There are five main issues regarding organ transplantation from the brain dead that are answered as follows:

1. Are the brain dead considered dead?

According to the opinion of Allamah Mansoor Hashemi Khorasani, may Allah Almighty protect him, death means the complete separation of the soul from the body, which is achieved by the complete cessation of brain and heart activity and, accordingly, the cessation of blood circulation and breathing, and at the same time, the coldness and dryness of the body. Therefore, the complete cessation of brain activity before the complete cessation of heart activity and, accordingly, blood circulation and breathing is not considered death, nor is it sufficient for the application of the rulings on the dead, such as washing, shrouding, and burying the dead. Therefore, washing, shrouding, and burial cannot be performed for one who has a heartbeat, blood circulation, and breathing, even if his brain has no activity. Yes, the complete cessation of brain activity is the beginning of the prolonged process of death and a stage of it that cannot be reversed. It is referred to in the terminology of jurists as “unstable life”; as one of our companions informed us, he said:

«سَأَلَنِي طَبِيبٌ بِإِيرَانَ أَنْ أَسْأَلَ الْمَنْصُورَ الْهَاشِمِيَّ الْخُرَاسَانِيَّ أَيَّدَهُ اللَّهُ تَعَالَى عَنْ تَوَقُّفِ نَشَاطِ الدِّمَاغِ طُرًّا، فَسَأَلْتُهُ عَنْهُ، فَقَالَ: سَكْرَةٌ مِنْ سَكَرَاتِ الْمَوْتِ، قُلْتُ: تُرِيدُ حَيَاةً غَيْرَ مُسْتَقِرَّةٍ؟ قَالَ: هَكَذَا يَقُولُونَ»[1]; “A doctor in Iran asked me to ask His Eminence Mansoor Hashemi Khorasani may Allah support him about stopping all brain activities, and I asked, so he said: It is one type of unconsciousness from all types of death unconsciousness. I said: Do you mean unsettled life? He said: (The jurists) call it that.”

Based on this, one who has experienced brain death has not yet reached the final stage of death, but he is going through its stages and has reached a stage from which he cannot return, and is unable to do any voluntary actions of the living, such as acts of worship and transactions. From this aspect, he is like the dead; similar to one who is free falling from the sky to the ground, and naturally, there is no hope for his return or his survival, and he cannot do anything.

2. Is it permissible to stop the treatment of the brain dead if it is not effective?

According to the opinion of Allamah Mansoor Hashemi Khorasani, may Allah Almighty protect him, if the heart activity of one who has experienced brain death is only the result of an external factor and artificial breathing, such that it will stop immediately if that is cut off and there is no hope of being free from the need for it even in the long term, then it is not obligatory to continue the treatment and it is permissible to stop using the external factor and artificial breathing; because continuing the treatment in this case is not justified and is considered irrational, but rather it may be a waste of wealth and harm to the person who is dying; as one of our companions informed us, he said:

«سَأَلْتُهُ عَنِ الطَّبِيبِ يُدْخِلُ جِهَازًا فِي جَوْفِ مَنْ مَاتَ دِمَاغُهُ، فَيُحَرِّكُ قَلْبَهُ، قَالَ: ذَلِكَ لَحْمٌ يَعْبَثُ بِهِ»[2]; “I asked His Eminence about a doctor who inserts a device into the abdomen of a person who has suffered brain death, so it makes his heart work, he said: It is a meat that he plays with.”

