What is the Allamah Mansoor Hashemi Khorasani’s opinion about the organ transplantation for those who have suffered from brain death?
Regarding the organ transplantation for people with brain death, there are five basic questions that will be answered as follow:
1. Are the people who have suffered from brain death considered dead?
According to the opinion of Allamah Mansoor Hashemi Khorasani (may God protect him), death means the complete cessation of the soul from the body, which occurs with the complete cessation of the activity of brain and heart, and consequently the cessation of blood flow and respiration, and simultaneously cooling and drying of the body. With this description, the complete cessation of brain activity before the complete cessation of heart activity, and consequently flow of blood and respiration is not considered death and is not sufficient for the follow of laws of dead individuals, such as bathing, enshrouding and burring. Therefore, someone who has heartbeat, blood flow and respiration cannot be bathed, enshrouded and buried, even if his brain does not have an activity. Yes, the complete cessation of brain activity is the beginning of the prolonged process of death and is an irreversible stage of its stages, which, in the term of the jurists, is called “unsettled life”; as one of our companions informed us, said:
«سَأَلَنِي طَبِیبٌ أَنْ أَسْأَلَ الْمَنْصُورَ أَیَّدَهُ اللّهُ تَعَالَى عَنْ تَوَقُّفِ نَشاطِ الدِّماغِ طُرّاً، فَسَأَلْتُهُ عَنْهُ فَقالَ: سَكْرَةٌ مِنْ سَكَراتِ الْمَوتِ! قُلْتُ: تُریدُ حَیاةً غَیْرَ مُسْتَقِرَّةٍ؟ قالَ: هَكَذَا یَقُولُونَ»; “A physician wanted me to ask his honor Mansoor (may God help him) about stopping all the activities of brain, and I asked, so he said: It is an unconsciousness of death’s unconsciousnesses! I said: Do you mean unsettled life? He said: they say similar to this (meaning, it is so-called similar to that)”!
Accordingly, someone, who has suffered from brain death due to the activity of his heart, has not yet reached the final destination of death, but is going through its stages and has reached a stage of its stages, who is no longer able to return and able to do voluntary actions of the living people such as worships and transactions, and in this respect, is similar to the dead individuals; similar to someone who is thrown from the sky and is falling freely toward the earth, and naturally there is no hope of his return and no hope of his survival, and is unable to do anything.
2. Is it permissible to discontinue treatment for those who have suffered from brain death, if there is no benefit in treating them?
According to the opinion of Allamah Mansoor Hashemi Khorasani (may God protect him), whenever the activity of the heart of those who have suffered from brain death is solely due to an external element and artificial respiration, in a way that with its disconnection will stop immediately, and there be no hope of being needless from that, even in the long run, it is not obligatory to continue this work, and the use of external element, and artificial respiration can be stopped; because its continuation, in such a case, is nonsense and is not considered rational, but may be an example of squandering property and harassing someone who Is dying; as one of our companions informed us, said:
«سَأَلْتُهُ عَنِ الطَّبِیبِ یُدْخِلُ جِهازاً فِي جَوْفِ مَنْ ماتَ دِماغُهُ فَیُحَرِّكُ قَلْبَهُ، قالَ: ذَلِكَ لَحْمٌ یَعْبَثُ بِهِ»; “I asked his honor about a physician who inserts a device into the abdomen of someone who has suffered from brain death, so he makes his heart beating, said: It is a meat that he plays with”.
3. Is amputation of organs of those who have suffered from brain death permissible for transplantation to the bodies of those who need these organs for survival?
