Corneal Graft – Ask Mufti

Q: Is it permissible to receive a donor cornea?

A: SHAR’I PERSPECTIVE TO CORNEAL GRAFT

The cornea is a thin transparent tissue on the front part of the eye that covers the iris, pupil, and anterior chamber, providing most of an eye's optical power. This is one portion of the human body that contains no blood.

A corneal graft is when this tissue is removed from the eye of a dead person and stitched into the eye of a patient who needs a new cornea.

The Shar'i status of this falls under the issue of organ transplant, since the cornea is a portion of the human body. With regard to organ transplant, there are two distinct views among the Ulama. Former Ulama ruled that organ transplant of any sort is totally Haraam. Today the majority of Ulama maintain the same view. Meanwhile, there are other senior Ulama today who have shifted from this orthodox view and maintain that in view of the wide scale medical needs of people and the increase in injuries and health complications, organ transplant is permissible

We take a look at some of the reasons furnished by those who prohibit this medical procedure, as well as the counter arguments.

A common ground for the prohibition of organ transplant is the fact the human parts are sacred, and removing these parts is tantamount to desecration of human life. For this very reason, Jurists of former times have prohibited intifaa’ (deriving benefit) from human parts. They maintain that due to man’s honour and sanctity, one cannot derive benefit from human life.

In answer to this, pro-organ transplant scholars say that in using the body part of one human in another there is no desecration but preservation of that part. They claim that in former times organ transplant never existed, so the benefit referred to in classical works of Fiqh could never refer to transplanting organs. Instead, what the Fuqahaa and former jurists meant by intifaa’ was the consuming of human parts or utilization of the same for some external purpose. Hence we find in Fataawa Hindiyyah the law that one human is not allowed to consume the flesh of another, even if the former is dying. The reason: Sanctity of human life. Furthermore Fuqahaa mention that any portion of the human body that has been severed must be buried. Again, the reason forwarded here is respect and reverence for the human body. Should that part not be buried, it will rot and decay, or become food for vultures and scavengers. However, in the transplant of a human organ there is no desecration or irreverence. Instead, the organ is preserved with the utmost care and continues its normal function. Should that organ not be serving its normal function, it cannot remain inside that body. Should the recipient of the organ die, he will be buried with the organ. The organ is not removed and then subject to desecration and disrespect. In short, the intifaa’ or benefit spoken of in former books did not refer to utilization of that organ in another human body, since this concept never existed in those days. The benefit spoken of there was that of eating or external usage that entailed desecration and destruction to the organ. Indeed eating the body parts of another is highly disrespectful and ignominious, for then man is relegated to the level of ordinary animals. Furthermore, what is consumed will eventually be expelled from the body in the form of impurity and faeces. This is also highly disrespectful, whereas in organ transplant the human part remains intact; it continues its natural function and is not subject to waste and impurity.

The second reason for prohibition stated is that the Hadeeth prohibits the breaking of the bones of a dead person. In organ transplant, the organ is removed from the dead body, so this is contrary to the Hadeeth cited.

The answer advanced against this argument is that the Hadeeth in question refers to breaking the bone deliberately for no valid reason and out of disregard for human sanctity. Moreover, there is a difference between the breaking of bones referred to in the Hadeeth and the removal of an organ. Breaking a bone itself is a violent and harsh act, the effects of which, according to Hadeeth, are felt by the dead. Too much jostling of the bier is also a cause for discomfort to the dead. However, in organ removal, though there may be discomfort but the intention behind this is not to cause pain to the body and not deliberate desecration. The example in Fiqh of this is the case of a pregnant woman who has died. If doctors are of the firm opinion that the baby inside her is alive, then they are allowed, and according to some it is Waajib, to cut open the stomach and remove the baby. This Mas’alah is mentioned in the Jawaahirul Fiqh of Hadhrat Mufti Muhammad Shafee Saheb (RA). Now here too, there is discomfort to the dead when the stomach is cut open. But because there is hope in saving the life of the unborn baby, this bit of desecration has been permitted. Pro-organ transplant Ulama say that in like manner, the removal of an organ from a person who is brain dead, is done for a valid purpose and there is certainty that this will save a life. The discomfort caused here is, therefore, tolerated. However, doctors should be exhorted to remove the organ with utmost care and respect to the human body.

