. The eye functioned even better than before.� Prophet Muhammad (pbuh) had also put back the arm of Micwaz bin cAfra‘ into its place after it was being cut off by the enemy as well as the arm of Habib bin Yusuf that was disconnected from the body during Badar war. These events were some of Prophet Muhammad’s (pbuh) miracles.2

The act of putting back the detached or disconnected organ back to its place is part of the organ transplantation being discussed in today’s medical scenario, though it was not set as a reference for ulama who allow organ donation and transplantation. These ulama, on the other hand, chose other aspects for their decisions.

Human organ transplantation is an issue that comes into the surface in the 20th century. The previous ulama did not debate on the issue in detail, much more to decide or conclude what are rules or law related to it. It is an issue closely associated with research result achieved by modern science study, specifically in the field of transplanting organ from one human into another human who needs it. This issue, in fact, is one of the fields covered in Ijtihad.3 In Malaysia, organ transplantation from a donor to a patient in need had already begun since 1975. However, failure to acknowledge the practice and procedure used by the medical specialist in organ transplant surgery had resulted in organ donation among Muslims still has not achieved a satisfactory level. Some ulama determined that organ donation is haraam because it inflicts physical damage and pain to the deceased.

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Among the crucial questions to be outlined in this article is what is the definition of organ transplantation, how is it practiced in Malaysia and is the practice fulfills the Organ Transplation Etiquette 1991?

The leading objective of this article is to clarify on the organ transplantation concept, its practice in medical world in Malaysia and its integration with the Organ Transplantation Act 1991.

The importance of this research is to enhance the understanding among the Muslims in Malaysia about the practice and procedure related to organ transfer from a donor to a patient performed by the medical specialists.

Analysis on organ transplantation has already existed in Malaysia in the form of paper work that was presented in Islamic Seminars and Organ Transplantation organized by the Institute of Islamic Understanding Malaysia and this paper work was compiled for community reference. There are also books that discuss the issue of organ donation and transplantation like the one produced by Muhammad Nacim Yasin, a lecturer in Islamic Studies at the University of Jordan witht the title Abhath Fiqhiyyah Li Qadaya Tibbiyah Mu

casirah (1996) and

Muhammad Nurudi al-Banjari in his book, Adillah Tahrim Naqli al-Acda’’ (1995). Nevertheless, both books only stress on the opinion of Islamic ulama in the related enigma without going deeper on the the practice and how it is executed in Malaysia.

The data collected in this research is based in the library research which involves hadeeth scriptures and fiqh muktabar as well as field research which includes interviews with the medical experts that handle organ transplant, related officers and film presentation about organ transplant surgery.

DEFINITION OF ORGAN TRANSPLANTATION

Organ transplantation is defined as replacing organ that fails to perform its function well in a patient’s body with a new organ from a donor, whether the donor

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is alive or dead (cadaveric).4 The transplant treatment is aimed at saving a patient that can only be saved with the organ transplantation surgery.

FATWAS THAT ORGAN TRANSPLANTATION IS A MUST

Fatwas that organ transplantion is a must came from Islamic ulama magnates that are world-famous, as well as muktamar and Islamic organizations in both Islamic and non-Islamic countries. Amongst the fatwas are:

1. From individual

a. al-Qaradawi.5 b. Sheikh Jad al-Haq cAliyy Jad al-Haq. 6

c. Muhammad Sayyid Tantawi. 7

e. Sheikh Ahmad cUmar Hashim. 8 f. Sheikh cAbdullah al-Mashd. 9

g. Sheikh Abu Saric cAbd al-Hadi. 10

h. Sheikh Husayn Micwad. 11

i. Sheikh Hasanayn Muhammad Makhluf. 12

j. Sheikh Hasan Ma’mun.13

k. Sheikh Huraidi 1966.

l. Sheikh Muhammad Khatir. 14

m. Sheikh Muhammad cAbd al-Latif al-Subki. 15

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2. From Islamic Conferences

a. International Islamic Conference that took place in Malaysia in 1969.16

b. The 3rd International Islamic Conference of Islamic Legislation experts (OIC) in 1986.17

c. The 4th International Islamic Conference of Islamic Legislation experts (OIC) in 1988.

d. The 6th International Islamic Conference of Islamic Legislation experts (OIC) in 1990. 18

3. From Islamic Organizations

a. Al- Jaza’ir Islamic High Council, 1972.

b. Fatwa High Council of Jordan Government, 1977.

c. Ulama Organization, Government of Saudi Arabia, 1978.

d. Kuwait’s Ministry of Religious Alms, 1980.

e. Prominent Ulama Organization, Government of Saudi Arabia, 1980.

f. Fatwa Islamic World League, 1985.

g. Fiqh Academy under Rabitah al-Alam al-Islami in the 8th conference, 1985.19

h. Shariah Islam Research Institute in west Cape Town, South Africa, 1994.

i. Islamic Shura Council in west Cape Town, 1994.

j. Muslim Judiciary Council (MJC) in west Cape Town, 1994.20

k. Ulama Organization (Kuwazulu-Natal), a Muslim Theology organization, South Africa 1994.

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l. Ulama Council South Africa, 1994. 21

m. Islamic Council Singapore (MUIS). 22

The fatwas mentioned above represents the voice of majority of the Muslim and even if it is not compulsory to practice the expressed opinion, at least it is convenient to hold on to those fatwas. Other than that, fatwa of a number of Islamic ulama magnates is safer to be observed and safer than misconception. In addition, abiding the ulama is obligatory in matters not related to vice. Allah (swt) commanded:

]_� a c�ا d�ل وأوhiaا ا��jوأ ki �ا أ�j�ا ا�l mnoiا� �pqnأ�n….3

Oh you who believe! Obey Allah, and obey the Messenger and those of you who are in authority…..

