Learning from the Dead: Body Donation for Research

Transcription

1 Middle-East Journal of Scientific Research 13(Approaches of Halal and Thoyyib for Society, Wellness and Heal): 61-66, 2013 ISSN IDOSI Publications, 2013 DOI: /idosi.mejsr s Learning from e Dead: Body Donation for Research M.I. Farah Salwani Faculty of Syariah and Law, Universiti Sains Islam Malaysia (USIM), Bandar Baru Nilai, Negeri Sembilan, Malaysia Abstract: Human bodies are needed and widely used in e development of medicine and medication ough not much attention is given to promote it. The objective of is paper are two folds, namely to analyse e significance of human body donation and evaluate e procedures applicable including challenges faced in promoting it. Body donation is important and it provides massive benefit to e entire society. Unfortunately supply is very limited even ough ey are mostly preferred to be used in conducting research and experiments, as ey form e best type of experimental subjects. Some countries already have laws governing is practice, nevereless a standardised procedural guideline to legally regulate is activity is necessary. As for Islamic countries, clear rulings in e form of contemporary fatwas regarding e permissibility of is practice are equally needed, to help Muslims make a decision wheer or not to contribute as a body donor. Key words: Body Donation Islam Research Dead INTRODUCTION in patterns of diet and lifestyle contributes towards more people suffering from obesity and diabetes [1]. Therefore, Human organs donated are commonly used to help in order to provide new solutions and strategies of cure patients who are in need of ose particular organs, overcoming diseases, continuous erapeutics and to help em survive and continue living. This is one of non-erapeutic researches need to be carried out [2]. e miracles in medicine, particularly when precious Therapeutic research aims to improve treatment to a human lives are able to be saved, just by transferring class of patients while non-erapeutic research is to organs from donors to recipients. However, anoer enhance e furerance of purely scientific knowledge. side of donation at has been hiding in its shadow and Therefore, e human bodies are used to teach students not been given much publicity, is donation of e whole about e structure of e body and how it works; ey human body, made after dea, for e purpose of may also be used to train surgeons and oer healcare research and experimentation. Body donation provides professionals. People have to decide in advance wheer huge benefits and contributions towards e society. or not to donate eir body after dea. These donations A wide range of human bodily material may be provided are highly valued by staff and students at anatomy by one person for e treatment of oers, or for medical establishments. Moreover, a donated body can be used research at aims to improve medical treatment in e for a number of possible purposes including: future. This time, it does not provide immediate cure for a)"anatomical examination"- is term describes e just a few patients, but it actually benefits e whole teaching of e structure and function of e human body society including our future generation. It provides for to students or healcare professionals. b) "Research"- e need of a population seeking heal, or better heal is term describes scientific studies which improve e an presently enjoyed. For example, e fact at e understanding of e human body. c) "Education and population is aging increases e number of patients training" - ese terms describe e training of healcare suffering from diseases of old age. Likewise, e changing professionals, usually ose learning surgical techniques, Corresponding Auor: Farah Salwani, M.I., Faculty of Syariah and Law, Universiti Sains Islam Malaysia (USIM), Bandar Baru Nilai, Negeri Sembilan, Malaysia. Tel:

2 Middle-East J. Sci. Res., 16(Approaches of Halal and Thoyyib for Society, Wellness and Heal): 61-66, 2013 as opposed to anatomical examination [3]. The objective of is paper are two folds, namely to analyse e significance of human body donation and evaluate e procedures applicable including challenges faced in promoting it. Donating e Human Body and its Importance: Using real samples of human bodies to develop any new medication or eory for human use is e best option available. Animals such as guinea pigs and mice are commonly used in medical studies; resorting to actual human bodies and cadavers will provide results which are exact, more accurate and convincing. The use of human bodies for research would seek to reduce, upgrade and replace animal experimentation. This is in line wi e Directive of European Union on e Protection of Animals Used for Scientific Purposes, which holds at member states must develop alternative approaches which could provide e same or higher levels of information as ose obtained in procedures using animals [4]. Moreover, wi e constantly changing and mutilating profile of diseases and conditions at affect e emphasis of medical attention, continuous research must be carried out to find e best cure and prevent em from becoming worst. In oer words, e increased demand for human samples in research is due to e rapid development of technology. For example, by identifying specific DNA mutations, we could predict