According to the opinion of Allamah Mansoor Hashemi Khorasani (may God protect him), the amputation of the organs of those who have suffered from brain death to be transplanted to the bodies of believers, whose lives’ saving are obligatory in Islam, and without that it is usually not possible, has no problem; because this work, in such a situation, is a matter of emergency, and emergency governs the laws of Sharia according to the law of reason; Considering that assigning a task to a compelled person is rationally indecent and is not issued from God; as He has said as a general rule: ﴿فَمَنِ اضْطُرَّ غَيْرَ بَاغٍ وَلَا عَادٍ فَلَا إِثْمَ عَلَيْهِ ۚ إِنَّ اللَّهَ غَفُورٌ رَحِيمٌ﴾; “Should someone be compelled, without being oppressor or aggressive, there shall be no sin upon him. Indeed Allah is all-forgiving, all-merciful”. Yes, emergency does not remove the law of murder; because ending life of another person for saving our life is considered ”oppression or aggression”, but the amputation of someone’s organ, whose life has already been unsettled and is in a state of inevitable decline and is unstoppable, is not considered murder; because his death, in this situation, does not adduce to that, but adduces to something that has thrown his life into the downhill of decline; similar to taking out the intestines of someone whose neck artery has already been cut or shooting the head of someone whose heart and lungs have already been shot, assuming that cutting the neck artery or shooting the heart and lungs is sufficient for death, and taking out the intestines or shooting the head afterwards, is similar to reaching what has been reached and is in the law of the crime against the corpse. It is understood from here that the amputation of someone’s organ who has suffered from brain death, even if it is from the chief organs, is not considered murder and does not require retribution; because his death was also certain without the amputation of such the organ, and the amputation of such the organ did not play a decisive role in it. Accordingly, there is no doubt that the rule of emergency includes the amputation of the organ in this situation; because amputation in this situation is less than murder, and less than murder - whatever it is - is permissible in the state of emergency. Yes, there is no doubt that the sanctity of the crime against the corpse and someone who is in the law of the corpse, whenever conflicts with the obligation of saving the life of a living and Muslim man, is abolished; as one of our companions Informed us, said:
«سَأَلْتُهُ عَنِ الْمَرْأَةِ یُدْرِكُهَا الْمَوتُ وَ فِي بَطْنِها وَلَدٌ یَرْكُلُ، قالَ: یُشَقُّ بَطْنُها وَ یُخْرَجُ الْوَلَدُ وَ سَأَلْتُهُ عَنِ الرَّجُلَیْنِ یَخِرُّ السَّقْفُ عَلَیْهِما فِي زَلْزَلَةٍ أَوْ طُوفانٍ أَوْ سَیْلٍ فَیَهْلِكُ أَحَدُهُما وَ یَبْقَی الآخَرُ أَیّاماً لا یَعْثِرُ عَلَیْهِ النّاسُ فَیَخافُ أَن یُهْلِكَهُ الْجُوعُ، أَیَأْكُلُ مِنْ أَخِیهِ؟ قالَ: یَأْكُلُ مِنْهُ ما یَسُدُّ بِهِ رَمَقَهُ إِنْ عَلِمَ أَنَّهُ قَدْ هَلَكَ ثُمَّ یَتَصَدَّقُ بِدِیَةِ ما أَكَلَ مِنْهُ إِنْ نَجّاهُ اللّهُ وَ سَأَلْتُهُ عَنِ الرَّجُلِ یُحِیطُ بِهِ الْمَوتُ لِمَرَضٍ لا عِلاجَ لَهُ أَوْ نَقْصٍ فِي عُضْوِهِ فَلا یَجِدُ إِلّا عُضْوَ مَیِّتٍ أَیَقْطَعُهُ وَ یُرَقِّعُهُ؟ قالَ: لا بَأسَ بِهِ إِذا كانَ عَلَى هَذِهِ الْحالِ وَ یُنْفِقُ دِیَةَ ما قَطَعَ فِي سَبِیلِ اللّهِ إِنْ أَرادَ شُكْراً أَوْ أَرادَ إِحْساناً»; “I asked his honor about a woman whose death is approached, while there is a baby in her womb who is kicking, said: her womb will be cut, and the baby will be taken out, and I asked his honor about two men, who the roof in earthquake or storm or a flood is collapsed on them; so one of them perishes, and the other stays for a few days, while people do not find him, so he is afraid that the hunger will perish him, will he eat from his brother (corpse)? He said: He eats of that as much as it keeps his strength, if he knows that he has been perished, and then he will pay the blood money of what he has eaten as charity (it is Mustahabb as it comes at the following), if God saved him, and I asked his honor about a man who is surrounded by death due to an incurable pain or a defect in organ, so he does not find any organ except of a corpse, Does he must amputate it and transplant to himself? He said: There is no problem if he is in this situation, and he spends the blood money of what he has cut in the way of God, if he has the will of gratitude or a will of goodness”.