FATWA FOR ORGAN TRANSPLANTATION IN MALAYSIA

The law for organ transplantation was set in Muzakarah of the National Fatwa Committee on the 23rd and 24th June 1970. Eye and heart transplant from the deceased to the living ones is allowed in Islam with the approval of the owner/donor and after considering these factors:

a. It is in excruciating and urgent situation and the lives of the receiver solely depend on the organ transplantation and that the transplantation is believed to be successful.

b. For heart transplantation, the death of the donor must be confirmed before transferring the heart.

c. All actions deemed necessary has been taken up to ensure there would be no human murder and the trading of their organs; and

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d. Approval must be obtained from the donor before transferring any organ for normal death. For death caused by accidents, approval must be obtained from the family of the deceased. 24

THE RULES FOR ORGAN TRANSPLANTATION

The rules for organ transplantation include:

a. The illness to be treated must be clearly identified. This means if the illness is not clearly identified, then organ donation and transplantation is not allowed.

b. The side effects to the donor are fully known. Otherwise the organ transplantation may bring harm to the donor.

c. The differences between the illness to be cured and the harm such surgery may inflict are clearly and certainly known.

d. Both illness and harm cannot be eliminated simultaneously.25

e. Organ transplant is done due to exigency or excruciating needs that resulted in exigency.26

f. Organ to be donated is not for the purpose of bringing down human nobility. 27

g. The donor must be a perfect candidate or eligible to donate when the organ transplantation process and surgery is done.

h. The donor donates organ willingly.28

i. The donor has received opinions and advice from specialist doctors, that the organ donation to be done will not bring extreme harm to the donor.

j. The donor must clearly state his or her consent to donate, following the procedures set.

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k. The donor must be above the legal age to donate which either is 18 or 21 years and above.

l. The donor is confirmed to be dead if it involves cadaveric donor.

m. Must obtain approval from the family member of the deceased, if the deceased did not state clearly that his or her organ cannot be taken, after his or her death.

n. The expert must be a fair and reliable person.29

o. The expert must have all the related skills and experience.30

ORGANS ALLOWED FOR TRANSPLANTATION

Organs involve in the transplantation to the patient can be in the form of complete organ like kidney, heart, liver, and others or in the form of tissues and cells like cornea, blood, bone marrow and others. Some of these organs have direct relation with blood circulation process such as heart, liver and kidney while some others are not related at all to the blood circulation like skin. Some, on the other hand, need blood veins like a damaged cornea.31

ORGAN TRANSPLANTATION ETIQUETTE 1991

The etiquettes contain guidelines as follows:

a. Organ can be obtained from a person’s body for the purpose of organ transplantation if:

i. Any consent required by the law are followed; and

ii. There is no reason to believe that the deceased would have objected such action, if no formal consent was given during his or her lifetime.

b. The medical staff that determines the death of the future donor is not supposed to have any connection with the procedure in taking or transferring

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the organ to the patient and that staff cannot be involved in giving treatment to the recipient.

c. Organ taken for the purpose of organ transplantation is best to be from a cadaveric donor. Even though adults can donate organ while they are still alive, they must have genetic connections with the recipients. Organ can be taken from an alive, adult donor provided that the donor gives his or her consent without pressure from any parties. The donor must also has a mature mind to understand and consider the risk, benefits and effect of giving such consent. 32

d. Organ cannot be taken from under age donor for the purpose of organ transplantation. Exceptions can be made under the country’s law in the cases of tissue that can regenerate.33

e. Human body and any part of it cannot be traded. In this case too, giving or receiving payments (including any gratuity or gift) in exchange of organ is strictly prohibited.

f. Advertising the need or the availability of an organ for trading purposes should be banned.

g. Medical member or any professional staff is prohibited from getting involved in organ transplantation procedure, if they have reasons to believe that the organ is part of a transaction.

h. Any individual or facility involves in organ transplant procedure is not allowed to receive payment more than the appropriate payment for the service.

i. The concept of fairness and justice must be applied. Organ to be donated must be given to a patient on the basis of medical need and not on financial or other basis.34

THE HISTORY OF ORGAN DONATION AND TRANSPLANTATION

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Malaysia has its own history in organ donation and transplantation. Kidney transplant treatment, for instance, started in this country in December 1975 when a businessman from Sarawak received a kidney donated by his brother. The kidney still functions well until today.35 In 1975 too, kidney transplantation from a deceased donor was performed in Malaysia for the first time. Up to 1995, as much as 518 patients had undergone kidney transplantation surgery where 509 cases are from living donor with family relations with the patient and another 9 are from cadaveric donors. 36

As for kidney transplantation for kids, from 1986 to 1999, 37 surgeries were done. Of these 37 surgeries, 35 are from living donor with family relations to the patient while another 2 are from cadaveric donors.37 In March 1995, liver transplantation surgery began its course in Malaysia.38 Twenty liver transplantations were successfully performed since then. Until April 1999, 25 cases of liver transplantation were performed in this country.39 The first liver transplantation between a donor and a recipient with no blood ties was successfully carried out on 3rd of April 1999.40

The first heart transplant surgery was successfully performed in December 1997, while the second and third successful surgeries were done in 1998.41 One of the successful heart transplant surgeries is the heart transplant surgeries performed on R. Sethuragnan. He is one of the heart recipients who live as a normal individual. He suffered an acute heart disease prior to the transplant.42

The transplantation surgery was carried out by 17 doctors, including 7 specialist doctors lead by the head of Cardiothoracic Department, Yahya Awang. 43

However, lung as well as pancreas transplant surgery was never performed in Malaysia due to donor unavailability up to this point of speaking and not because of the unavailability of the expertise and the needed equipment.44 Other than that, Malaysia also has record successful transplant surgeries for some tissues such as eye cornea, bone and bone marrow.

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THE PRACTICE OF ORGAN TRANSPLANTATION IN MALAYSIA

The practice of organ transplantation in Malaysia is carried out based on opting in

law system. Future donor make a decision freely and willingly to donate and that decision is recorded in a card that has to be carried by the donor all the time. This is the base if the Tissue Act 1974 used in Malaysia. The matter is highlighted in section 2 (1) which is:

“If any person, either in writing at any time or orally in the presence of two or more witnesses during his last illness, has expressed a request that his body or any specific part of his body be used after his death for therapeutic purposes, or for purposes of medical education or research, the person lawfully in possession his body after his death may, unless he has reason to believe that the request was subsequently withdrawn, authorize the removal of the body of any part or, as the case may be, the specified part, for use in accordance with the request.” 45

Based on this system, the authority can remove organ donated by the donor, after his death at the hospital provided that the organ is suitable to be given to the patient. Anyhow, a survey performed by researchers on the National Transplant Resources Center in Kuala Lumpur Hospital (PSTN) found out that even though the donor has passed away, the hospital will not remove organ donated by the deceased straightaway, instead, the family of the deceased is informed first. If the family agrees, the hospital will then proceed to remove the organ and if the family objects, then the hospital will not proceed with such an operation.46

This shows that even though a hospital has the right to take out donated organ without further consent from the family of the deceased, in reality it does not practice organ donation system based on the principle of opting in because public education is a major focus and to avoid public fear to donate their organs. Hospital still put priority in ethics and morals rather than reinforcing the system that has become their principal.