how a particular patient will respond to a specific drug treatment and furer understand e molecular basis of each disease [1]. From ese human bodies, bodily materials like blood, blood products, tissue, bones, skin arteries, corneas, reproductive material including embryos, fetal, embryonic stem cells are all essential for research purposes. In oer words, e whole body itself is beneficial for education, training and experiments. The person providing e bodily material can be eier a living person or a deceased party and ese materials can be used almost immediately or it can also be stored for long periods of time. The material can be used raw or heavily processed, for e direct treatment of oers or for research purposes. Procedures to Donate Human Bodies for Research: Due to e importance of human body donation, countries are recommended to adopt a clear legal framework which regulates e acceptance of donations for medical education and research, which clearly addresses any oer related legal issues [5]. In e United Kingdom, whole bodies are donated to medical schools particularly for e purpose of education, training or research. This practice is covered by e Human Tissue Act 2004 and regulated by e Human Tissues Auority (HTA). By virtue of ese provisions, donated bodies are still used for teaching purposes in medical schools, also for anatomical and surgical training. However, under e Human Tissue Act 2004, written and witnessed consent must be obtained from e potential body donor prior to his dea, as e executor of an estate may no longer act based on his knowledge of e deceased s wish to donate his body. The consent form can be obtained from e nearest medical school and a copy should be kept wi e donor s will. Family, close friends and e General Practitioner should be informed and made aware of any decision to donate e body. It is entirely a matter for e Medical School wheer or not to accept a body. In certain circumstances, bodies will definitely not be accepted, for example when a post mortem examination has been performed. The body accepted for donation will be examined and preserved and is may extend over up to a period of ree years. Once complete, arrangements will be made to bury or cremate e remains, in accordance wi e wishes expressed by e deceased or any surviving spouse or relative. However, in cases where certain tissues or body parts are of special interest for educational, medical and scientific research reasons, e medical school may ask potential donors if ey would allow e school to keep such tissue for a longer duration, since is might be of great value in medical student education and research projects. In Malaysia, Section 2(1) of e Human Tissues Act 1974 focuses on cadaver donors and requires any person willing to become an organ donor to specifically make known his wishes eier in writing or if e request is made orally, in e presence of two or more witnesses present during his illness. The donor must also specify his body or any specified part of his body, which is to be used after his dea and must decide wheer it should be used for erapeutic purposes, medical education or research. The Act furer states at e person lawfully in possession of e body, may after dea, auorize removal of e specified body parts according to e request made, after ensuring at e deceased had not expressed any retractions soon after e request was made. Subsequently, Section 2(2) of e Human Tissues Act 1974 provides at, is person may permit e donation to take place, after making reasonable enquiries and 62

3 Middle-East J. Sci. Res., 16(Approaches of Halal and Thoyyib for Society, Wellness and Heal): 61-66, 2013 believes at e deceased and e surviving spouse or lastly, religious belief [19]. This shows at serious next of kin had not objected. However, e person campaigns must be done, to convince e public, lawfully in possession of e body is nowhere especially ese anatomists first, so at ey can furer specifically interpreted in e Act as to who does is promote e public to follow eir footsteps. person actually refer to. Previously, under Section 7 of e This is not surprising as in a study conducted upon Anatomy Act 1832 in e UK, auority goes to e next Sou Asians in e UK regarding eir attitude towards of kin or e executors of e deceased to claim e body; body donation, a huge majority of e respondents totally if ere is none, e hospital auority would be lawfully rejected e notion eier by claiming ey were unsure of in possession of it. it or clearly unwilling to become one [8]. Thus e public understands and trust towards is type of donation is Challenges in Promoting Human Body Donation: crucial to be increased, to ensure at more are willing to There is a continual need to ensure at people are willing register as potential body donors and supply is sufficient. to step forward, to donate eir bodies. Therefore, adequate supply of ese dead bodies must be The Islamic Perspective on Human Body Donation: maintained, to avoid difficulties in accessing bodily Religious and cultural values of every population have a material at could jeopardize e progress of any significant impact on heal, education and social research conducted. According to e Royal College of policies [9]. Therefore, e impact of religious belief is Surgeons, shortage of bodies donated to medical