3. Is it permissible to transplant organs from the brain dead into the bodies of those who need them to survive?

According to the opinion of Allamah Mansoor Hashemi Khorasani, may Allah Almighty protect him, there is nothing wrong with transplanting organs from the brain dead into the bodies of believers whose lives, according to Sharia, must be preserved while it is usually not possible to do without this procedure; because this procedure, in this case, is done out of necessity, and necessity overrides the rulings of Sharia; considering that imposing an obligation on one who is forced by necessity is abhorrent and is not issued from Allah, glory be to Him; as He has said as a general rule: ﴿فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلَا عَادٍ فَلَا إِثْمَ عَلَيْهِ ۚ إِنَّ اللَّهَ غَفُورٌ رَحِيمٌ﴾[3]; “Whoever is forced by necessity, not desiring, nor exceeding the limit, no sin is upon him. Indeed, Allah is the All-Forgiving, the Most Merciful.” Yes, necessity does not remove the prohibition of killing; because taking the life of another to preserve one’s own life is considered “exceeding the limit and transgression.” However, the removal of an organ from one whose life has already become unstable and is approaching its inevitable and irreversible end is not considered killing him; because in this case, his death is not attributed to the removal of the organ, but rather to what has brought his life to its final stages of decline; like removing the intestines of a person whose jugular veins have already been cut or shooting him in the head while his heart and lungs have already been shot, assuming that cutting his jugular veins or shooting him in the heart and the lungs would be enough to kill him, and removing his intestines or shooting him in the head would be considered as achieving what has already been achieved or a crime against the dead. It is understood from here that the removal of an organ from one who has experienced bread death, even if it is one of the vital organs, is not considered killing him and does not require retribution; because his death was inevitable without the removal of the organ, and the removal of the organ did not play a decisive role in that. Based on this, there is no doubt that the rule of necessity includes the removal of the organ in this case; because the removal of the organ, in this case, is not killing, and everything except for killing is permissible in cases of necessity. It is clear that the prohibition of harming a dead person or one who comes under the ruling of the dead is waived if it conflicts with the obligation to save a Muslim; as one of our companions informed us, he said:

«سَأَلْتُهُ عَنِ الْمَرْأَةِ يُدْرِكُهَا الْمَوْتُ وَفِي بَطْنِهَا وَلَدٌ يَرْكُلُ، قَالَ: يُشَقُّ بَطْنُهَا وَيُخْرَجُ الْوَلَدُ، وَسَأَلْتُهُ عَنِ الرَّجُلَيْنِ يَخِرُّ السَّقْفُ عَلَيْهِمَا فِي زَلْزَلَةٍ أَوْ طُوفَانٍ أَوْ سَيْلٍ، فَيَهْلِكُ أَحَدُهُمَا وَيَبْقَى الْآخَرُ أَيَّامًا لَا يَعْثِرُ عَلَيْهِ النَّاسُ، فَيَخَافُ أَنْ يُهْلِكَهُ الْجُوعُ، أَيَأْكُلُ مِنْ أَخِيهِ؟ قَالَ: يَأْكُلُ مِنْهُ مَا يَسُدُّ بِهِ رَمَقَهُ إِنْ عَلِمَ أَنَّهُ قَدْ هَلَكَ، ثُمَّ يَتَصَدَّقُ بِدِيَةِ مَا أَكَلَ مِنْهُ إِنْ نَجَّاهُ اللَّهُ، وَسَأَلْتُهُ عَنِ الرَّجُلِ يُحِيطُ بِهِ الْمَوْتُ لِمَرَضٍ لَا عِلَاجَ لَهُ أَوْ نَقْصٍ فِي عُضْوِهِ، فَلَا يَجِدُ إِلَّا عُضْوَ مَيِّتٍ، أَيَقْطَعُهُ وَيُرَقِّعُهُ؟ قَالَ: لَا بَأْسَ بِهِ إِذَا كَانَ عَلَى هَذِهِ الْحَالِ، وَيُنْفِقُ دِيَةَ مَا قَطَعَ فِي سَبِيلِ اللَّهِ إِنْ أَرَادَ شُكْرًا أَوْ أَرَادَ إِحْسَانًا»[4]; “I asked him about a woman who is dying, while there is a baby in her womb who kicks, he said: her abdomen must be opened and the baby must be taken out, and I asked him about two men whom the roof collapses on their head in an earthquake or a storm or a flood, so one of them dies and the other stays for a few days while the people do not find him, so he fears that he would starve do death, can he eat from (the body of) his brother? He said: He eats as much as he can keep alive if he knows that he is dead and then he pays Diya of what he has eaten (as follows) as donation, if Allah saved him, and I asked him about a man who is dying by an incurable disease or an organ disability, so he does not find an organ but the one belonging to a dead person, does he cut it and transplant it to himself? He said: There is no problem if he is in this state and he pays the Diya of what he has cut in the way of Allah if he has a will of gratitude or a good will.”