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Malaysia does not practice opting out system because it contains an element of compulsion and related to public education.47 In opting out system, a future donor is considered agree to donate organ, if that donor did not state his objection during his lifetime. In this system, the authority has the power to remove organ if there is no proof that the donor did not agree to such operation. This system is practiced in a few countries including Singapore and European countries. In this system, the responsibility to make a choice not to donate organs lies on each individual. It may be unfair in a situation or country where the citizen has different level of education and not all citizens are provided enough information on the organ transplantation activities. However, in Malaysia, if the family willingly agrees to donate organ of the deceased family members that died in a hospital and the deceased did not state clearly that he did not want to donate his organs during his lifetime nor did any objection arise to prevent from removing the organs, and provided that the organ is in good condition, the hospital may receive the donated organ. 48

Donor Detection System

Donor detection system in Malaysia use multi hospital system which is multi production and multi transplantation. It involves territory management. Registration can be done in various hospitals in this country and this registration will be recorded in a center hospital which is Kuala Lumpur General Hospital, under PSTN monitoring.49

Hospital Detection Method

To detect an organ donor, TPM officer (managing transplantation acquisition) tasked to prepare a list of patients admitted into accident and emergency department. TPM then will check the list and identify patients with low prognosis (prediction on causes of death).50

TPM is also informed of all death at the hospital by the staff responsible of the mortuary. TPM visits all areas at the hospital to identify eligible donor

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candidate such as the ICU ward, emergency and accident ward and others. TPM is also informed by clinical staff on all brain dead cases.51

Clinical Assessments

Clinical assessments for donor organ involve, first and foremost stating clearly cause of the death. Secondly, donor habits are taken into consideration for the purpose of identifying risk that may arise. The third assessment is providing illness reasons that relate to the organ or tissue.52

This method is used to obtain good organs from the deceased who state his consent to donate organs as well as those who did not state their approval to donate organs. This shows that clinical assessment system for organ donor practiced in Malaysia is very thorough before the process of removing organ and transplanting it into a patient is performed.

Tests before Organ Transplant

To determine a suitable organ to be donated to a patient, medical expert will carry out two types of tests which are the blood test and tissue typing test. The tissue

typing test is only carried out to determine the suitability of kidney and not for other organs. To determine the suitability of other organs like heart and liver, blood test is sufficient. Future donor must have the same blood type with the future recipient. Otherwise, organ transplant process cannot be done.53

Organ Acceptance Procedures

Patients suffer from diseases related to certain organs and need organ transplantation treatment from donors must first register their names at any hospital where they receive medical treatment so that their names can be put under the recipients list. In the process of distributing organ from a donor to a recipient, the hospital will give organ to the first patient in the waiting list for organ transplantation, regardless of the patient being a Muslim or non-Muslim. If the first patient does not fit with the received organ, then the organ will be given to the

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second person in the waiting list and so on and so forth. If the donor is a Muslim while the recipient is a non-Muslim patient, the organ will still be given to the non-Muslim patient because he deserves to receive the organ based on the waiting list.

To ensure that the donor’s organ is fairly distributed to the recipient, a few principal have been used. The first principal is utility or beneficence that emphasize that any action has to give optimum benefit or at least it has to be able to avoid any harm. Based on this principal an organ will be given to a receiver with the best matching with the donor. A result of tremendous research shows that the organ will stay longer inside a patient’s body that has received an organ with a good matching. This utility principal only focuses on objective matters and it does not count in other facts such as a patient’s situation and et cetera.54

Organ Transplantation Procedures

Organ transplantation procedure begins with the donor’s body health verification and the donor’s death by specialist doctors.

1. Verification of Health and Death

Organ transplantation organ that is practiced and executed in Malaysia begins when a donor is verified to be healthy and clean from any kind of diseases, besides the transplantation will cause any harm to the donor in the future. This applies to donation that involves one side of the kidney and a small part of the liver.55 For transplant of organ involving cadaveric donor, the process started as soon as the donor is confirmed brain dead by two certified experts. The experts involve in the death confirmation of a donor must be free of any connection with the organ or tissue transplantation itself.

The death verification done by the experts are not done simultaneously. The first expert will perform check up after the donor has been dead for 6 to 8 hours. The second examination will be carried out after the first check up. For the purpose of organ transplantation treatment, organs such as heart, kidney, liver, lung and

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pancreas have to be removed while the donor’s heart is still beating with the help of a ventilator, but the brain is dead. A dead brain means a patient has passed away. Admitting the concept of brain dead is the base for organ transplantation program.56

It is very important that the brain death test is done thoroughly and it is done by doctors that have no connection with the organ transplantation planning or treating a patient that will become a donor. Even though there exists opinions that questioned the concept of brain dead, in overall most doctors accept the reality of brain dead.57

The experts who verify brain death are required not to have any connection with the organ transplantation and treatment to avoid the tendency to prioritize on certain sides. This kind of tendency is very harmful, for it dangers the live of both the patient and the receiver. When a donor is confirmed to be dead, the doctor and the patient in the waiting list for organ will be contacted as for preparations for the organ transplantation.