powerful enough to influence e attitude and response science is reatening e teaching of anatomy, where in of e public at large towards motivating people to accept e UK alone, at least 1,000 bodies are needed each year and consent to organ donation activities [10]. Religious for future doctors and surgeons to learn on e structure belief can pattern eir followers perceptions and have and composition of a real human body [6]. Therefore, always been a top priority consideration in accepting any individuals must be encouraged to donate eir bodies forms of new technologies introduced. Muslims are and bodily material rough advertising campaigns sensitive to issues touching on eir religion, especially done, while ensuring at elements of trust, consent and when it involves decisions related to matters related to confidentiality are strictly adhered to, besides offering eir everyday lives. There is always a feeling of financial incentives in e form of providing for e whole responsibility to protect and guard eir religion and to cost of funeral of at donor [1]. be wiin e confines set by Islam. Generally, in organ Adequacy of consent by e donor is anoer issue donation matters, ough it is not mentioned directly in at definitely needs to be addressed well. It must be e Quran and Sunnah, Muslim jurists have reached a ensured at any decisions about e deceased donation consensus and have decided on its permissibility. As must be made on e known wishes of e donor during Islam is not only a religion, but also a complete code of his lifetime. Normally, ese donation are made due to e life which aims to fulfil e interest of e people, it aims to spirit of altruism, as a means to avoid funeral ceremonies, secure em e necessities of life and to provide an easier to avoid waste of e bodies and in some rare cases, to and more comfortable life [10, 11]. evade e expense of a funeral [7]. Duty of care and In anticipating e issue wheer donation of human respect of his confidentiality must also be preserved bodies should also be made permissible for Muslims, a under a good and responsible governance system. few matters must be considered first. To say at it should The concept of trust must really be uphold, to ensure be made permissible, we could rely on e fact at Islam at none of e donated bodies or bodily parts are does promote e preservation of life in all situations. misused and traded illegally in black markets. Conversely, e saving of one life is regarded as e Interestingly, a study conducted in Turkey, on e saving of all humanity. This is based on e following attitude of anatomists towards e idea of donating eir Quranic verse: own body discovered at e majority of e anatomist respondents were emselves not in favour of body whoever kills a human being for oer an donation. This was particularly caused by e feeling of killing or corruption in e ear, it shall be as if he unwillingness to be dissected by eir own fellow had killed all mankind and whoever saves e life of colleagues, family rejection, psychological reasons, one, it shall be as if he had saved e life of anxiety of disrespectful behaviour to cadavers and mankind [12] 63

4 Middle-East J. Sci. Res., 16(Approaches of Halal and Thoyyib for Society, Wellness and Heal): 61-66, 2013 This verse clearly signifies how human life is valuable He had explained to you in detail what is and must be protected and preserved. The maintenance of forbidden to you, except under compulsion or human life is one of e ultimate goals of Islamic necessity [14] legislation, us all possible means should be used to treat and save human life, as long as it remains wiin e Islam emphasizes at it is crucial and significant to realms of Syariah. Thus, to apply is verse to our issue, save and maintain human life. That is why in certain it is also clear at all research conducted upon e situations of dharurah (necessity), an exception can donated human body is also aimed to produce new be made to allow and make permissible ings at are findings and technologies at will later improve our forbidden in normal circumstances. Muslims are allowed knowledge for e maintenance of human lives as well. to do what is forbidden if ey are exposed to danger These new findings will help treat new diseases and and imminent dea [10]. ensure e continuity and perseverance of human lives. Anoer argument at can be considered is Islam Additionally, alough human beings do not own does enjoin its believers to seek redress. In a renowned eir bodies, as ey actually belong to Allah, comparing saying, e Prophet Muhammad is reported to have said, it wi organ donation, as long as it is done wi e intention of saving lives and curing serious diseases, There is a cure for every illness, ough we may erefore it should be permitted [13]. Saving e life of a not know it yet [15] living person is more important an e sacredness of e deceased person because e end justifies e In anoer Sunnah, e Prophet also said, means [10]. Nevereless, some may also argue at is might O servants of Allah! Seek remedies! He who causes violate e cadaver, as e body will en be subjected to ailments also brought cures and redemption. snips and cuts, dissections and experiments, which will There is a cure for every illness [16] cause pain to e deceased body. However, if e argument at one is permitted to commit a