The third reason advanced for prohibition is the issue of mutilation. Removing the organ is mutilation of the body. Ulama have responded to this by stating that mutilation actually means the unceremonious disfiguring and dismemberment of the human body. In organ removal, this is not the case; instead, a careful incision is made and the organ carefully removed. Sure there will be a scar left and there will be cutting and bleeding, but that cannot be likened to the mutilation that Shari'ah prohibits. Again, the example of cutting open the stomach of a dead mother to remove the baby, as well as making incisions in the body for general operations on a live person prove that this much of cutting is allowed provided there is a valid reason to do so.

The fourth objection against organ transplant is that the Hadeeth of Rasulullah (Sallallaahu Alayhi wa Sallam) prohibits a woman from adding human hair to her existing hair in order to enhance her looks or increase the amount of hair on her head. The Ulama say that in this Hadeeth, which is narrated in Bukhaari, Muslim, and several other Hadeeth works, the use of a human body-part has been prohibited. Some Hadeeth mention that even a woman who had lost her hair was prohibited from resorting to this form of treatment. It is thus clear that no matter what the reason may be, utilization of a human part is Haraam.

This is undoubtedly the strongest proof of all, for all previous proofs were logical and inferential, whereas this Hadeeth provides categorical evidence of prohibition, which is always stronger and more tenable. However, other Ulama have countered this with a more in-depth study of the Hadeeth in particular. Firstly they maintain that the main reason for this prohibition was because it constituted a form of deception. The onlooker will think that this is the natural hair of the woman, meanwhile it is either artificial or “borrowed’’ hair. For this reason, some Scholars of Hadeeth who quote this Hadeeth maintain that the use of even artificial (synthetic) hair to enhance natural hair is not allowed. This statement supports the theory that the prohibition in the Hadeeth is not due to the fact that a part of the human body is being used. Instead, it is the deception that this will create. Secondly, in some narrations an exception is made for illness. In the Musnad of Imam Ahmad, there is a narration of Ibni Mas'ood (Radhiyallaahu Anhu) wherein he mentioned the prohibition of adding the hair of one woman to that of another, but makes the exception at the end by saying: except due to illness. This Hadeeth appears in other books as well, and according to Allaamah Ibni Hajar, its Sanad or transmission chain is sound. It thus emerges that human hair, which is part of the human body, may be used in cases of illness. By extension and analogy we could say that human body parts may be used in cases of illness.

THE CORNEAL GRAFT

Having gone through some of the main arguments for and against organ transplant in general, we concede that the case in favour of organ transplant does not appear very strong, since the arguments presented in its support do not entirely satisfy the heart nor succeed in fully dispelling the objections against. We, therefore, advocate the route of caution and abstention in this regard. However, a corneal graft is not similar to other forms of organ transplant. When considering the nature of the corneal graft we notice that in this operation some of the above reasons against organ transplant are not found. There is no mutilation of the body, there is no discomfort caused to the body as in cutting and removing, and the tissue that is removed is very small and hardly constitutes an organ. The Fuqahaa have overlooked the pieces of skin and hair that inadvertently fall into food when cooked, despite one being aware of this. Yet they disallow the consumption of food in which a human tooth or bone has been ground and cooked. This can be attributed to the small and negligible amount of human tissue that is involved. The same would apply to the small tissue that is removed from the front of the eye.

As regards benefiting from a human part, we have mentioned above that deriving benefit is only Haraam when there is desecration to the body, as in eating for example. In a corneal graft there is absolutely no desecration because of the tiny piece of tissue involved and because this tissue is preserved in the eye of another to continue its function. Here there is minimum disturbance to the body.

It has also been reliably reported that some of our Akaabir, such as Hadhrat Moulana Yusuf Binnori Saheb (RA) and Hadhrat Mufti Wali Hasan Saheb (RA, former Grand Mufti of Pakistan) gave permission for a corneal graft, in spite of the fact that these very same Ulama prohibited organ transplant. The Fiqh Academy of India, comprising hundreds of senior Ulama in India, under the presidency of the late Qaadhi Mujaahidul Islam, held a seminar to discuss this issue. The consensus that emerged from their deliberations was that all forms of organ transplant are permissible, provided this is done for valid medical reasons and not just for cosmetic fancies. However, they prohibited the exchange of money for organs donated.

On the basis of the above, it is the writer’s humble opinion that the ruling on corneal graft should be one of permissibility. Should anyone opt for this ruling, there will be no sin incurred, since this ruling was handed down by renowned and acclaimed Ulama. It will be permissible to act on their fatwa and undergo surgery of this nature.

And Allah knows best.
Mufti Siraj Desai