4. Does the transplantation of organs from the brain dead into the bodies of those who need them to survive require blood money?

According to the opinion of Allamah Mansoor Hashemi Khorasani, may Allah Almighty protect him, the removal of organs from the brain dead in cases of necessity is permissible, and what is permissible cannot require blood money, such as cutting a limb in cases of prescribed penalty and retribution that does not require blood money due to its permissibility; especially considering that blood money is a form of punishment and appropriate for one who does what is not permissible, while one who has removed an organ from a dead person to save a Muslim has done a permissible deed, but rather a good deed according to Sharia and common practice, and therefore, he does not deserve punishment; as Allah Almighty has said: ﴿مَا عَلَى الْمُحْسِنِينَ مِنْ سَبِيلٍ﴾[5]; “There is no way (to blame) against those who do good,” and said: ﴿هَلْ جَزَاءُ الْإِحْسَانِ إِلَّا الْإِحْسَانُ﴾[6]; “Is the reward of goodness anything but goodness?!” It is understood from here that those who say it is obligatory to pay the blood money of a dead person along with the permissibility of removing his organs issue fatwas in a contradictory manner; because if paying the blood money of a dead person is obligatory, it is not permissible to remove his organs, and if it is permissible to remove his organs, it is not obligatory to pay his blood money, and combining them contradicts the rule. In addition to that, they do not consider the blood money of a dead person for his heirs but rather say that it is only to be spent on good deeds on his behalf, while removing his organs to save a Muslim is one of the greatest good deeds and fulfills the purpose of paying blood money in the best possible way; as one of our companions informed us, he said:

«سَأَلْتُ الْمَنْصُورَ أَيَّدَهُ اللَّهُ تَعَالَى عَنِ الرَّجُلِ مَاتَ دِمَاغُهُ وَقَلْبُهُ نَابِضٌ، أَهُوَ مَيِّتٌ؟ قَالَ: لَوْ كَانَ مَيِّتًا مَا سَأَلْتَنِي عَنْهُ! قُلْتُ: إِنَّهُ لَا شُعُورَ لَهُ، وَلَا تَكَلُّمَ، وَلَا تَحَرُّكَ، وَلَا تَنَفُّسَ، إِلَّا إِذَا أُجْبِرَ عَلَيْهِ بِجِهَازٍ وَلَا يُرْجَى بَقَاؤُهُ، وَإِنَّمَا يَنْبَضُ قَلْبُهُ لِمَا يُجْبَرُ عَلَيْهِ مِنَ التَّنَفُّسِ، وَلَوْ لَمْ يُجْبَرْ عَلَيْهِ لَسَكَنَ! قَالَ: لَيْسَ عَلَيْكَ أَنْ تُجْبِرَهُ عَلَيْهِ إِذَا كَانَ عَبَثًا لَا طَائِلَ تَحْتَهُ، دَعْهُ يَذْهَبُ إِلَى رَبِّهِ إِذَا دَعَاهُ، قُلْتُ: فَإِنْ كَانَ مَرِيضٌ يُضْطَرُّ إِلَى عُضْوٍ مِنْ أَعْضَائِهِ كَقَلْبٍ أَوْ كَبِدٍ، أَيَجُوزُ أَنْ يُؤْخَذَ ذَلِكَ الْعُضْوُ فَيُلْصَقَ بِهِ؟ قَالَ: لَا بَأْسَ بِهِ إِذَا كَانَ الْمَرِيضُ مُؤْمِنًا يُخَافُ عَلَيْهِ الْمَوْتُ، وَلَا دِيَةَ عَلَيْهِ وَلَا عَلَى الْآخِذِ، قُلْتُ: إِنَّهُمْ يَقُولُونَ عَلَيْهِ دِيَةُ الْمَيِّتِ تُصْرَفُ عَنْهُ فِي وُجُوهِ الْخَيْرِ! قَالَ: وَأَيُّ خَيْرٍ أَخْيَرُ مِنْ إِحْيَاءِ نَفْسٍ مُؤْمِنَةٍ مَنْ أَحْيَاهَا فَكَأَنَّمَا أَحْيَى النَّاسَ جَمِيعًا؟! ثُمَّ قَالَ: مَنْ أَخْرَجَ قَلْبَ مَيِّتٍ أَوْ كَبِدَهُ ظُلْمًا فَعَلَيْهِ الدِّيَةُ»[7]; “I asked His Eminence Mansoor may Allah help him about a man whose brain is dead, while his heart is beating, is he dead? He said: If he were dead, you would not ask me about him! I said: He has no sense, no speech, no movement, no breathing except when he is made to do so by a device, and there is no hope for his survival, and his heart beats only because of the breathing that is forced upon it, and if it is not forced upon it, it will stop! He said: It is not your responsibility to make it to do so whenever it is pointless and useless, let him to go to his Lord if He has called him! I said: So if there is a patient who urgently needs an organ of his such as the heart or the liver, is it permissible to take that organ and transplant it to him? He said: There is no problem if the patient is a believer and there is a fear that he is dying and there is no Diya for him or for the one who took (the organ) for him! I said: They say that the Diya of the deceased is his responsibility to spend in good deeds by him! He said: What good deed is better than reviving the soul of a believer that whoever revives it is like he has revived the souls of all people?! Then he said: Whoever removes the heart or the liver of a corpse out of oppression is responsible for the Diya.”