lesser evil in Seeking treatment is specifically urged by Islam for order to combat a greater evil is used, it could be proved hereditary as well as acquired diseases and ailments. at, e general gain obtained shall outweigh e This in no way, conflicts wi e Islamic teachings of negative aspect of is action. Therefore, permitting perseverance and acceptance of God s will as Islam human bodies to be donated for research should be enjoins its people to protect e security, heal and weighed as a lesser evil an giving up and just leaving safety of Muslims and considers lawful every effort to all e humans to die, due to inabilities to carry out treat and cure diseases [11]. Surely, only by having researches to discover its cure and furer prevent research done, particularly on human bodies, we should outbreaks of new mutating diseases. be able to obtain maximum benefit to help restore e It is undeniable at Islam forbids any act of heal of patients in need and e society at large. aggression against e human life as well as e body Moreover, it could also be argued at human bodies after dea, but perhaps reliance on e doctrine of donated for research could be classified as a charitable Maslahah Mursalah, which makes e public interest contribution which is highly recommended in Islam. As and benefit outweigh e negative aspects of it could be it may be seen as Sadaqat ul Jariiiya, it can enhance applicable. This means at, while e deceased body e spirit of helping each oer on e basis of needs to be respected, e life of a living human is broerhood. considered to be more valuable and should be given Nevereless donation of human bodies for research priority to be saved, when e two are in conflict. It is should also be seen from e oer side of e coin. indeed equally important to honour e sacredness of The human body is indeed e sole property of Allah. e body and it is an important interest at must be Since we do not own our body, erefore, we cannot respected; however, maintaining e heal of e decide to give away parts or our whole body to anoer members of e nation as much as possible and protecting person. No man or auority has e right to decide e em from suffering and dea is even more essential. fate or end of a human s life. The human body is sacred As Allah says: and regarded as an amanah (divine trusteeship) given 64

5 Middle-East J. Sci. Res., 16(Approaches of Halal and Thoyyib for Society, Wellness and Heal): 61-66, 2013 by Allah for us to guard and upon dea, e body needs all, expressed consent must be obtained from e to be buried according to e principles of Islam [17]. deceased party during his life time, consenting it to be The holy Quran states; used for research. In e UK, witnesses are required to be present during is process of obtaining consent. Make not your hands contribute to your own Though human bodies seem needful for research, destruction [18]. This can be extended to forbidding any now we have e technology of virtual autopsies being act of aggression to e body, even after dea, which is introduced. This procedure allows a body to be scanned considered not permissible. The Prophet Muhammad oroughly, wi 3D images being produced, in less an also said, 30 minutes. The virtual autopsy can provide almost 80% accurate data which involves e whole body including Breaking e bones of e dead person is similar cutting rough ligaments, tendons and tissues, wiout in sinfulness and aggression to breaking it while e even a slightest scratch inflicted upon e dead body. person is alive. [19]. This Sunnah stresses e rd The National Fatwa Committee in its 73 Muzakarah importance of body wholeness at dea [20] and is sitting convened in 2006 had ruled at virtual autopsy against any form of bodily aggression which could lead should be given priority to e traditional post mortem to mutilation of e body [17]. Moreover, by permitting procedures. Giving a ought on is, one cannot stop e deceased body to be used for research purposes, from wondering perhaps is remarkable development in is will definitely delay e process of burying it and technology will affect our existing rulings. For example, as violate e integrity of e deceased body [21]. e virtual autopsy is capable of producing 80% accuracy of data, feasibly is could negate e argument of acting Islamic Rulings on Body Donation in Selected Islamic in dharurah or necessity upon dead bodies. Are we still Countries: There is no fatwa specifically on donation of able to argue and justify at our act of purposely human cadaver bodies for research purposes as yet in inflicting injury and cuts to e dead body, ough for e most of e Islamic countries. Nevereless in Malaysia, purpose of research still amounts to a necessity when e 25 Muzakarah of e National Fatwa Committee in ere is already a reliable alternative meod available? 