4. Does the amputation of those who have suffered from brain death for transplantation to the bodies of those who need them to survive, require blood money?
According to the opinion of Allamah Mansoor Hashemi Khorasani (may God protect him), amputation of the organs of those who have suffered from brain death is permissible in the state of emergency, and doing what is permissible cannot require blood money, such as amputating the organ of someone for punishment and retaliation, which does not require blood money according to its permission; especially considering that blood money is a form of punishment and is suitable for someone who has done something that is not permissible, while the amputator of the corpse’s organ, for saving a Muslim’s life, has not done impermissible work, but has done goodness according to sharia and custom, and with this description does not deserve punishment; as God has said: ﴿مَا عَلَى الْمُحْسِنِينَ مِنْ سَبِيلٍ﴾; “There is no cause for (punishment) the virtuous” and has said: ﴿هَلْ جَزَاءُ الْإِحْسَانِ إِلَّا الْإِحْسَانُ﴾; “Is the requital of goodness anything but goodness?!”. It is understood from here that those who consider it obligatory to pay the blood money of a corpse, assuming that its organs are promised to be taken, issue fatwas in a contradictory manner; because if it is obligatory to pay the blood money of a corpse, taking its organs will not be permissible, and if it is permissible to take its organs, it will not be obligatory to pay its blood money, and the sum between these two is against the rule. Moreover, they do not consider the blood money of the corpse for his heirs, but generally believe that it is only for consumption in good deeds on his part, while the essence of taking his organs to save the life of a Muslim is the greatest good deed on his part, and achieves the purpose of paying the blood money on the best possible way; as one of our companions informed us, said:
«سَأَلْتُهُ عَنِ الرَّجُلِ ماتَ دِماغُهُ وَ قَلْبُهُ نابِضٌ، أَهُوَ مَیِّتٌ؟ قالَ: لَوْ كانَ مَیِّتاً ما سَأَلْتَنِي عَنْهُ! قُلْتُ: إِنَّهُ لا شُعُورَ لَهُ وَ لا تَكَلُّمَ وَ لا تَحَرُّكَ وَ لا تَنَفُّسَ إِلّا إِذا أُجْبِرَ عَلَیْهِ بِجِهازٍ وَ لا يُرْجَى بَقائُهُ وَ إِنَّما یَنْبُضُ قَلْبُهُ لِما یُجْبَرُ عَلَیْهِ مِنَ التَّنَفُّسِ وَ لَوْ لَمْ یُجْبَرْ عَلَیْهِ لَسَكَنَ! قالَ: لَیْسَ عَلَیْكَ أَنْ تُجْبِرَهُ عَلَیْهِ إِذا كانَ عَبَثاً لا طائِلَ تَحْتَهُ! دَعْهُ یَذْهَبَ إِلَى رَبِّه إِذا دَعاهُ! قُلْتُ: فَإِنْ كانَ مَرِیضٌ یَضْطَرُّ إِلَى عُضْوٍ مِنْ أَعْضائِهِ كَقَلْبٍ أَوْ كَبِدٍ أَیَجُوزُ أَنْ یُأخَذَ ذَلِكَ الْعُضْوُ فیُلْصَقَ بِهِ؟ قالَ: لا بَأسَ بِهِ إِذا كانَ الْمَرِیضُ مُؤْمِناً یُخافُ عَلَیْهِ الْمَوتُ وَ لا دِیَةَ عَلَیْهِ وَ لا عَلَی الآخِذِ! قُلْتُ: إِنَّهُمْ یَقُولُونَ عَلَیْهِ دِیَةُ الْمَیِّتِ تُصْرَفُ عَنْهُ فِي وُجُوهِ الْخَیْرِ! قالَ: وَ أَيُّ خَیْرٍ أَخْیَرُ مِنْ إِحْیاءِ نَفْسٍ مُؤْمِنَةٍ مَنْ أَحْیاها فَكَأَنَّما أَحْیَی النّاسَ جَمِیعاً؟! ثُمَّ قالَ: مَنْ أَخْرَجَ قَلْبَ مَیِّتٍ أَوْ كَبِدَهُ ظُلْماً فَعَلَیْهِ الدِّیَةُ»; “I asked his honor about a man whose brain is dead, while his heart is beating, is he dead? He said: If he was dead, you would not ask me about him! I said: He has no senses, no speech, no movement, no