The Current Practice of Organ Transplant in Malaysia

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Jan , th 7 Year , Issue

THE CURRENT PRACTICE OF ORGAN
TRANSPLANT IN MALAYSIA
By
Dr. Basri bin Ibrahim al-Hasani al-Azhari
Senior Lecturer,
Department oI Shari
c
ah, Faculty oI Islamic Contemporary Studies
Universiti Darul Iman Malaysia (UDM),
21300 K. Terengganu, Malaysia
basriudm.edu.my
ABSTRACT
This study intends to understand the current practise oI organ transplantation in
Malaysia. Facts and relevant inIormation are obtained directly Irom the individuals
concerned such as the specialists, donors, recepients, medical centres and the
Ministry oI Health. Results oI this research suggest that the issue oI organ donation
and transplantation is important to the present day Muslims and the majority oI
ulama agree that organ transplantation is permissible, but strict enIorcement oI the
rules and regulations is required beIore it can be carried out. Their decision is
based on ijtihad jama
c
i. The organ transplantation practised in Malaysia is not
against the rules and regulations draIted by ulama.

KEY WORDS: organ transplantation, donors, recipients, ijtihad jama
c
i, regulations

,-'-- ,'= '=- NL . ULUM . WWW -'-' --' : -' : '-- - . Jan , th 7 Year , Issue

INTRODUCTION
Medical treatment in terms oI donation and transIer oI organs which is widely in
practice today was not practiced during the Rasulullahs (pbuh) time. The closest
resemblance was in terms oI replantation oI detached organ back into its original
place. As an example, Rasulullah (pbuh) once put back an eyeball oI a sahabah by
the name oI Qatadah bin Nu
c
man back into the eye socket, aIter it was yanked out
while he was Iighting in Badar war. The eye Iunctioned even better than beIore.

Prophet Muhammad (pbuh) had also put back the arm oI Mi
c
waz bin
c
AIra into its
place aIter it was being cut oII by the enemy as well as the arm oI Habib bin YusuI
that was disconnected Irom the body during Badar war. These events were some oI
Prophet Muhammads (pbuh) miracles.
2

The act oI putting back the detached or disconnected organ back to its place
is part oI the organ transplantation being discussed in todays medical scenario,
though it was not set as a reIerence Ior ulama who allow organ donation and
transplantation. These ulama, on the other hand, chose other aspects Ior their
decisions.
Human organ transplantation is an issue that comes into the surIace in the
20
th
century. The previous ulama did not debate on the issue in detail, much more
to decide or conclude what are rules or law related to it. It is an issue closely
associated with research result achieved by modern science study, speciIically in
the Iield oI transplanting organ Irom one human into another human who needs it.
This issue, in Iact, is one oI the Iields covered in Ijtihad.
3
In Malaysia, organ
transplantation Irom a donor to a patient in need had already begun since 1975.
However, Iailure to acknowledge the practice and procedure used by the medical
specialist in organ transplant surgery had resulted in organ donation among
Muslims still has not achieved a satisIactory level. Some ulama determined that
organ donation is haraam because it inIlicts physical damage and pain to the
deceased.

3
Among the crucial questions to be outlined in this article is what is the
deIinition oI organ transplantation, how is it practiced in Malaysia and is the
practice IulIills the Organ Transplation Etiquette 1991?
The leading objective oI this article is to clariIy on the organ transplantation
concept, its practice in medical world in Malaysia and its integration with the
Organ Transplantation Act 1991.
The importance oI this research is to enhance the understanding among the
Muslims in Malaysia about the practice and procedure related to organ transIer
Irom a donor to a patient perIormed by the medical specialists.
Analysis on organ transplantation has already existed in Malaysia in the
Iorm oI paper work that was presented in Islamic Seminars and Organ
Transplantation organized by the Institute oI Islamic Understanding Malaysia and
this paper work was compiled Ior community reIerence. There are also books that
discuss the issue oI organ donation and transplantation like the one produced by
Muhammad Na
c
im Yasin, a lecturer in Islamic Studies at the University oI Jordan
witht the title Abhath Fiqhiyyah Li Qadaya Tibbiyah Mu
c
asirah (1996) and
Muhammad Nurudi al-Banjari in his book, Adillah Tahrim Naqli al-A
c
da (1995).
Nevertheless, both books only stress on the opinion oI Islamic ulama in the related
enigma without going deeper on the the practice and how it is executed in
Malaysia.
The data collected in this research is based in the library research which
involves hadeeth scriptures and Iiqh muktabar as well as Iield research which
includes interviews with the medical experts that handle organ transplant, related
oIIicers and Iilm presentation about organ transplant surgery.
DEFINITION OF ORGAN TRANSPLANTATION
Organ transplantation is deIined as replacing organ that Iails to perIorm its
Iunction well in a patients body with a new organ Irom a donor, whether the donor