For that reason, a patient in the waiting list for organ transplantation is given an open flight ticket to ease the process. When organ is received by a donor, the patient is required to confirm a seat in a flight and he must come to IJN as soon as possible. Once arrived, the IJN staff will check the patient once again and then the IJN will state its approval that the respected patient is eligible to receive the newly acquired organ.58

The experts involve in the process of removing and transferring an organ typically consist of an aesthetician, 2 nurses, 2 surgeons and other related experts. In overall it normally requires 8 to 10 people altogether. The specialists groups will be divided into two groups knows as the organ retrieval group at the related hospital and organ transplant group who will standby at the operating theater together with the patient who will receive the organ.59

2. Forming Coordinator Agency

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In organ transplantation process, coordination is carried out for time saving purposes. Coordination exists in all organ transplantation processes. Each and every hospital is instructed to coordinate to ensure smooth operation of organ transplantation. If a patient who passed away is an organ donor and his relatives agree to donate the deceased organ after being informed by the hospital staff, the hospital where the deceased had been treated will inform the coordinator center about the organs that can be used, including heart. Specialists for each organ will come to verify that all organs are in good condition. Usually the criteria related to organs and donor’s medical record will be compiled by the hospital that provides the treatment.60

In heart transplantation, for instance, the heart will only be used if the criteria of the disease suffered by a patient matched with the criteria of the donor. The waiting patient is required to stay at the hospital area in 4 hours.61

In liver transplantation, coordinator team is also needed as in heart transplantation. The specialist doctors groups will be divided into two groups. One group focuses on the tasks required to preserve the organ after it was removed from a body. The organ will be brought to the operating theater in shortest time possible to be implanted into the recipient’s body.

Surgeons will determine which part to be removed. Once identified, these experts will carefully cut 20% of the part without disturbing other parts. Removing part of a liver does not affect other part because the liver parts consist of their own nerves.62 The wound caused by such surgery does not require treatment like the treatment needed for a wound on the outer part of the body. The liver will heal itself and will be back to normal after a few weeks. This is due to a liver is capable of renewing itself and the removed part will regenerate, even though the size may not be the same as the original size prior to surgery. After the liver grows to its original state, the donor is free from any harmful risk.63 Coordinators are also needed in kidney transplantation as well as other organs transplantation.

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3. Organ Delivery

While the doctors and medical specialists group performs the surgery to remove an organ, the receiving patient and the related specialists are already in standby position in the operating theater. Organ obtained will be sent by a specific coordinator as soon as possible to the hospital where the patient is waiting to enable prompt surgery for organ transplantation. This delivery is done using hospital transportation or sometime using helicopter, in distant location case. The removed organ will be kept in a special box that is filled with ice to prevent the organ from being damaged.64

A heart, for example will be kept in a plastic bag with a specific medicine to prevent it from being damaged by germs attack. Air is pumped out of the plastic bag and the box will be filled with ice to ensure that the heart is in an extremely cold level.65 The organ delivery time depends on the place on where the organ is obtained. If the organ is from a nearby hospital, it may take 10 to 15 minutes but if the organ is from far away, it may take 45 minutes or more.

4. Duration of Organ Transplantation

The long and the short of an organ transplantation surgery performed by the surgeons really depend on the type of organ being transplanted. The longest organ transplant surgery is the transplantation involving liver. The surgery typically consume between 12 to 18 hours.66

This is due to the fact that liver transplantation involves more complicated procedures compared to heart transplantation. Liver transplantation is even more complicated if it involves a live donor. On the other hand, heart transplantation surgery takes about 4 hours and kidney transplantation surgery takes about 1 to 1 ½ hours to be transferred into the needing patient.

According to Yahya Awang, a fairly complicated heart transplantation surgery sometimes can take up to 6 hours as was the case of Aizai Awang Abd Rahman, a

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surgeon at IJN. In tissue transplantation, the time consumed is entirely different than those of organ transplantation because tissue can be kept for a long time.67

5. The Process of Organ Transplantation

Organ and tissue transplantation process is a clean and sterile surgery. Surgery is performed in an operating theater by experienced surgeons. Acquisition of organ or tissue from a deceased donor will not affect the face and body form of the deceased donor.68

The same applies to a donor who is alive. Researchers had watched the original video on organ transplantation performed on Wan Mohd Hafizam. The surgery was performed in an extremely delicate manner in a special room in Subang Jaya Medical Center by skilled specialists. The surgery did not harm the donor and did not change his physical form. The body part being cut open in the surgery was the body part opposite to his heart. Other parts were not touched.69

Recipient’s organ that has failed to function is taken out. Before the heart is taken out however, the patient’s body is connected to a ventilator machine, a machine mechanically designed to help breathing mechanism, while waiting for the new heart from a donor arrives. After the original heart is removed, a new heart is connected at the exact same place where the old heart was previously connected to.70

The left heart vessel is the first part to be sutured followed by the right heart vessel and then other related parts. In a kidney transplant surgery, the first part to be sutured is its blood vessel.71

Upon completion of the stitching, the ventilator machine which acts as the temporary heart is switched off. After that the new heart will start beating as normal. The surgical wound is given a special medicine. The recipient’s chest cavity is closed and stitched and the patient will be transferred to the ICU ward.72

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In liver transplantation, the part taken is the left side because it poses less risk to the donor. The amount taken is 20%.73

In kidney surgical transplant, the original kidney of the patient is not removed because its existence is not detrimental to the patient. This original kidney will contract by itself. A new kidney is attached next to the failed kidney. In addition, if the failed kidney is removed, it will take longer time for a patient to recover from such surgery.74

Usually, the kidney transplant surgery only switches the blood vessel from old kidney to the new one. For a patient who suffers failure of both kidneys, he will only receive one kidney from a donor and it is up to specialist doctors to decide whether to place the new kidney on the left side or right side.75

After organ was removed, the body of a deceased donor will be cleaned. Each organ such as heart, liver and kidney is taken by its own specialist group. They did not remove the organs simultaneously. Instead, it is done by turn. For instance, after the heart was removed, liver was removed followed by kidney.76

In short these experts work hand in hand with each other when taking the organs. Time is monitored to avoid damaging the organs especially if the donor donates all organs or tissues of his body. The team that removes the organ is not involved with the team that implants the organ into a patient’s body.77

Their function is solely to remove organ. The same applies for the team that performs the implant; they only involve in the implantation and have nothing to do with the team that removes organ.

