Padela and Zaganjor (1) provide details of the relationship between religiosity and attitudes toward deceased organ donation in an American Muslim cohort of 97 respondents. Their findings identify negative religious coping (i.e. Muslims viewing difficulties in life as divine punishments) to be independently associated with negative attitudes to deceased organ donation, but higher levels of intrinsic self-rated religiosity had no similar association. They also identified that Arab Muslims had more favorable attitudes toward deceased organ donation in comparison with South Asian Muslims, with both more favorable than African American Muslims. These interesting results, using validated qualitative measures to assess religiosity among Muslims, provide an interesting insight into the complex decision-making process that influences Muslims with regard to organ donation.
The reluctance for organ donation among Muslims is more pronounced for deceased versus living donation (2), and it is the former that was the subject matter for this analysis. The lack of association between intrinsic self-rated religiosity and positive attitudes to organ donation contrasts with previous work analyzing Western Muslim and British Asian Muslim attitudes (3, 4). In these analyses, negative attitudes toward organ donation were identified with increasing scales of self-rated religiosity. There are likely to be a number of explanations for these contrasting results. First, the analysis by Padela and Zaganjor has used more robust qualitative measures to assess Islamic religiosity. Second, as the authors rightly point out, the respondent demographics are completely different. South Asians have more negative attitudes to organ donation, clouded by less clear guidance from Islamic scholars emanating from South Asia (2), which adds a cultural component to this debate. It is important to acknowledge that global Muslims are a heterogeneous group with varied social, cultural, linguistic, and historical values that overlap with religious affiliation. Teasing apart attitudes that are cultural rather than religious is difficult in this context and requires further research.
The association between negative religious coping and negative attitudes toward deceased organ donation highlights a new finding that suggests psychological obstacles that may require further investigation. Overcoming such negativity may require targeted psychosocial interventions and is likely to be resistant to standard organ donor awareness campaigns. However, before such interventions can be planned, unravelling the complexity of the organ donation debate within Islam requires further understanding. This requires further targeted qualitative and quantitative research within the Muslim community, carefully designed to shed light to and provide insight into the complicated debate that surrounds organ donation.
Despite this ongoing need for further research, there is one poorly understood concept in this organ donation debate that seems untenable, that is, the notion that one can be negative about organ donation but positive about organ receipt. There is no sound theological argument within Islam that plausibly allows such a contradiction to be morally acceptable, but the irony is for many Muslims, this seems an acceptable paradox (3, 4). Perhaps, there is some theological basis to justify this position, but it is not clear on what basis such foundations are set. A clear distinction must be made with Jehovah’s Witnesses, who refuse to donate blood but will reciprocally refuse to take blood. Regardless of whether we as medical professionals agree with this, it is a tenable position that can be respected. It is unlikely that the average Muslim is (or ever will be) familiar with the overwhelming philosophical dilemmas, metaphysical intricacies, and juristic conundrums that have burdened this organ donor debate among Islam scholars for decades. Such debate is unlikely to be the major obstacle for Muslims signing up as organ donors; apathy and disinformation are probably more pertinent issues rather than theology.
A famous Islamic parable, narrated by Abu Huraira, states, “A prostitute was forgiven by Allah, because, passing by a panting dog near a well and seeing that the dog was about to die from thirst, she took off her shoe, and tying it with her head-cover she drew out some water for it. So, Allah forgave her because of that (act of kindness)” (5). This parable is often cited to support the importance of animal welfare within Islam, but it also demonstrates the magnanimity of human kindness and its cherished place in the eyes of Islam. Transplantation is dependent on the generous act of organ donation—surely, there can be no kinder act than the gift of life. Those happy to receive such organs would therefore be wise to reflect carefully on their willingness to donate as, from a moral psychology perspective, “failure to follow one’s own expressed moral principles is termed hypocrisy” (6).
Department of Nephrology and Transplantation
Queen Elizabeth Hospital
Birmingham, United Kingdom
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