About Organ Donation

ORGAN DONATION & TRANSPLANTATION

Organ donation is the process of surgically removing organs and tissues from a donor and placing it into a recipient. Organ donation can occur in two ways, (i) deceased donation (donation after death) and (ii) living donation (living donation is when an individual offers to donate a kidney or part of their liver. Deceased organ donors are able change the lives of up to 8 individuals. The image below provides a pictorial demonstration of organs / tissues that can be donated.

DECEASED DONATION

In Malaysia, family members or next-of-kin may consent for organ and tissues donation. Consent for organ donation is obligatory and a legal requirement prior to the initiation of organ donation, procurement and transplantation.

Death can be categorized as :

a) Brain death is a state of irreversible cessation of all brain function as a result of a medical condition (eg: aneurysm) or severe trauma to the head, and the individual becomes fully dependent on a life support machine. Brain death is a legal death and is accepted worldwide by medical professionals, as well as acknowledged by Malaysia’s National Fatwa Council (Majlis Fatwa Kebangsaan 2011). A brain death certification is needed to diagnose an individual as being brain dead. This vigorous test is performed twice by highly trained and qualified medical practitioners, who are not part of the organ donation or transplantation service.

b) Cardiac death is a death categorized by circulatory cessation (no circulation of blood to the body and its vital organs). This death, caused by the loss of heart function, is also the leading cause of death in Malaysia (2020). At present, only tissues (corneas, heart valves, bones and skin) are harvested from an individual following certification of cardiac death.

The primary treating doctor may approach the next of kin or family members when there is a suspicion of brain death to discuss about the opportunity for organ and tissue donation. Brain death must be declared by a qualified medical practitioner and at this point the family can elect to withdraw from life support. When an individual is certified brain dead, a family discussion session will be scheduled. This allows the treating doctor to share and to understand the family’s decision regarding organ and tissue donation. This process is done with utmost respect in the presence of various family members.

Myths: I will be left to die if I am an organ and tissue donor

It is imperative to understand, that in any medical setting, the primary aim is to treat you or your loved ones. This means the focus is on treating you and not somebody else. The question of donation only becomes a possibility when an individual is brain dead with the obtainment of consent from next of kin or family members.

LIVING DONATION

Living donation provides an alternative source of transplantable organs. Living donation is acceptable when the donor voluntarily consents to the donation. There are only 2 organs that can be donated:

  1. kidney;
  2. part of liver.

A thorough assessment will be performed by a qualified medical practitioner to determine the eligibility of the potential living donor. A series of tests will be conducted to evaluate the health status of the donor and fitness for donation of the potential recipient. This is to ensure that the living organ donation can take place without compromising both donor and recipient’s safety and health.

In Malaysia, living donation is accepted from family members such as parents, siblings or child – and is termed as “Related Living Organ Donation”. However, if the potential donor has no blood relation with the recipient, an approval must be obtained from the Ministry of Health (MOH) prior to donation.

TRANSPLANTATION

Organ transplantation is one of the greatest advances in modern medicine. It is the surgical process of placing a donated healthy organ or tissue into a patient with organ or tissue failure. Successful transplantation results in improved quality of life amongst recipients.

Organ transplantation is the best treatment for end-stage organ failure. In certain circumstances, organ transplantation becomes a life-saving treatment for patients. This includes patients with end-stage heart, lung and liver failure.

Kidneys can be transplanted from a living or deceased donor. It is the best treatment modality for End-Stage Renal Failure patients.

Not only it improves the survival rate (compared to hemodialysis); kidney transplant also reduces the treatment cost from long-term hemodialysis/hospital treatment. Patients who received donated kidneys are generally able to enjoy better life quality.

It is a life-saving surgery for patients with end-stage liver failure. Liver can be transplanted from a living or deceased donor.

This is also categorized as a life-saving surgery for certain cardiac conditions. Although in certain cases ventricular assist devices (VADs) may be offered, a heart transplant is still the definitive treatment.

Transplantation of the lungs is indicated in patients with chronic respiratory disease refractory to medications, such as those with pulmonary fibrosis. In Malaysia, lungs can only be donated from a deceased donor.

Long bones such as humerus, femur, tibia and fibula can be transplanted to replace damaged bones either due to cancer or injury.

Corneal transplant has the ability to restore lost vision due to certain illnesses, or reduce the damage or discomfort from it.

Heart valve is valuable in replacing damaged valves, such as in children born with certain heart defects (congenital heart valve disease) and adults with damaged heart valves.

Donated skin can be used as grafts in patients with skin loss due to severe scalds and burns; this in turn reduces the risk of dehydration from fluid loss or infection. Skin grafts also promote faster healing, reduced pain, discomfort and scarring in recovering patients.

RELIGIOUS PERSPECTIVES

Malaysia Department of Islamic Development (JAKIM). (2011). ORGAN TRANSPLANTATION FROM THE ISLAMIC PERSPECTIVE. Malaysia, Ministry of Health.

A fatwa regarding organ transplantation was issued in 1970 by the National Fatwa Council. It states that organ transplantation and donation are permissible in Islam. Read more about this fatwa here.

The permissibility of donating and transplanting organs is also bound to the following conditions which are meant to protect everyone’s interest in accordance to Islamic law. These are:

  • Living donors are not inflicted with harm such as death or disabilities (loss of hearing, sight, and mobility).
  • Transplantation is performed with the permission from the donors.
  • The permission is obtained from donors who are legally able to do so. As such, permission cannot be obtained from children, mentally-incompetent people (people with intellectual disabilities), or individuals who are confused, under pressure or coerced to donate.
  • Not conducted in ways that could violate human dignity such as organ trading. It should be done for altruistic reasons.

Doctors involved in the transplantation have sufficient knowledge to assess the donors’ and recipients’ conditions based on the principles of maslahah (benefits) and mafsadah (harms) according to Islamic law

Organ donation is positively accepted in Buddhism. The past Chief Buddhist High Priest of Malaysia and Singapore, the late Venerable Dr. K. Sri Dhammananda Nayake Maha Thera stated, that “donating one’s organs after death for the purpose of restoring another human’s wellbeing is an act of charity – which constitutes the backbone of a spiritual way of life”.

Organ and tissue donation are encouraged as long as there is no element of commercialization.

Hinduism is a religion based on love, compassion and generosity – It is a practical aspect that is held by Hindus.

A Hindu is allowed to donate anything including their organs, while either still alive or after death. Hinduism does not prevent their followers from donating their organs for the purpose of saving the life of others.

Christians are encouraged to assist those who are sick; and organ donation is one way to heal the lives of many others.

However, organ donation should be regulated by law and ethics, as to prevent sale and exploitation by irresponsible parties.

In principle, Sikhism does not prohibit its devotees from donating their eyes or other organs. The act of donating the eyes or any other organs is an invaluable gift.