6. Rehabilitation Treatment

After receiving a new organ, the patient is required to be in the Intensive Care Unit (ICU) ward for 1 or 2 days. After that, the patient will be removed to normal ward for 1 or 2 weeks. At the end of this period, the patient is allowed to go home. A patient must undergo post-surgery rehabilitation or follow-up treatment. The

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treatment can be divided into two types; specific rehabilitation treatment and general rehabilitation treatment.78

Specific rehabilitation treatment involves a medicine called immunosuppressant. This medicine acts as a defend mechanism from a patient’s antibody towards the newly received organ. This is due to the fact that even though the donor and the patient are of the same blood type, organ rejection still can occur either when the heart rejects the patient’s body or the patient’s body rejects the heart. Immunosuppressant is given to control rejection so both sides can accept the existence of each other.79

Other than that there is also general follow-up treatment in terms of weekly, biweekly, bimonthly, and so on and so forth schedule. Tissue sample is taken to monitor the development of the received organ such as heart and as research material to detect should any rejection occurs. If rejection still occurs, the treating doctor will increase the dosage of the medicine or modify the medicine to stop the rejection.80

7. Post Organ Transplantation Surgery

After an organ or a tissue is acquired, the surgical wound will be sutured flawlessly and the body of the deceased donor will not have any physical deformity. The hospital guarantees that the whole organ transplantation process is done in fully respectable and the best manner as in other normal surgeries performed on living patients.81

8. Rejection Upon the Received Organ

It was highlighted above in rehabilitation treatment about the patient’s need to a medicine that defends from antibody attack or immunosuppressant to prevent rejection on the newly received organ. This is due to the undeniable fact that there is a probability of organ transplantation failure when the patient’s body tries to reject the organ it just received.

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The recipient’s body can recognize that the new organ is a foreign organ. To tackle this rejection problem, a patient usually will be given to weaken the rejection, among them are immunosuppressant. Most rejection cases can be treated successfully.82

In addition to taking the prescribed medicine, a patient is also advised to avoid from consuming high cholesterol food and to stop smoking habit.83

The usage of immunosuppressant may prolong the life of a patient who suffers organ failure at critical stage. Indeed, with the use of this medicine, organ transplantation achieves prominent success in today’s modern medical world. Today there exist new type of agents that strengthen immunity such as cyclosporine and rapamycin. The combination of these two immunity strengthener agents has successfully reduced rejection cases at the rate of 85-90%.84

9. The Success of Organ Transplantation

The success percentage relies on the procedures of the performed surgery. If the transplantation surgery is done correctly, it will result in excellent success without any negative impact. Rejection towards the newly received organ can be tackled as explained above. The success of organ transplantation in Malaysia so far has achieved more than 90% level. Transplantation of heart, kidney and liver are great success that can be proud of.85

According to Abu Bakar Sulaiman, in 1980s the decision to kidney transplantation treatment increased significantly as a result of a new medicine that successfully refrain human body from rejecting the new organ. Besides, research shows that in reality, the lives of the patient who receive new kidneys are better than those patients who undergo dialysis86 which usually involve high cost and barely affordable for the poor.

10. Cost of Surgery

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The cost of surgery is very expensive and is different from one organ to another. For a kidney transplantation surgery which takes 4 hours, the cost is RM26000 at the government hospital.87 For one heart transplantation surgery starting from acquiring the heart to implanting it inside a patient’s body, the cost is in between RM100000 to RM110000. The payment of surgery cost is born by IJN. The patient is asked to pay based on only what they can afford.88

Anyhow organ transplantation cost in Malaysia is still relatively low which is in between RM150000 to RM200000 for the first time and RM40000 to RM50000 for subsequent surgeries. From 1992 to 1997, the Malaysian health authority allocated RM309 million to bear the cost for 187,836 patients who cannot afford to pay the treatment cost in IJN.89

11. Handling of the Deceased

Organ transplantation does not affect handling of remains of the deceased and the burial process. The burial process can be done as normal. After organs and tissues are acquired from the donor’s body, the remains will be washed, wrapped and then returned to the donor’s relative as soon as possible. The process of acquiring the organs does not interfere with the burial procedures such as paying respect to the deceased.90

Example of Successful Organ Transplantation

An example of the success of organ transplantation performed in Malaysia is the case of kidney transplantation to a patient named Ahmad Kamal Mohd Noor, a 39-year-old grocery shop owner, who received a kidney donated by a 43-year-old gentleman. The true identity of the man is not known because it is hospital’s confidential. Ahmad Kamal actually suffered from a chronic kidney failure. The disease weakened him and he lost many job opportunities including offers for a military course and a skill course. All of these offers had to be rejected by him because of the illness he suffered.

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The disease had also taken its toll on Ahmad Kamal relationship when he had to break up his engagement because he did not want other people to share his sufferings. Ahmad Kamal was confirmed to suffer kidney disease in 1980 after both of his kidneys failed. He faced frequent urinary infection disease, had no energy and had to lay down all the time. Things got worse when he was also confirmed to suffer high blood pressure and bones TB disease. The condition caused him to be under unconscious state until he had to be admitted into the Intensive Care Unit (ICU).

The specialist who treated him told him that his chance to live is short and that it’s just his time to die. In effort to cure his illness, he had to undergo 27 operations. His mother, Ms Rokiah Mat Jahrah donated one side of the kidney to him, but it was later found out that that kidney was not suitable for Ahmad Kamal’s body, causing him to face many difficulties and his suffering got worse until he was unable to live a normal life. He could not urinate and his body became swollen and fat.

A year later, he was informed that there was a donor from a 43-year-old guy. The donated kidney, however, had to be frozen first because it came from Ipoh hospital while Ahmad Kamal at that time was in Kuala Lumpur Hospital (HKL).

The kidney transplant surgical technique performed on Ahmad Kamal was the first of its kind performed in HKL. It costs RM100000. After the surgery, he was able to lead a normal life like other people without having to rely on the dialysis machine to remove toxic substances from his blood. The surgery performed on Ahmad Kamal was carried out in 1989, 9 years after he was diagnosed with kidney failure on both kidneys. After the surgery he got married and was blessed with one child.91

SUMMARY

Organ transplantation is defined as removing certain organs such as heart, liver, kidney and such that is donated by a donor and placing or planting it into a needing

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patient. The organ transplantation practice in Malaysia is done very carefully and because of this carefulness, until today the authority has never reported any case of organ abuse or organ mishandling caused by careless medical specialist. The practice of organ transplantation conforms to the rule outlined in Organ Transplantation Etiquette 1991 produced by World Health Organization.