is alive or dead (cadaveric).
4
The transplant treatment is aimed at saving a patient
that can only be saved with the organ transplantation surgery.
FATWAS THAT ORGAN TRANSPLANTATION IS A MUST
Fatwas that organ transplantion is a must came Irom Islamic ulama magnates that
are world-Iamous, as well as muktamar and Islamic organizations in both Islamic
and non-Islamic countries. Amongst the Iatwas are:
1. From individual
a. al-Qaradawi.
5

b. Sheikh Jad al-Haq
c
Aliyy Jad al-Haq.
6

c. Muhammad Sayyid Tantawi.
7

e. Sheikh Ahmad
c
Umar Hashim.
8

I. Sheikh
c
Abdullah al-Mashd.
9

g. Sheikh Abu Sari
c

c
Abd al-Hadi.
10

h. Sheikh Husayn Mi
c
wad.
11

i. Sheikh Hasanayn Muhammad MakhluI.
12

j. Sheikh Hasan Mamun.
13

k. Sheikh Huraidi 1966.

l. Sheikh Muhammad Khatir.
14

m. Sheikh Muhammad
c
Abd al-LatiI al-Subki.
15


2. From Islamic Conferences
a. International Islamic ConIerence that took place in Malaysia in 1969.
16

b. The 3
rd
International Islamic ConIerence oI Islamic Legislation experts
(OIC) in 1986.
17

c. The 4th International Islamic ConIerence oI Islamic Legislation experts
(OIC) in 1988.
d. The 6th International Islamic ConIerence oI Islamic Legislation experts
(OIC) in 1990.
18

3. From Islamic Organizations
a. Al- Jazair Islamic High Council, 1972.
b. Fatwa High Council oI Jordan Government, 1977.
c. Ulama Organization, Government oI Saudi Arabia, 1978.
d. Kuwaits Ministry oI Religious Alms, 1980.
e. Prominent Ulama Organization, Government oI Saudi Arabia, 1980.
I. Fatwa Islamic World League, 1985.
g. Fiqh Academy under Rabitah al-Alam al-Islami in the 8th conIerence,
1985.
19

h. Shariah Islam Research Institute in west Cape Town, South AIrica, 1994.
i. Islamic Shura Council in west Cape Town, 1994.
j. Muslim Judiciary Council (MJC) in west Cape Town, 1994.
20

k. Ulama Organization (Kuwazulu-Natal), a Muslim Theology organization,
South AIrica 1994.

6
l. Ulama Council South AIrica, 1994.
21

m. Islamic Council Singapore (MUIS).
22

The Iatwas mentioned above represents the voice oI majority oI the Muslim
and even iI it is not compulsory to practice the expressed opinion, at least it is
convenient to hold on to those Iatwas. Other than that, Iatwa oI a number oI
Islamic ulama magnates is saIer to be observed and saIer than misconception. In
addition, abiding the ulama is obligatory in matters not related to vice. Allah (swt)
commanded:
- - - ' ' ' , - ' , , = '' , , = , - -' , - ' ' + , ' , .
3

Oh you who believe! Obey Allah, and obey the Messenger and those oI you who
are in authority..
FATWA FOR ORGAN TRANSPLANTATION IN MALAYSIA
The law Ior organ transplantation was set in Muzakarah oI the National Fatwa
Committee on the 23
rd
and 24
th
June 1970. Eye and heart transplant Irom the
deceased to the living ones is allowed in Islam with the approval oI the
owner/donor and aIter considering these Iactors:
a. It is in excruciating and urgent situation and the lives oI the receiver solely
depend on the organ transplantation and that the transplantation is believed
to be successIul.
b. For heart transplantation, the death oI the donor must be conIirmed beIore
transIerring the heart.
c. All actions deemed necessary has been taken up to ensure there would be no
human murder and the trading oI their organs; and

7
d. Approval must be obtained Irom the donor beIore transIerring any organ Ior
normal death. For death caused by accidents, approval must be obtained
Irom the Iamily oI the deceased.
24