breathing, except when he is forced to do so by a device, and there is no hope for his survival, and his heart beats only because of the respiration that is forced upon him, and if it is not forced, it will stop! He said: It is not your responsibility to force him to do that whenever it is futile and useless! Leave him to go to his God, if He has called him! I said: if there is a patient who is compelled of an organ of his organs, such as the heart or the liver, is it permissible to amputate that organ and transplant it to him? He said: There is no problem if the patient is a believer, and there is the afraid of his death, and there is no blood money for him or for the person who amputated (the organ) for him! I said: They say that the blood money of the corpse is on him in order to be spent in good deeds on his part! He said: What good deed is better than reviving the life of a believer that whoever revives it as if he has revived the lives of all people?! Then he said: Whoever takes out the heart or liver of a corpse out of oppression, the blood money is on him”!
Yes, it is Mustahabb to pay the blood money of the corpse in order to be used in good deeds on his part, especially if his organ has been amputated before the cessation of his heart activity, and it is considered a very good deed; as it is stated in a lighting saying from his honor Khorasani (may God protect him) and in addition, one of our companions informed us, said:
«سَأَلْتُهُ عَنِ الْمَیِّتِ یُخْرَجُ قَلْبُهُ لِیُلْحَقَ بِحَيٍّ مُضْطَرٍّ إِلَیْهِ، قالَ: لا أَرَى بِذَلِكَ بَأساً! ذَلِكَ مِنْ آیاتِ اللّهِ! ذَلِكَ مِمّا قالَ اللّهُ تَعَالَى: ﴿يُخْرِجُ الْحَيَّ مِنَ الْمَيِّتِ﴾! قُلْتُ: لا تَزالُ تَفْتَحُ عَلَیْنا أَبْواباً مِنَ الْعِلْمِ! فَهَلْ لَهُ مِنْ دِیَةٍ عَلَى مَنْ فَعَلَ ذَلِكَ بِهِ؟ قالَ: إِنْ فَعَلَ ذَلِكَ بِهِ وَ قَدْ سَكَنَتْ أَنْفاسُهُ فَلَیْسَ عَلَیْهِ دِیَةٌ وَ إِنْ فَعَلَ وَ هُوَ یَتَنَفَّسُ أَرَى أَنْ یَتَصَدَّقَ عَنْهُ عُشْرَ الدِّیَةِ لِئَلّا یَخْتَلِجَ فِي صَدْرِهِ أَنَّهُ آثِمٌ! فَأَخَذَنِي الْبُكاءُ، فَقالَ: وَ ما یُبْكِیكَ؟! قُلْتُ: رَأَیْتُ عَظَمَتَكَ فِي غُرْبَتِكَ فَبَكَیْتُ! قالَ: الْعَظَمَةُ لِلّهِ وَ إِنَّما أَنا عَبْدٌ آتَانِي مِنْ عِنْدِهِ رَحْمَةً وَ جَعَلَنِي هادِیاً مَهْدِیّاً»; “I asked his honor about a corpse whose heart is being taken out to be transplanted to a living who is compelled of it, said: I do not see any problem in it! It is one of the verses of God! It is an example of what Almighty God has said: <He brings the living from the dead>! I said: You always open the doors of knowledge toward us! With this description, is there any blood money for him on who did this to him? He said: If he did this to him while his breath was cut, there is no blood money on him, and if he did it while he was breathing (artificially), I see (expedient) that one tenth of the blood money (equivalent to ten camels or one hundred Dinars) gives as a charity on his part until he does not think that he is a sinner! (The narrator says:) I cried at this time! His honor said: What made you crying?! I said: I saw your greatness in your homelessness, so I cried! He said: Greatness is for God, and I am only a servant that He has given to me a mercy from Himself and has appointed me a guided guider”.