Yes, paying the blood money of a dead person to be spent on good deeds on his behalf, especially if his organ was removed before the cessation of his heart activity, is recommended; as mentioned in the illuminating statement of His Eminence Khorasani, may Allah Almighty protect him. Also, one of our companions informed us, he said:

«سَأَلْتُ الْعَالِمَ عَنِ الْمَيِّتِ يُخْرَجُ قَلْبُهُ لِيُلْحَقَ بِحَيٍّ مُضْطَرٍّ إِلَيْهِ، قَالَ: لَا أَرَى بِذَلِكَ بَأْسًا، ذَلِكَ مِنْ آيَاتِ اللَّهِ، ذَلِكَ مِمَّا قَالَ اللَّهُ تَعَالَى: ﴿يُخْرِجُ الْحَيَّ مِنَ الْمَيِّتِ﴾[8]، قُلْتُ: لَا تَزَالُ تَفْتَحُ عَلَيْنَا أَبْوَابًا مِنَ الْعِلْمِ! فَهَلْ لَهُ مِنْ دِيَةٍ عَلَى مَنْ فَعَلَ ذَلِكَ بِهِ؟ قَالَ: إِنْ فَعَلَ ذَلِكَ بِهِ وَقَدْ سَكَنَتْ أَنْفَاسُهُ فَلَيْسَ عَلَيْهِ دِيَةٌ، وَإِنْ فَعَلَ وَهُوَ يَتَنَفَّسُ أَرَى أَنْ يَتَصَدَّقَ عَنْهُ عُشْرَ الدِّيَةِ لِئَلَّا يَخْتَلِجَ فِي صَدْرِهِ أَنَّهُ آثِمٌ! فَأَخَذَنِي الْبُكَاءُ، فَقَالَ: وَمَا يُبْكِيكَ؟! قُلْتُ: رَأَيْتُ عَظَمَتَكَ فِي غُرْبَتِكَ فَبَكَيْتُ! قَالَ: الْعَظَمَةُ لِلَّهِ، وَإِنَّمَا أَنَا عَبْدٌ آتَانِي مِنْ عِنْدِهِ رَحْمَةً، وَجَعَلَنِي هَادِيًا مَهْدِيًّا»[9]; “I asked His Eminence about a dead person whose heart is taken out to be transplanted to a living person who urgently needs it, he said: I do not see any problem in it. It is one of the signs of Allah. It is an example of what Allah Almighty has said: “He brings the living out of the dead!” I said: You always open some doors of knowledge for us! However, is there any Diya upon the one who did this to him? He said: If he did this to him while his breathing was stopped, there is no Diya upon him, and if he did it while he was breathing (artificially), I would see (it good) that he donates for him one tenth of the Diya (equivalent to ten camels or one hundred dinars) so that he would not feel that he is a sinner in his heart! (Ibn Mahmud says:) At this time I cried, His Eminence said: What made you cry?! I said: I saw your greatness in your loneliness, so I cried! He said: Greatness is for Allah and I am just a servant whom He has given me mercy from Himself and has made me a guided guidance.”