THE RULES FOR ORGAN TRANSPLANTATION
The rules Ior organ transplantation include:
a. The illness to be treated must be clearly identiIied. This means iI the illness
is not clearly identiIied, then organ donation and transplantation is not
allowed.
b. The side eIIects to the donor are Iully known. Otherwise the organ
transplantation may bring harm to the donor.
c. The diIIerences between the illness to be cured and the harm such surgery
may inIlict are clearly and certainly known.
d. Both illness and harm cannot be eliminated simultaneously.
25

e. Organ transplant is done due to exigency or excruciating needs that resulted
in exigency.
26

I. Organ to be donated is not Ior the purpose oI bringing down human
nobility.
27

g. The donor must be a perIect candidate or eligible to donate when the organ
transplantation process and surgery is done.
h. The donor donates organ willingly.
28

i. The donor has received opinions and advice Irom specialist doctors, that the
organ donation to be done will not bring extreme harm to the donor.
j. The donor must clearly state his or her consent to donate, Iollowing the
procedures set.

8
k. The donor must be above the legal age to donate which either is 18 or 21
years and above.
l. The donor is conIirmed to be dead iI it involves cadaveric donor.
m. Must obtain approval Irom the Iamily member oI the deceased, iI the
deceased did not state clearly that his or her organ cannot be taken, aIter his
or her death.
n. The expert must be a Iair and reliable person.
29

o. The expert must have all the related skills and experience.
30

ORGANS ALLOWED FOR TRANSPLANTATION
Organs involve in the transplantation to the patient can be in the Iorm oI complete
organ like kidney, heart, liver, and others or in the Iorm oI tissues and cells like
cornea, blood, bone marrow and others. Some oI these organs have direct relation
with blood circulation process such as heart, liver and kidney while some others
are not related at all to the blood circulation like skin. Some, on the other hand,
need blood veins like a damaged cornea.
31

ORGAN TRANSPLANTATION ETIQUETTE 1991
The etiquettes contain guidelines as Iollows:
a. Organ can be obtained Irom a persons body Ior the purpose oI organ
transplantation iI:
i. Any consent required by the law are Iollowed; and
ii. There is no reason to believe that the deceased would have objected
such action, iI no Iormal consent was given during his or her liIetime.
b. The medical staII that determines the death oI the Iuture donor is not
supposed to have any connection with the procedure in taking or transIerring

9
the organ to the patient and that staII cannot be involved in giving treatment
to the recipient.
c. Organ taken Ior the purpose oI organ transplantation is best to be Irom a
cadaveric donor. Even though adults can donate organ while they are still
alive, they must have genetic connections with the recipients. Organ can be
taken Irom an alive, adult donor provided that the donor gives his or her
consent without pressure Irom any parties. The donor must also has a mature
mind to understand and consider the risk, beneIits and eIIect oI giving such
consent.
32

d. Organ cannot be taken Irom under age donor Ior the purpose oI organ
transplantation. Exceptions can be made under the countrys law in the cases
oI tissue that can regenerate.
33

e. Human body and any part oI it cannot be traded. In this case too, giving or
receiving payments (including any gratuity or giIt) in exchange oI organ is
strictly prohibited.
I. Advertising the need or the availability oI an organ Ior trading purposes
should be banned.
g. Medical member or any proIessional staII is prohibited Irom getting
involved in organ transplantation procedure, iI they have reasons to believe
that the organ is part oI a transaction.
h. Any individual or Iacility involves in organ transplant procedure is not
allowed to receive payment more than the appropriate payment Ior the
service.
i. The concept oI Iairness and justice must be applied. Organ to be donated
must be given to a patient on the basis oI medical need and not on Iinancial
or other basis.
34

THE HISTORY OF ORGAN DONATION AND TRANSPLANTATION


Malaysia has its own history in organ donation and transplantation. Kidney
transplant treatment, Ior instance, started in this country in December 1975 when a
businessman Irom Sarawak received a kidney donated by his brother. The kidney
still Iunctions well until today.
35
In 1975 too, kidney transplantation Irom a
deceased donor was perIormed in Malaysia Ior the Iirst time. Up to 1995, as much
as 518 patients had undergone kidney transplantation surgery where 509 cases are
Irom living donor with Iamily relations with the patient and another 9 are Irom
cadaveric donors.
36