Based on explanation from three specialists; Mohd Zaki Morad Zaher and Harjit Singh from Kuala Lumpur Hospital and Yahya Awang from IJN, it is undeniable that all rules related to organ transplantation from either alive or cadaveric donor outlined in Organ Transplantation Etiquette 1991 is in practice. However, to ensure one hundred percent success in organ transplantation donated by donor is impossible. All three specialists consulted by the researcher made it clear that at most, the only thing they can do is to assume that organ transplantation will be successful based on past experience. Apparently, these specialists are doing their best but the success depends on Allah (swt), truly. If it is strongly believed that the organ transplantation will danger the lives of the donor and the patient, the transplantation will not be recommended because it will not only affect the organ donor but also the organ transplantation field itself in Malaysia.92 For a living donor without blood ties with a patient is required to pass the etiquette, medical and psychiatric criteria when making decision to donate organ.

Almost all rules outlined in Islam are adhered to. Only two aspects are not practiced by the authority, firstly, for the doctors involved in the transplantation, priority must be given for Muslim doctors and secondly, if an organ is received from a Muslim donor, a Muslim recipient should be given the priority. These requirements are not complied because the Malaysian authority is tied with the organ transplantation principal set in 1991 by the World Health Organization. In all 9 principals of organ transplantation being discussed, it is not clearly stated about the impact of organ transplantation from religious view. In other words it is not mentioned that only Muslim doctors can handle organ transplantation of a Muslim while non-Muslim doctors are not allowed to perform such operation. There is also

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no statement that states believers of other religions are not allowed to donate or receive organs if they are of different religious beliefs.

The involvement of non-Muslim doctors in treating Muslim patients in the issue of organ transplantation however, is allowed by certain ulama such as Hanafi, 93 al-Shafici94 dan Hanbali95 in a chronicle. This group reasoned, among others, that getting treatment from non-Muslim is just worldly matter and hence it is allowed. This is the same case as Muslims are allowed to live in a house, purchase clothes and use weapons produced by non-Muslim and engage in daily activities with them. The Messenger (pbuh) had once dealt with the Jews community from Khaybar clan. The Messenger (pbuh) had once rented a navigator and entrusted His life and possessions to the navigator when he migrated to Madinah.96 Al-Quran also acknowledged that among the musyrik (polytheist) and ahl al-Kitab (Christians and Jews), there exist people who are reliable and thus it is allowed to engage in matters with them. Allah (swt) said:

n�� k��ر �� n{د|} c� إن m ]p� ��ر n{د|} إ�� و� k� c� إن m و m أه� ا�_��ب

�� k�� د �i97....إ�� إ�

“Among the People of the Book are some who, if entrusted with a hoard of gold, will (readily) pay it back; others, who, if entrusted with a single silver coin, will not repay it unless thou constantly stoodest demanding,…”

Allah (swt) said:

آ[ d� ا��|mnإ��p�n ��iآ[�� mnoiا� m� ki 98. … ا�

“Allah only forbids you, with regard to those who fight you for (your) Faith,…”

These A’yah explains the consent to give gifts to the non-Muslim whether that person is related by family ties or not. The Messenger (pbuh) used to receive gifts from a few musyrik. 99

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According to Sheikh Jād al-Haq, receiving treatment from non-Muslim doctors is allowed even though in the existence of Muslim doctors because the aspect being considered is not religious aspect but the skills possessed by that doctors. Non-Muslim doctors are not inferior in terms of skills compared to Muslim doctors.100 In fact, some non-Muslim doctors have higher skills compared to Muslim doctors. Sheikh Jād al-Haq statement carries the meaning that in organ transplantation operation, not only it can be done by Muslim doctors, it can also be done by non-Muslim doctors because it does not related to ibadah matters. The important thing is to have high skills and wide experience.

So far the Malaysian authority sticks to the principal that can bring benefits not only to the Muslim citizens but also to the non-Muslim citizens. This matter does not contradict with the holy Islamic teaching because in Islam, performing deeds is not limited to Muslims only. Non-Muslims should also receive the same treatment.

It is admitted that if there is a Muslim organ donor, priority should be given to a Muslim patient also to receive that donated organ. However, if the patient in the waiting list is not a Muslim, it is not reasonable to let that patient suffer until he dies just for the sake of getting a Muslim patient even though that Muslim patient maybe in the 10th person in the waiting list. This means violating the person who should be given priority based on the list. Islam never teaches its followers to ignore a person, even if he is not a Muslim, to die just like that without proper treatment. Islam instructed its followers to be fair not only among the Muslims but also for the non-Muslims. Allah (swt) said:

�i_[ ��ن �م �� أ� a�n و� ��p� ki�اء �� m� �ا آ�ا �iاl mnoiا� �pqnأ�n �ىi� ��.. ��ا ا��ا ه أa�ب �

“O you who believe! Stand out firmly for Allâh and be just witnesses and let not the enmity and hatred of others make you avoid justice. Be just: that is nearer to piety,…”

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The principal of giving priority among the Muslims is not a principal that is fixed and not unchanged, even more in emergency situation. Furthermore there are Muslim patients in this country who received organ from non-Muslim donors because the patients were on the top list of patients who need organ transplantation. If by priority, the organ should be given to a patient of the same religious belief. If there is none, then it can be given to a Muslim patient. Truthfully, priority is given to Muslim doctors if organ transplantation is from a

Muslim donor to a Muslim recipient. If the donor is a Muslim, it is more suitable

to be related to a condition where the doctors involve have freedom to do so.

The authority in Malaysia and other Islam countries abide to the rules stated in the organ transplantation principal that was set by the World Health Organization.

In Malaysia, after all the needed organs and tissue were taken, the remains will be returned to the relatives after being cleaned from all trace of surgery and it does not interfere with the handling of the deceased at all. A donor who wishes to pull back his intention to donate organ is not considered as a crime, even though such an act is quite unethical. In Malaysia organ transplantation process is carried out not only in the government hospitals but also private hospitals that possessed the expertise.

It is hoped that this explanation will enhance the understanding among the Muslim about the practice and procedures of organ transplantation in Malaysia and it is hoped that organ transplantation for the purpose of helping the needing patients will increase in terms of the number of donors in the future.

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1 Muhammad Yusuf al-Kandahlawi, Hayah al-Sahabah, Dar al-Qalam, Dimashq, 1987M, vol. 3, p. 555.