1989, had decided at post mortem procedure is Therefore, Islamic scholars in particular need to draw a permissible if it is considered as a necessity, particularly line as to distinct between what is still considered as in identifying e cause of dea in criminal cases. Later, dharurah and what is not. st in e 61 Muzakarah in 2004, e same committee This development will also draw an impact upon decided at ough e general rule does not permit original rulings at prohibit any particular act and are operating on cadavers, unless in dharurah situations and initially haram but is later considered permissible due to if ere is an urgent need to make research on diseases, elements of dharurah found in existence. For example, identifying e cause of dea and education especially anatomization of e human body is generally forbidden, in medicine, en only it is considered as permissible. regardless of wheer it is e body of a Muslim or a It is recommended at, should a specific fatwa be non-muslim. However, if ere is a considerable made on is matter, it must lay down details on which advantage in dissecting e corpse, en at is greater type of cadavers at would be permitted to be used. an e sanctity of e corpse itself. But if e dissection Perhaps, if ere is a choice between a Muslim body and is necessary, it should be done preferably to e corpse a non-muslim one, e latter should be given priority. of a non-muslim and if ere is any oer way at could We should also list guidelines on how to handle e be used to get e required knowledge, en it particular body as well. Whenever possible, e aurah becomes unlawful to make an autopsy on e dead body. and dignity of e deceased body must be protected. The Supreme Council of Emminent scholars in Saudi Handling it should also be done wi care and caution. Arabia and e committee of Fatwa Al-Azhar on 29 Issues on embalmment of e body must be made known Feburary 1971 also concur wi is view [22]. In al-ifta, to e donor. Additionally, a specific contractual time The Permanent Committee for Legal Rulings (Fataawa) limit to which e body intends to be used must also be in Saudi Arabia concluded at dissection on dead specified, for example in ree years time and afterwards, bodies to discover wheer ere is any criminal act e body must be buried accordingly. Most important of causing e dea or to see if ere is any contagious 65

6 Middle-East J. Sci. Res., 16(Approaches of Halal and Thoyyib for Society, Wellness and Heal): 61-66, 2013 disease and to en conclude how to stop its spread is 6. Donating a Body for Medical Research. sanctioned. Any act of dissection for educational and Retrieved on 10. July training purposes is considered acceptable [23]. 7. Richardson, R. and B. Hurwitz, Donors' Attitudes Towards Body Donation for Dissection. CONCLUSION The Lancet, 29. July, 346(8970): Aziz, S. and S. Dhami, Attitude of Organ Effort to invite more people in registering as body Donors among Sou Asians in UK. Journal of Royal donors must continue ough vast emergence in high Society of Medicine, 93(3): 161. technology is starting to replace certain manual 9. Hussein, R.G., The Crescent and Islam: Healing, procedures previously done upon e human body. Nursing and Spiritual Dimension. Some Thus, ere is a need to weigh wheer it is still relevant Considerations towards an Understanding of e to carry out researches on humans, especially on Muslim Islamic Perspectives on Caring. Journal of Advanced bodies. If at all is is still deemed necessary, a Nursing, 32(6): comprehensive guideline must be developed to ensure 10. El-Shahat, Y.I.M., Islamic Viewpoint of maximum use of ese donated bodies can be carried out, Organ Transplantation. Transplantation Proceedings, while still remaining wiin e realms of Shariah and 31: human codes and eics. Full respect to a human body 11. Abdel Moniem, H., Definition of Dea, Organ eier while one is still alive or already dead must be Donation and Interruption of Treatment in Islam, guaranteed and ensured, until we no longer need to 11 Nephrol Dial Transplant, pp: depend on em for e development of our medicine and 12. Al-Quran. Al-Maidah, 5: 32. medicinal procedures. 13. Al-Mousawi, M., T. Hamed and H. Al-Matouk, Views of Muslim Scholars on Organ Donation REFERENCES and Brain Dea. Transplantation Proceedings, 29: Nuffield Council on Bioeics Human Bodies: 14. Al-Quran. Al-Nahl, 16: 89. Donation for Medicine and Research, Al-Bukhari M.I. and Sahih al Bukhar, 1958, Retrieved on 27. Cairo.Maktabat al-shcab (Kitab al-tib), pp: 7. July Al-Bukhari M.I. and Sahih al Bukhar, Mason, J.K. and G.T. Laurie, Mason and Mc Cairo.Matbaat Al-Sihaba, pp: 2. Call Smi s Law and Medical Eics. Oxford. Oxford 17. Abul Fadl, M.E., 1995, Organ Transplantation: University Press. Contemporary Sunni Muslim Legal and Eical 3. Human Tissue Auority, How to Donate Your Perspectives. Bioeics, 9: rd Bodies. Retrieved on Al-Quran. Surah Al-Baqarah, 2: 295. June Hadi. Sunnan Abi Da ud, Directive of e European Parliament and of e 20. Courtney, S.C., Religion and e Body in Council. 121, Directive 2001/20/EC. Paper. Medical Research. 8.3 Kennedy Institute of Eics 5. McHanwell, S.E. Brenner, A.R.M. Chirculescu, Journal, pp: J. Drukker, H.V. Mameran, G. Mazzotti, D. Pais, 21. Umit, S.S., S. Erdinc and O. Sarikaya, F. Paulsen, O. Plaisant, M.C. Maître, E. Laforêt, Attitudes of Turkish Anatomists towards Cadaver B.M. Riederer, J.R. Sañudo, J.L. Bueno-López, Donation, Clinical Anatomy, 17: F. Doñate-Oliver, P. Sprumont, G. Teofilovski-Parapid 22. Fatwa, No , 24 April and B.J. Moxham The Legal and Eical 23. Organ Transplant, Islam, Fiqh, Ruling, Syariah-A Framework Governing Body Donation in Europe A Juristic Ruling Regarding Organ Transplant. Review of Current Practice and Recommendations for Retrieved on 10. July Good Practice. European Journal of Anatomy, 12(1):