By Mary Agidi

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According to the Nigerian Journal of Surgery, organ transplantation has become a rapidly expanding and important surgical specialty in the last four decades. Transplantation of solid organs has become the treatment of choice for end-stage renal, hepatic, cardiac, and pulmonary diseases.

Organ transplantation is broadly classified based on the similarity between the site of transplantation and also between the donor and the recipient.

There are different types of organ transplantation which include Autotransplants, Allotransplants, and Xenotransplants. The focus of this piece is therefore on Allotransplants which involves transfer from one individual to a different individual of the same species. This is the most common scenario for most solid organ transplants performed today.

A research report published in the Nigerian Journal of Surgery, entitled: “Organ Transplantation: Legal, Ethical and Islamic Perspective in Nigeria “, states that Organ transplantation is dated back to ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. According to the report, as the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues.

 It further stated that, in decision-making for organ transplantation, bioethical principles like autonomy, beneficence, and justice must be employed.

It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, some throw legal support as to its permissibility while the other group sees it as illegal.

Organ/tissue transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with the right to dignity of the human person.

Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation, and for recipient should be obtained without coercion before embarking on such medical treatment.

Even though organ transplantation has become the best medical treatment for patients with end-stage organ failure worldwide, there is no law/legislation backing organ/tissue transplantation in Nigeria, like in other developed countries.

Using the kidney allograft recipient as a surrogate for the other organ recipients, it is obvious that many people can benefit greatly in terms of length and quality of life from organ and tissue transplants. Whereas the matter of inadequacy of suitable organs for a teeming population of potential recipients is a worldwide problem, the case in Nigeria is further aggravated by the absence of an enabling legislation for cadaveric(organs of dead persons) donation, leaving the live organ donor as the only source of allograft. This led to illegal organ harvesting.

In the current Nigeria, due to the inadequate suitable organs as mentioned above, there are increasing rate of illegal organ harvest, especially by the rich class who manipulate the poor victims using money to deceive them into illegal donation. Some victims have been lured into the organ harvesting business unknowingly, through a human trafficking approach, where they were being promised lucrative jobs abroad.

An instance is the case of the former deputy Senate President, Ike Ekweremadu who is currently serving a jail term in the United Kingdom for trafficking a Teenager to the United Kingdom to harvest his kidney to save his dying daughter, without the consent of the boy.

As a way of curbing the illegal and unethical practices in organ donation and transplantation, the Federal Government of Nigeria in May 2024 announced its readiness to launch national policies and guidelines on organ transplants.

The Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, disclosed this during the Living Kidney Donor Day event organized by Nisa Medical Group in Abuja.

As Nigerians await the guidelines, will religious and cultural believers accept cadaveric or Xenotransplants? Especially for kidney transplantation which is the most common one now. And what issues should form the body of the guidelines putting into consideration, religious, cultural, and ethical concerns?

There has been a proposal to ease the pressure of organ demand in Nigeria, which entails sourcing donors from genetically modified animal organs but was said to have experienced several legal, ethical, and religious concerns.

Meanwhile, no religion forbids the practice of organ transplantation as a form of treatment; however, certain groups within the major religions of the world discourage cadaveric organ procurement.

Certain Native American tribes, Roma Gypsies, Confucians, Shintoists, and some orthodox Jewish rabbis discourage cadaveric donation, while some South Asian Muslim scholars were said to have advocated for the use of xenografts rather than allografts.

Organ transplants between living persons have been controversial because of the basic “no harm” principle in medicine. According to the belief of Catholic theologians, to mutilate one living person to benefit another violates the principle of Totality. However, Gerald Kelly and other ethicists made a closer study when such transplants began in the early 1950’s.

They argued that such donations, done to help others, could be justified by the principle of Fraternal Love or Charity provided that there was only limited complication to the donor.

Such living donations can be distinguished between parts of the body such as the regenerating part like blood and bone marrow and those parts that do not regenerate such as the paired ones, like kidneys, corneas, and lungs, and unpaired like the heart.

Procurement of organs or tissues from human fetuses or Anencephalic infants has also raised a lot of ethical and legal questions. When the fetus has died or will die as a result of procured abortion also raises an issue whether it is justifiable to carry out the abortion. Is it ethical to transplant brain or other tissues from human fetuses to benefit others like those suffering from Parkinson’s disease?

According to the criteria of death, they are also living beings, hence, to increase the chance of procuring viable organs from them, some would like to redefine death in terms of partial brain death so that they could be included as dead or for them to be exempted from the total brain death criteria, or to consider them nonpersons.

