Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture

Abstract

Organ transplantation from living related donors in Bangladesh first began in October 1982, and became commonplace in 1988. Cornea transplantation from posthumous donors began in 1984 and living related liver and bone marrow donor transplantation began in 2010 and 2014 respectively. The Human Organ Transplantation Act officially came into effect in Bangladesh on 13th April 1999, allowing organ donation from both brain-dead and related living donors for transplantation. Before the legislation, religious leaders issued fatwa, or religious rulings, in favor of organ transplantation. The Act was amended by the Parliament on 8th January, 2018 with the changes coming into effect shortly afterwards on 28th January. However, aside from a few posthumous corneal donations, transplantation of vital organs, such as the kidney, liver, heart, pancreas, and other body parts or organs from deceased donors, has remained absent in Bangladesh. The major question addressed in this article is why the transplantation of vital organs from deceased donors is absent in Bangladesh. In addition to the collection of secondary documents, interviews were conducted with senior transplant physicians, patients and their relatives, and the public, to learn about posthumous organ donation for transplantation. Interviews were also conducted with a medical student and two grief counselors to understand the process of counseling the families and obtaining consent to obtain posthumous cornea donations from brain-dead patients. An interview was conducted with a professional anatomist to understand the processes behind body donation for the purposes of medical study and research. Their narrative reveals that transplant physicians may be reticent to declare brain death as the stipulations of the 1999 act were unclear and vague. This study finds that Bangladeshis have strong family ties and experience anxiety around permitting separating body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes. Posthumous organ donation for transplantation is commonly viewed as a wrong deed from a religious point of view. Religious scholars who have been consulted by the government have approved posthumous organ donation for transplantation on the grounds of necessity to save lives even though violating the human body is generally forbidden in Islam. An assessment of the dynamics of biomedicine, religion and culture leads to the conclusion that barriers to posthumous organ donation for transplantation that are perceived to be religious may actually stem from cultural attitudes. The interplay of faith, belief, religion, social norms, rituals and wider cultural attitudes with biomedicine and posthumous organ donation and transplantation is very complex. Although overcoming the barriers to organ donation for transplantation is challenging, initiation of transplantation of vital organs from deceased donors is necessary within Bangladesh. This will ensure improved healthc...

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“…In contrast, Bangladeshis have strong family ties and experience anxiety around violating the human body, which is generally forbidden in Islam. They do not permit the separation of body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes [ 30 ]. Posthumous organ donation for transplantation is commonly viewed as wrong from a religious point of view.…”

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“…Muslim scholars who oppose and support organ donation for transplantation use almost the same verses of the Quran and Sunnah [14,47,50,51], but their opinion about the permissibility of the issue varies with their interpretation of the texts. Geographical and historical differences, cultural and societal diversity, prevailing social customs, and the variety of politico-administrative systems have inevitably led to differing views among Muslim scholars about whether organ donation should be permitted [52].…”

“…Most Muslim scholars, Sunni and Shia, support organ donation and transplantation [47,51,54] but their opinions are not universally accepted, as some hold the view that organ procurement contradicts sharia Islamic law [36]. By citing the following Quranic verses (2:195; 5:32; 8:27; 17:70), scholars who oppose organ donation base their stance on the Islamic belief that the human body, whether dead or alive, is a sacred thing that should be treated with care, respect, compassion, and utmost attention [55].…”

“…Muslim scholars also oppose organ transplantation because human life is a divine gift and the human body, including its integral organs, is an Al-Amanah or a sort of trusteeship that Muslims receive from The Almighty, not the sole property of humans themselves (Quran 4:58). Muslims should therefore maintain this trusteeship [51]. Humans can not donate any organs which are not their own [47].…”

“…They also assert that The Almighty will not accept those who alter His creations by cutting the human body and obtaining organs for transplantation as they have committed a wrongdoing. They warn that wrongdoers who alter The Almighty's creation will be punished in the alakhirah or the hereafter [51].…”