5. Is the amputation of organs of those who have suffered from brain death for transplantation to the bodies of those who need them for survival, dependent on the permission of their guardians?
According to the opinion of Allamah Mansoor Hashemi Khorasani (my God protect him) for amputation of the organs of those who have suffered from brain death in the state of emergency, the permission of their guardians is not required; because, on the one hand, the inclusion of the guardianship of the corpse’s guardians and the person who is in the law of the corpse has no reason and is against the principle, and on the other hand, the obligation of saving the life of a Muslim by amputation of the corpse’s body’s organ and someone who is in the law of the corpse is greater than the obligation of gaining the permission of his guardians, assuming it is proof, to the extent that, in case of conflict, it precedes that. Yes, if the obligation of gaining the permission of the guardians to amputate the organs of those who have suffered from brain death is proof, it will be revoked only when it is not possible to obtain it due to their absence or refusal; except in this case, the obligation to obtain their permission is vain; because their avoidance of permission is equal to their permission; meaning, it does not prevent to amputation of the organs of those who have suffered from brain death in the state of emergency. It is understood from here that obtaining the permission of guardians is not obliged to the compelled person, but if he asks for their permission, it is obligatory on them to give him the permission; as one of our companions informed us, said:
«سَأَلْتُهُ عَنِ الْمُضْطَرِّ الَّذِي قَدْ أَحاطَ بِهِ الْمَوتُ لِنَقْصٍ فِي عُضْوِهِ أَوْ عَیْبٍ فَلا یَجِدُ إِلّا مَیِّتاً، أَ لَهُ أَنْ یَقْطَعَ ذَلِكَ الْعُضْوَ مِنْهُ فَیُلْحِقَهُ بِنَفْسِهِ إِذا خافَ أَنْ یُدْرِكَهُ الْمَوتُ؟ قالَ: ماذا یُرِیدُ؟! أَیُرِیدُ أَن یَفِرَّ مِنَ الْمَوتِ؟! ﴿قُلْ لَنْ يَنْفَعَكُمُ الْفِرَارُ إِنْ فَرَرْتُمْ مِنَ الْمَوْتِ أَوِ الْقَتْلِ وَإِذًا لَا تُمَتَّعُونَ إِلَّا قَلِيلًا﴾! ثُمَّ سَكَتَ حَتَّى ظَنَنْتُ أَنَّهُ لا یُجَوِّزُهُ ثُمَّ قالَ: لَیْسَ عَلَیْهِ جُناحٌ إِذا كانَ بالِغاً ذَلِكَ الْمَبْلَغَ، قُلْتُ: فَهَلْ عَلَیْهِ أَن یَسْتَأذِنَ لِذَلِكَ أَوْلیاءَ الْمَیِّتِ؟ قالَ: لَیْسَ عَلَیْهِ أَن یَسْتَأذِنَهُمْ إِذا كانَ بالِغاً ذَلِكَ الْمَبْلَغَ وَ إِنِ اسْتَأذَنَهُمْ فَلَیْسَ لَهُمْ أَن یَمْنَعُوهُ إِنْ وَجَدُوهُ مُؤْمناً، فَإِنَّمَا الْمُؤْمِنُونَ بِمَنْزِلَةِ الْجَسَدِ الْواحِدِ إِذَا اشْتَكَى عُضْواً مِنْهُ وَجَدَ أَلَمَ ذَلِكَ فِي سائِرِ أَعْضائِهِ، لِأَنَّ أَرْواحَهُمْ مِنْ رُوحٍ واحِدَةٍ وَ إِنَّ رُوحَ الْمُؤْمِنِ لَأَشَدُّ اتِّصالاً بِرُوحِ اللّهِ مِنِ اتِّصالِ الشُّعاعِ بِالشَّمْسِ»; “I asked his honor about a compelled person that the death surrounded him due to a defect or negligence in his organ, so he has no access except to a corpse, can he cut that organ from that corpse and transplant it to himself, whenever he fears that death will approach him? He said: What does he want?! Does he want to escape from death?! <Say, ‘Flight will not avail you should you flee from death or from being killed, and then you will be let to enjoy only for a little while>! Then his honor became silent, until I thought he did not consider it permissible, then he said: It is not a sin for him if he has reached to this level (of emergency), I said: In this case, is it obligatory for him to ask permission from the guardians of the dead for that? He said: It is not obligatory for him to ask their permission whenever he has reached to this level (of emergency), and if he asks their permission, they are not able to prevent him if they find him a believer; because believers are similar to a body that whenever an organ of it, is suffering from pain, it feels its pain in its other organs as well, because their souls are from one soul, and the believer’s soul is more connected to the God’s soul than the sun’s rays to the sun”!