5. Does the transplantation of organs from the brain dead into the bodies of those who need them to survive require the permission of their guardians?

According to the opinion of Allamah Mansoor Hashemi Khorasani, may Allah Almighty protect him, removing the organs of the brain dead in cases of necessity does not require the permission of their guardians; because, on the one hand, there is no evidence that the authority of the guardians of a dead person or one who comes under the ruling of the dead extends to the organs of his body, and the principle is that it does not, and on the other hand, the obligation to save a Muslim by removing the organs of the body of a dead person or one who comes under the ruling of the dead is greater than the obligation to seek the permission of his guardians, assuming that it is proven, to the extent that it is preferred over it in cases of conflict. Yes, if the obligation to seek the permission of the guardians to remove the organs of the brain dead is proven, it is not waived except if it is impossible to seek their permission due to their absence or their refusal. However, the obligation to seek their permission in this case is ineffective; because their permission or lack of permission is the same, meaning that there is no obstacle to removing the organs of the brain dead in cases of necessity. It is understood from here that seeking the permission of the guardians is not obligatory for one who is forced by necessity, but if he asks them for permission, they must give it to him; as one of our companions informed us, he said:

«سَأَلْتُهُ عَنِ الْمُضْطَرِّ الَّذِي قَدْ أَحَاطَ بِهِ الْمَوْتُ لِنَقْصٍ فِي عُضْوِهِ أَوْ عَيْبٍ، فَلَا يَجِدُ إِلَّا مَيِّتًا، أَلَهُ أَنْ يَقْطَعَ ذَلِكَ الْعُضْوَ مِنْهُ، فَيُلْحِقَهُ بِنَفْسِهِ، إِذَا خَافَ أَنْ يُدْرِكَهُ الْمَوْتُ؟ قَالَ: مَاذَا يُرِيدُ؟! أَيُرِيدُ أَنْ يَفِرَّ مِنَ الْمَوْتِ؟! ﴿قُلْ لَنْ يَنْفَعَكُمُ الْفِرَارُ إِنْ فَرَرْتُمْ مِنَ الْمَوْتِ أَوِ الْقَتْلِ وَإِذًا لَا تُمَتَّعُونَ إِلَّا قَلِيلًا﴾[10]، ثُمَّ سَكَتَ حَتَّى ظَنَنْتُ أَنَّهُ لَا يُجَوِّزُهُ، ثُمَّ قَالَ: لَيْسَ عَلَيْهِ جُنَاحٌ إِذَا كَانَ بَالِغًا ذَلِكَ الْمَبْلَغَ، قُلْتُ: فَهَلْ عَلَيْهِ أَنْ يَسْتَأْذِنَ لِذَلِكَ أَوْلِيَاءَ الْمَيِّتِ؟ قَالَ: لَيْسَ عَلَيْهِ أَنْ يَسْتَأْذِنَهُمْ إِذَا كَانَ بَالِغًا ذَلِكَ الْمَبْلَغَ، وَإِنِ اسْتَأْذَنَهُمْ فَلَيْسَ لَهُمْ أَنْ يَمْنَعُوهُ إِنْ وَجَدُوهُ مُؤْمِنًا، فَإِنَّمَا الْمُؤْمِنُونَ بِمَنْزِلَةِ الْجَسَدِ الْوَاحِدِ، إِذَا اشْتَكَى عُضْوًا مِنْهُ وَجَدَ أَلَمَ ذَلِكَ فِي سَائِرِ أَعْضَائِهِ، لِأَنَّ أَرْوَاحَهُمْ مِنْ رُوحٍ وَاحِدَةٍ، وَإِنَّ رُوحَ الْمُؤْمِنِ لَأَشَدُّ اتِّصَالًا بِرُوحِ اللَّهِ مِنِ اتِّصَالِ الشُّعَاعِ بِالشَّمْسِ»[11]; “I asked His Eminence about an urgently needy person who is about to die due to a defect or disability in his organ, so he has no access except to a dead person, can he cut that organ from that dead person and implant it to himself whenever he fears of dying? He said: What does he want?! Does he want to escape from death?! “Say that fleeing will never benefit you if you flee from death or being killed, and then you will no benefit but only a little!”. Then His Eminence was silent until I thought he did not consider it permissible, then he said: There is no sin for him if he has reached this level (of urgency), I said: In this case, is it obligatory for him to seek permission from the guardians of the dead person for that? He said: It is not obligatory for him to ask their permission whenever he has reached this level (of urgency), and if he asks their permission, they should not stop him if they find him a believer; because believers are like one body that whenever an organ of it suffers, other organs will feel its pain as well, because their souls are from one soul and the soul of the believer is more connected to the soul of Allah from the sunlight to the sun.”