As Ior kidney transplantation Ior kids, Irom 1986 to 1999, 37 surgeries were
done. OI these 37 surgeries, 35 are Irom living donor with Iamily relations to the
patient while another 2 are Irom cadaveric donors.
37
In March 1995, liver
transplantation surgery began its course in Malaysia.
38
Twenty liver
transplantations were successIully perIormed since then. Until April 1999, 25 cases
oI liver transplantation were perIormed in this country.
39
The Iirst liver
transplantation between a donor and a recipient with no blood ties was successIully
carried out on 3
rd
oI April 1999.
40

The Iirst heart transplant surgery was successIully perIormed in December
1997, while the second and third successIul surgeries were done in 1998.
41
One oI
the successIul heart transplant surgeries is the heart transplant surgeries perIormed
on R. Sethuragnan. He is one oI the heart recipients who live as a normal
individual. He suIIered an acute heart disease prior to the transplant.
42

The transplantation surgery was carried out by 17 doctors, including 7
specialist doctors lead by the head oI Cardiothoracic Department, Yahya Awang.
43

However, lung as well as pancreas transplant surgery was never perIormed in
Malaysia due to donor unavailability up to this point oI speaking and not because
oI the unavailability oI the expertise and the needed equipment.
44
Other than that,
Malaysia also has record successIul transplant surgeries Ior some tissues such as
eye cornea, bone and bone marrow.


THE PRACTICE OF ORGAN TRANSPLANTATION IN MALAYSIA
The practice oI organ transplantation in Malaysia is carried out based on opting in
law system. Future donor make a decision Ireely and willingly to donate and that
decision is recorded in a card that has to be carried by the donor all the time. This
is the base iI the Tissue Act 1974 used in Malaysia. The matter is highlighted in
section 2 (1) which is:
II any person, either in writing at any time or orally in the presence oI
two or more witnesses during his last illness, has expressed a request
that his body or any speciIic part oI his body be used aIter his death Ior
therapeutic purposes, or Ior purposes oI medical education or research,
the person lawIully in possession his body aIter his death may, unless
he has reason to believe that the request was subsequently withdrawn,
authorize the removal oI the body oI any part or, as the case may be,
the speciIied part, Ior use in accordance with the request.
45

Based on this system, the authority can remove organ donated by the donor,
aIter his death at the hospital provided that the organ is suitable to be given to the
patient. Anyhow, a survey perIormed by researchers on the National Transplant
Resources Center in Kuala Lumpur Hospital (PSTN) Iound out that even though
the donor has passed away, the hospital will not remove organ donated by the
deceased straightaway, instead, the Iamily oI the deceased is inIormed Iirst. II the
Iamily agrees, the hospital will then proceed to remove the organ and iI the Iamily
objects, then the hospital will not proceed with such an operation.
46

This shows that even though a hospital has the right to take out donated
organ without Iurther consent Irom the Iamily oI the deceased, in reality it does not
practice organ donation system based on the principle oI opting in because public
education is a major Iocus and to avoid public Iear to donate their organs. Hospital
still put priority in ethics and morals rather than reinIorcing the system that has
become their principal.


Malaysia does not practice opting out system because it contains an element
oI compulsion and related to public education.
47
In opting out system, a Iuture
donor is considered agree to donate organ, iI that donor did not state his objection
during his liIetime. In this system, the authority has the power to remove organ iI
there is no prooI that the donor did not agree to such operation. This system is
practiced in a Iew countries including Singapore and European countries. In this
system, the responsibility to make a choice not to donate organs lies on each
individual. It may be unIair in a situation or country where the citizen has diIIerent
level oI education and not all citizens are provided enough inIormation on the
organ transplantation activities. However, in Malaysia, iI the Iamily willingly
agrees to donate organ oI the deceased Iamily members that died in a hospital and
the deceased did not state clearly that he did not want to donate his organs during
his liIetime nor did any objection arise to prevent Irom removing the organs, and
provided that the organ is in good condition, the hospital may receive the donated
organ.
48

Donor Detection System
Donor detection system in Malaysia use multi hospital system which is multi
production and multi transplantation. It involves territory management.
Registration can be done in various hospitals in this country and this registration
will be recorded in a center hospital which is Kuala Lumpur General Hospital,
under PSTN monitoring.
49

Hospital Detection Method
To detect an organ donor, TPM oIIicer (managing transplantation acquisition)
tasked to prepare a list oI patients admitted into accident and emergency
department. TPM then will check the list and identiIy patients with low prognosis
(prediction on causes oI death).
50