Ahmad bin Muhammad al-Qastalani, Khususiyat al-Rasul, Majlis Ihya’ al-Kutub al-Turath al-Islami, al-Qahirah, 1996M, ed. 3, p. 28. 2 Ahmad Shihab al-Din al-Khaffaji, Nasim al-Riyad Fi Sharh al-Shifa’ al-Qadi

cIyad, Dar al-Fikr, n.d.

vol. 3, p. 111. Abu al-Fadl cIyad bin Musa bin cIyad al-Yahsubi, al-Shifa’ Bi Tacaruf Haqa’iq al-Mustafa,

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82. Sacid Hawa, al-Asas Fi al-Sunnah Wa Fiqhuha, al-Sirah al-Nabawiyyah, Dar al-Salam, Cairo, 1989M, vol. 4, ed.1. 1, p. 2036. 3 Ijtihad membawa maksud mencurah segala daya fikiran untuk mengetahui hukum-hukum syarak. ( Sacdi Abu Jayb, al-Qamus al-Fiqhi, Dar al-Fikri, Dimashq, 1988, ed.2. p. 71 ) 4 Muhammad Ali al-Bar, al-Tabib Adabuhu Wa Fiqqhuhu, Dar al-Qalam, Kuwait, 1993, p. 208. 5 Yusuf al-Qaradawi, Fatawa Mu

casirah, Dar al-Wafa’, al-Mansurah, Cairo, 1993, vol. 2, pp. 532-537.

6 Jad al-Haq, al-Fiqh al-Islami, Murunatuhu Wa Tatawwuruhu, Majmac Buhuth al-Islamiyyah, 1989, pp. 233, 247 and 248. 7 Akhbar al-Liwa’ al-Islami, 25 Shacban 1408H, p. 5. 8 Akhbar al-Liwa’ al-Islami, 7 Jamadil Akhir 1407, p. 5. Akhbar al-Liwa’ al-Islami, 20 Jamadil Akhir, 1410, p. 14. 9 Akhbar al-Nur, 21 Safar 1408, p. 1. 10 Akhbar al-Liwa’ al-Islami, 19 Rabicu Awwal 1409, p. 8. 11 Akhbar al-Liwa’ al-Islami, 23 Rajab 1406, p. 4. 12 Hasanayn Muhammad Makhluf, Fatawa Sharciyyah, Dar al-Ictisam, Cairo, n.d. pp. 35 and 37 .

13 Muhammad cAli al-Bar, Islamic Views On Organ Tranplant, Paper Work Islam And Organ Transplant Seminar, Kuala Lumpur, IKIM, 20&30 Oktober 1996, p. 6. 14 Ibid. 15 Muhammad Rajab al-Bayyumi, Qadaya Islamiyyah, Munaqashat Wa Rudud, Dar al-Wafa’, Cairo, 1985, p. 154. 16 al-Bar, op.cit., p. 6. 17 Ibid. 18 Ibid. 19 Muhammad cAli al-Bar, al-Mawqif al-Fiqhi al-Akhlaqi Min Qadiyyah Zar

ci al-A

cda’, Dar al-Qalam.

Dimashq, 1414H, p. 168. 20 Shabir Ahmad Wadee, Organ Transplantation And The Shariah ( Islamic Law ) A South African

Perspective, Paper Work International Seminar On Organ Transplantation And Health Care Management From Islamic Perspective, Yarsi Universiti, Jakarta,29-30 July 1996, p. 7. 21 Ibid. p. 8 . 22 Hukum Pendermaan Ginjal, Warita Kita, Majlis Ugama Islam Singapura, Julai /Ogos, 2000, pp.8-9.

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23 al-Quran, al-Nisa’ : 59 24 Himpunan Fatwa Kebangsaan Malaysia ( 1970 an hingga 1990 an ) Bahagian Penyelidikan, Jabatan Kemajuan Islam Malaysia, n.d, p. 35. 25 Muhammad Nacim Yasin, Abhath Fiqhiyyah Fi Qadaya Tibiyyah Mu

casirah, Dar al-Nafa’is, Jordan,

1996, p. 160. 26 Ibid. 27 Shawqi Abduh al-Sahi, al-Fikr al-Islami Wa al-Qadaya al-Tibbiyyah al-Mu

casirah, Maktabah al-

Nahdah al-Misriyyah, Cairo, p. 205. 28 Ibid., p. hlm. 204. Hajjah Zainab bt. Othman, Pemindahan Organ Manusia, Jurnal Penyelidikan Islam, Jabatan Kemajuan Islam Malaysia, bil. 11 1998/1419H, p. 65. 29 Wahbah al-Zuhaili, Nazariyyah al-Darurah al-Shar

ciyyah Muqaranah Ma

ca al-Qanun al-Wad

ci, Dar

al-Fikr al-Mucasir, Beirut, 1997, p. 76. 30 Jad al-Haq, op.cit. p. 431. 31 al-Bar, op.cit., p. 209.

32 The World Health Organisation’s, Nine Guiding Principles On Human Organ Transplantation, Malaysian Transplantation News, Malaysian Society Transplantation, September 1997, p. 2. Legislative Responses To Organ Transplantation, Martinus Nijhoff Publishers, Netherland, 1994, pp. 473-474. 33 Ibid. 34 Malaysian Transplantation News, p. 2. Legislative Responses To Organ Transplantion, pp. 473-474.

35 Zaki Morad Zaher, Rawatan Bagi Kegagalan Pemindahan Organ Dan Isu-isu Berkaitan, Paper Work Islam And Organ Transplant Seminar, Kuala Lumpur, IKIM, 20&30 Oktober 1996, p. 5. 36 Fokus, al-Islam, January 1995, p. 10. 37 Lim Yam Ngo, Progress In Transplantation In Malaysia: Paediatric Renal Transplant, In. Progress In

Tranplantation, Malaysian Society Transplantation, 4th Annual Scientific Meeting, Grands Season Hotel, Kuala Lumpur, 30& 31 Oktober 1999, p. 13. 38 Lim Yam Ngo, Progress In Transplantation In Malaysia: Paediatric Renal Transplant, In. Progress In