The United Kingdom government in 2020, passed a law that provides that any living human being is deemed to have consented to transplanting or harvesting his organs when he or she dies for donation to save somebody’s life. The law stipulates that when you are living, you are presumed to have consented that your organ, upon death, should be donated for the service of humanity. So, you are given the option to opt in or out of the law.

Opting in is when you do not do anything about it, but if you want to opt out, you need to register your name in the National Health Service Register on organ donation. If you do not register, you may inform your relative that when you die, your organ should not be donated.

Contributing to the FG’s plan on regulating organ transplants, the Deputy Medical Director of the Federal University of Technology Akure, FUTA, Clinic, Dr. Emmanuel Onyeama advised the government to convey stakeholders’ meeting to get their views before reeling out any guidelines due to religious and cultural differences.

According to him, The issue of organ transplantation is complex. It involves what we call a multidisciplinary approach. A lot of people and organizations are involved who are essentially stakeholders. So, before such a policy is put in place, I think we have to take into consideration certain issues. One is about our cultural differences, other opinions, and the present state of our economy and the security situation in the country.

“But, by and large, it’s the medical profession that champions the cause of setting up an organ transplantation policy or guidelines.

“There will be a need for the federal government to set up a body, something like the Transplantation Society of Nigeria, for example, which will be drawn from various organs of the health profession, medical specialists, different aspects of surgeries, general practitioners, nurses, laboratory scientists, and all that.

“So, when we have that body in place, then it’s now the role of that body to put in place ethical practices and standards that will help to put these guidelines and policies in place”, he averred.

Onyeama, who is the Medical Director of Unity Clinic, also listed what should be prioritized in the organ transplantation process, including consent, assent, and privacy of the donor, the health conditions of the organs to be donated which must undergo thorough clinical examinations.

According to him, organ donations should not be monetized for any reason, saying: “It’s not supposed to be based on monetary purpose, saying it should be seen as an altruistic act in the sense that you do it out of your own will just to help.

 “It is not something that the donor is expected to get benefits or get paid for. Because when people begin to attach monetary terms to it, it’s going to lead to a lot of problems. People will want to kill other people to get money”.

 Sharing the Islamic perspective on organ transplants and the unethical practices associated with them, the Chief Imam of Police officers’ mess mosque, Akure, Imam Taofik Akintola described the monetization of organs to save a life as ungodly, regardless of whether it’s consensual or through organ harvesting for sale.

He however hinted that Islamic religion is not against organ transplantation, but that the donor must be a living human being and not from dead persons.

“If it’s from a living person, organ transplants are allowed. But if it’s from a dead person, it’s not allowed”. He affirmed.

On the Federal government’s plan to launch guidelines to regulate organ donation, Imam Akintola underscored the importance of reorientation and disabuse of people’s minds against money-making mental entitlement which had made humans lose their morality and spirituality. He noted that aside from the fact that religious organisations and clerics have derailed the essence of worshipping God part of which is to preach holy attitudes, the government also needs to ensure enforcement of any enacted laws, regardless of who is involved in the offense.

Sighting the case of Sen. Ike Ekweremadu, the Islamic Cleric condemned the action of the Federal Government for sending a delegation to the United Kingdom to plea for his release, noting that such action was insulting and embarrassing for the country, considering the gravity of the offense he committed.

“So, let’s bring ourselves back to God, people are not morally upright and definitely, this kills their spirituality. They’re not God-fearing, they see anybody under them as nothing. That’s why you can see highly placed individuals in society who can smuggle another man’s child out to go and harvest his organ. All these things are happening because the moral is no more there. We are not ashamed again; self-esteem is no more there”. He averred. 

On the Islamic position on the use of a dead person’s organ for transplantation, the Chief Imam revealed, “As a matter of fact, Islam condemned it. Any part of our body is not for sale. Even blood. Those who are donating blood for money is ungodly in Islam. It should be done willingly”.

Also speaking, the General Overseer of the Rebirth of His Grace and Mercy Ministry Akure, Pastor Abiodun Olorunyomi, condemned organ harvesting for monetary purposes, noting that every part of human beings shouldn’t be for sale.

“The Bible says freely we have received, freely give. God created man in his image and likeness. So scripturally, if you want to follow the way of God, you should do it without charge”.

On the use of a dead person’s organ, he averred that it’s based on an individual’s differences and faith. He asserted that the deceased’s family and relatives have a choice to either release the organs of their person, or the government can decide to release the organs of the dead person in their custody for those whose faith is not against it.

“As for me, I believe in a miracle that there’s nothing God cannot do in respect to healing. But individual differences, and personal faith matter. And if medical science supports it, it’s not a crime because you cannot rule out the part of medical science, which is also the wisdom of God, and they’re doing very well. If medical science approves it that it’s okay for that person and cannot malfunction, there is nothing wrong with subscribing to it”, he said.