Yes, the guardians of the brain dead should permit patients in need who are at risk of death, if they are believers and not disbelievers or oppressors, to use their organs to save themselves; because this is beneficial for these patients and their families as well as for the brain dead and their guardians, all of them; as one of our companions informed us, he said:

«اسْتَشَارَهُ رَجُلٌ فِي تَرْقِيعِ قَلْبِ أَبِيهِ بَعْدَ أَنْ مَاتَ دِمَاغُهُ، وَقَالَ: يَأْتِينِي رَجُلٌ مَرِيضٌ يُخَافُ عَلَيْهِ الْمَوْتُ، فَيَسْأَلُنِي أَنْ آذَنَ لَهُ فِي ذَلِكَ، فَلَا أَدْرِي مَا أَقُولُ لَهُ، قَالَ: انْظُرْ، فَإِنْ كَانَ مُسْلِمًا يُوَالِي آلَ مُحَمَّدٍ صَلَّى اللَّهُ عَلَيْهِ وَآلِهِ وَسَلَّمَ وَيُوَالِينِي فَأْذَنْ لَهُ، فَإِنَّكَ لَوْ دَفَنْتَ قَلْبَ أَبِيكَ فِي صَدْرِ مُؤْمِنٍ يَذْكُرُ اللَّهَ وَيَعْمَلُ الصَّالِحَاتِ خَيْرٌ مِنْ أَنْ تَدْفَنَهُ فِي التُّرَابِ يَأْكُلَهُ الدُّودُ! ثُمَّ قَالَ: ائْذَنْ لَهُ يُحْيِي اللَّهُ بِهِ جُزْءَ أَبِيكَ يَعْبُدَهُ وَيَكُونَ لَهُ ثَوَابُ عِبَادَتِهِ»[12]; “A man consulted with His Eminence about his father’s heart transplant after brain death and said: A sick man who is afraid of dying comes to me and asks for my permission for that and I do not know what to say to him, he said: Take a look, then if he is a Muslim who loves the family of Muhammad peace be upon him and his family and he loves me, give him permission; for if you bury your father’s heart in the chest of a believer who remembers Allah and does good deeds, it is better than burying it in the ground so that the worms would eat it! Then he said: Give him permission so that Allah may resurrect a part of your father with him that worships Allah and the reward of his worship would be for him.”