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III. Organ and Tissue Transfer, Transplantation and Procurement
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Initially, transplantations were limited to the heart, liver and kidney. However, as medicine and surgery have advanced, more opportunities have emerged for the transplant of other vital organs, such as the pancreas, lungs and various types of tissue transplants. These tissue transplants include corneas, cardiac valves, and skin and bone, of which an estimated 3-5 million take place every year around the world.13

Kidney transplantation occupies a special status.   Although kidney diseases can be treated with dialysis, it is generally agreed upon that kidney transplants are the most optimal treatment for renal failure, in terms of survival rates, improved quality of life and cost efficiency. Both low and high-income countries are similar in this regard and kidney transplants are the most common type of transplantation, accounting for 50,000 of the 70,000 kidney transplants around the world every year.14

The transfer of organs from deceased donors requires a strong institutional structure. First of all, it is necessary to identify those who intend to donate their organ(s) and to obtain their consent or the consent of their loved ones. This is followed by the extraction of the donor’s organ and its secure transfer for transplant to the medical team performing the surgery.

Although, worldwide, there is a greater reliance on deceased donors, the procurement of organs from living donors has become inevitable to save the lives of thousands of patients on waiting lists. Thus living donation is a possibility, but it requires the formulation of special guidelines to avoid harm to the donor’s health.15

The problem currently facing the world is that there is a constant, growing need for a source of alternative organs. Until science finds a way to overcome the obstacles facing organ transplant with non-human tissue, humans, particularly the deceased, will remain the sole source of organs available for transplant. This has made organ transplant a sensitive, difficult endeavor, for it is the only medical specialty in which the death of one patient is the basic condition for saving the life of another. In turn, it has linked the complicated issue of the definition of death to organ transplantation.

How to define death?

Eliminating the traffic in organs is largely dependent on encouraging donations and fostering a culture of contribution. One of the biggest obstacles facing the passage of a law in Egypt is the controversy over the definition of death. Is a person whose brain stem is dead, considered dead? Or does death entail the total shut down of all bodily organs?

Official documents and reports issued by international medical groups and agencies, such as the WHO and the WHA are free of, or more precisely, intentionally avoid agreeing on a unified, international definition of death. Rather, each country has been left to determine those standards appropriate to, and consistent with, the thoughts and beliefs of its own citizens.

In fact, the current dispute is almost entirely a medical dispute; religion settled the matter long ago. Many Muslim clerics and legal scholars, as well as nearly all legislative and religious jurisprudential agencies, have issued statements declaring the permissibility of organ donation and the transfer of organs from living donors on the conditions that no harm come to the donor and no financial payment is made for the donated organ. These institutions have upheld the principle of donation without compensation in order to benefit the living, but they left the clarification of other important principles,  such as the definition of death, to doctors. Sheikh Mahmud Ashur, the former Deputy of al-Azhar and a member of the Islamic Research Council, expressed this stance when he said, “The debate over brain death is a medical, not religious, matter. Religious law sees death as the spirit’s exit from the body and the end of life in the body. As for brain death, no cleric should give an opinion; this is for doctors.”16 Sheikh Ashur placed the burden of defining death on doctors, adding that they are the real cause of the delay in the law since they cannot agree on the definition.​17

Many countries have overcome the debates on the definition of death. Thus they managed to issue legislation consistent with international standards by referring the issue to special committees of doctors to decide on the matter.
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13- Rüdiger von Versen, “Ethics, Access and Safety in Tissue and Organ Transplantation: Issues of Global Concern,” WHO document WHO/HTP/EHT/T-2003.1.
 
14- WHO, “Human Organ and Tissue Transplantation: Report by the Secretariat,” WHO document EB112/5, 2003.
 
15- Ibid.
 
16- Mona Abu al-Nasr, “al-Jadal hawl ta’rif al-mawt yu’arqil qanun zira’at al-a’da’ bi-Misr,” BBC Arabic, 24 Feb. 2008.
 
17- Ibid.
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Regular View
Organ Transplant Legislation: From Trade to DonationOrgan Transplant Legislation: From Trade to DonationThe ReportAcknowledgmentsI. Organ and Tissue Transplant: The Rights to Health and LifeII. International Standards Established by Organizations for Organ and Tissue TransplantationIII. Organ and Tissue Transfer, Transplantation and ProcurementIV. National Legislation to Regulate Organ Transfer, Transplant and Prevent Organ TraffickingV. Preliminary Observations on the BillVI. Basic Steps Needed to Implement the Law