Yes, it is appropriate for the guardians of those who have suffered from brain death to promise the needful and dying patients - if they are believers and are not infidels or oppressors- to use their organs for saving their lives; because this work benefits both these patients and their families, as well as those who have suffered from brain death, and their guardians; as one of our companions informed us, said:
«إِسْتَشارَهُ رَجُلٌ فِي تَرْقِیعِ قَلْبِ أَبِیهِ بَعْدَ أَنْ ماتَ دِماغُهُ وَ قالَ: یَأْتِینِي رَجُلٌ مَرِیضٌ یُخافُ عَلَیْهِ الْمَوتُ فَیَسْأَلُنِي أَنْ آذَنَ لَهُ فِي ذَلِكَ، فَلا أَدْرِي ما أَقُولَ لَهُ، قالَ: انْظُرْ فَإِنْ كانَ مُسْلِماً یُوالِي آلَ مُحَمَّدٍ صَلَّی اللّهُ عَلَیْهِ وَ آلِهِ وَ سَلَّمَ وَ یُوالِینِي فَأْذَنْ لَهُ فَإِنَّكَ لَوْ دَفَنْتَ قَلْبَ أَبِیكَ فِي صَدْرِ مُؤْمِنٍ یَذْكُرُ اللّهَ وَ یَعْمَلُ الصّالِحاتِ خَیْرٌ مِنْ أَنْ تَدْفَنَهُ فِي التُّرابِ یَأْكُلَهُ الدُّودُ! ثُمَّ قالَ: إِئْذَنْ لَهُ یُحْيِي اللّهُ بِهِ جُزْءَ أَبِیكَ یَعْبُدَهُ وَ یَكُونَ لَهُ ثَوابُ عِبادَتِهِ»; “A man consult with his honor about his father’s heart transplant after his brain death and said: A sick man, who is afraid of dying, is coming and asking me that I give him permission for that, and I do not know what to tell him. He said: Look, then if he is a Muslim who loves the family of Muhammad (PBUH) and loves me, give him permission; because if you bury your father’s heart in the chest of a believer who remembers God and does righteous deeds, it will be better than burying it in the ground for the worms to eat! Then he said: promise him until God resurrect a part of your father with him in order to worship God and the Thawab of his worship is for him”.
We thank God that among the darkness of ignorance, oppression and misguidance, has revealed us a bright light from the East, which, similar to a sign from His signs, and similar to a Caliph from His Caliphs, guides us to His ways and acquaints us with His beliefs and laws, without asking us for a wage or twitting us for the favor. In fact, who is equal to this noble man in knowledge or who approaches to his position of virtue?! Regretfully, most of the people do not appreciate him and do not benefit from the mine of his knowledge and virtue, but some of them do not refrain from any action against him, and many of them do not take any action to help him. May God compile the statistics of both groups and judge all of them; because he is the best judge.