Tranplantation, Malaysian Society Transplantation, 4th Annual Scientific Meeting, Grands Season Hotel, Kuala Lumpur, 30& 31 Oktober 1999, p. 13. 39 Abu Bakar Abdul Majeed, Organ Transplantation On Islamic Perspective. IKIM Journal, July/Dicember 1996, p. 41. 40 Sirosis Berlaku Apabila Sel-sel hati Rosak, Mingguan Malaysia, 25 April 1999, p.25. 41 Abu Bakar Abdul Majeed, op.cit., p. 41. 42 IJN Memerlukan Ramai Penderma Jantung Ramai Pesakit Mati Menunggu, Mingguan Malaysia, 7 Mac 1999, p. 20. 43 2200 Tisu, Organ Manusia Diperlu Untuk Pembedahan, Berita Harian, 11 Febuari 1998, p. 4. 44 Yahya Awang, Department of Cardiotorasic, National Heart Institute, Kuala Lumpur, Recorded Interview, 9 July 1999, 3.30 pm. 45 Laws of Malaysia, Act 130 Human Tissues Act 1974, The Commissioner of Law Revision, 1995, p. 5. 46 Zamki bin Abdullah, National Transplant Resource Center, Kuala Lumpur, Recorded Interview, 18 May 1999, 11.00 am. 47 Malaysian Transplantation News, Malaysian Society of Transplantation, September 1997,p. 4. 48 Zamki bin Abullah, op.cit. 49 Ibid.


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50 C C Tan dan Doktor M Cardosa, Detection, Indentification And Selection of Donors, Malaysian Transplantation News, Malaysian Transplantation Society, September 1997, p. 3 51 Ibid. 52 Ibid. 53 Dewan Kosmik, May, 1999, p. 12. 54 Abu Bakar Sulaiman, Prosedur Etika Dalam Pemindahan Organ, Paper Work Islam And Organ Transplant Seminar, Kuala Lumpur, IKIM, 20&30 Oktober 1996, p. 6. 55 Yahya Awang, op.cit. 56 Dewan Kosmik, May 1999, p. 11. 57 Abu Bakar Sulaiman, op.cit., p. 6. 58 Yahya Awang, op.cit. 59 Aizai Awang Abd Rahman, Department of Cardiology, National heart Institute, Recorded Interview, 13 September 1999, 10.30 am. 60 Muhammad Fauzi Yunus, Pemindahan Jantung Kejar Waktu, Media Kesihatan, September/Oktober 1998, p. 14. 61 Ibid, p. 15. 62 Hati Organ Hidup, Ibubapa, July 1999, p. 27. 63 Ibid. 64Yahya bin Awang, op.cit. 65 Ibid.

66 Ibid. 67 Ibid. 68 Dewan Kosmik, May 1999, p. 12. 69 Wan Mohd Hafizam bin Wan Ismail, Video Presentation On Lever Surgery, Universiti of Malaya Information Center, Kuala Lumpur, 9 March 2000, 10.00 am. 70 Yahya bin Awang, op.cit. 71 Ahmad Salehuddin, operation teater 0T 7, Malaysian National University Hospital, Kuala Lumpur, recorded Interview, 9 March 2000, 10.00 am. 72 Yahya bin Awang, op.cit.

73 Wan Mohd Hafizam bin Wan Ismail, Universiti of Malaya Informatioan Center, Recorded Interview, 25 February 2000, 8.30 am. 74 Wan Azman bin Wan Ismail, Department of Cardiology, Universiti Hospital Kuala Lumpur, Recorded Interview, 17 April 2000, 4.30 pm. 75 Ibid. 76 Aizai Awang Abd Rahman, op.cit.

77 Ibid. 78 Muhammad Fauzi Yunus, p. 15. 79 Ibid. 80 Ibid.

81 Dewan Kosmik, May 1999, p. 12. 82 Ibid. 83 Najibah Hasan, Pemindahan Jantung Bantu Menyelamatkan Nyawa, Mingguan Malaysia. 10 January 1999, p. 17.


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84S. Y. Tan, New Immunosuppresion Agents, In. Progress In Transplantation, Malaysian Society of Transplantation, 4 th Annual Scientific Meeting, Grand Seasons Hotel, Kuala Lumpur, 30&31 Oktober 1999, p. 23. 85 Malaysian Transplantation News, Malaysian Society of Transplantation, p. 4. 86 Abu Bakar Sulaiman, op.cit., 3. 87 Mohd Zaki Morad Zaher, Deparment of Nefrology, Kuala Lumpur Hospital, Recorded Interview, 10 July 1999, 3.00 pm. 88 Yahya bin Awang, op.cit.

89 2,200 Tisu Dan Organ Manusia Diperlu Untuk Pembedahan, Berita Harian, 11 Febuari 1998, p. 4. 90 Zamki bin Abullah, op.cit. 91 Nurul Adlina Kamarudin, Derma Organ Masih Asing Di Malaysia, Berita Minggu, 5 January 1998, p.

12. 92 Yahya bin Awang, op.cit. Mohd Zaki Morad Zaher, op.cit. Harjit Singh, Endoscopy Room, Kuala Lumpur Hospital, Recorded Interview, 8 September 1999, 10.00 am.

93 Muhammad Amin Ibn cAbidin, Hashiyah Ibn Abidin, vol. 2, Dar Ihya’ al-Turath al-cArabi, Beirut, 1984, p. 166. 94 Shihab al-Din Ahmad Qalyubi, Hashiyatan

cAla Minhaj al-Talibin, Dar al-Fikr, Beirut, vol. 3, n.d. p.

212. ibn Hajar al-cAsqalani, Fath al-Bari, Dar al-Matbacah al-Salafiyyah, Cairo, 1407H, vol. 10, p. 207. 95 Abu Muhammad Ibn Muflih, al-Furu

c, cAlam al-Kutub, Beirut, n.d,. vol. 2, pp. 462 and 479. 96 Ali Muhammad Yusuf al-Muhamadi, Hukm al-Tadawi Fi al-Islam, Majallah Fiqh al-Islami, Jeddah,

1992, p. 619. 97 al-Quran, Ali cImran : 75.

98 al-Quran, al-Mumtahanah : 9 99 Ibrahīm Muhammad al-Jamal, Fiqh al-Muslim

cAla al-Mazahib al-Arba

cah, Dar al-Jil, Beirut, 1992,

vol. 3, pp. 151-152. 100 Jad al-Haq, op.cit., p. 432. 101 al-Quran, al-Ma’idah: 8.

the current practice of organ transplant in malaysia

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