TPM is also inIormed oI all death at the hospital by the staII responsible oI
the mortuary. TPM visits all areas at the hospital to identiIy eligible donor

3
candidate such as the ICU ward, emergency and accident ward and others. TPM is
also inIormed by clinical staII on all brain dead cases.
51

Clinical Assessments
Clinical assessments Ior donor organ involve, Iirst and Ioremost stating clearly
cause oI the death. Secondly, donor habits are taken into consideration Ior the
purpose oI identiIying risk that may arise. The third assessment is providing illness
reasons that relate to the organ or tissue.
52

This method is used to obtain good organs Irom the deceased who state his
consent to donate organs as well as those who did not state their approval to donate
organs. This shows that clinical assessment system Ior organ donor practiced in
Malaysia is very thorough beIore the process oI removing organ and transplanting
it into a patient is perIormed.
Tests before Organ Transplant
To determine a suitable organ to be donated to a patient, medical expert will carry
out two types oI tests which are the blood test and tissue typing test. The tissue
typing test is only carried out to determine the suitability oI kidney and not Ior
other organs. To determine the suitability oI other organs like heart and liver, blood
test is suIIicient. Future donor must have the same blood type with the Iuture
recipient. Otherwise, organ transplant process cannot be done.
53

Organ Acceptance Procedures
Patients suIIer Irom diseases related to certain organs and need organ
transplantation treatment Irom donors must Iirst register their names at any hospital
where they receive medical treatment so that their names can be put under the
recipients list. In the process oI distributing organ Irom a donor to a recipient, the
hospital will give organ to the Iirst patient in the waiting list Ior organ
transplantation, regardless oI the patient being a Muslim or non-Muslim. II the Iirst
patient does not Iit with the received organ, then the organ will be given to the


second person in the waiting list and so on and so Iorth. II the donor is a Muslim
while the recipient is a non-Muslim patient, the organ will still be given to the non-
Muslim patient because he deserves to receive the organ based on the waiting list.
To ensure that the donors organ is Iairly distributed to the recipient, a Iew
principal have been used. The Iirst principal is utility or beneficence that emphasize
that any action has to give optimum beneIit or at least it has to be able to avoid any
harm. Based on this principal an organ will be given to a receiver with the best
matching with the donor. A result oI tremendous research shows that the organ will
stay longer inside a patients body that has received an organ with a good
matching. This utility principal only Iocuses on objective matters and it does not
count in other Iacts such as a patients situation and et cetera.
54

Organ Transplantation Procedures
Organ transplantation procedure begins with the donors body health veriIication
and the donors death by specialist doctors.
1. Verification of Health and Death
Organ transplantation organ that is practiced and executed in Malaysia begins
when a donor is veriIied to be healthy and clean Irom any kind oI diseases, besides
the transplantation will cause any harm to the donor in the Iuture. This applies to
donation that involves one side oI the kidney and a small part oI the liver.
55
For
transplant oI organ involving cadaveric donor, the process started as soon as the
donor is conIirmed brain dead by two certiIied experts. The experts involve in the
death conIirmation oI a donor must be Iree oI any connection with the organ or
tissue transplantation itselI.
The death veriIication done by the experts are not done simultaneously. The
Iirst expert will perIorm check up aIter the donor has been dead Ior 6 to 8 hours.
The second examination will be carried out aIter the Iirst check up. For the purpose
oI organ transplantation treatment, organs such as heart, kidney, liver, lung and


pancreas have to be removed while the donors heart is still beating with the help
oI a ventilator, but the brain is dead. A dead brain means a patient has passed
away. Admitting the concept oI brain dead is the base Ior organ transplantation
program.
56

It is very important that the brain death test is done thoroughly and it is done
by doctors that have no connection with the organ transplantation planning or
treating a patient that will become a donor. Even though there exists opinions that
questioned the concept oI brain dead, in overall most doctors accept the reality oI
brain dead.
57

The experts who veriIy brain death are required not to have any connection
with the organ transplantation and treatment to avoid the tendency to prioritize on
certain sides. This kind oI tendency is very harmIul, Ior it dangers the live oI both
the patient and the receiver. When a donor is conIirmed to be dead, the doctor and
the patient in the waiting list Ior organ will be contacted as Ior preparations Ior the
organ transplantation.
For that reason, a patient in the waiting list Ior organ transplantation is given
an open Ilight ticket to ease the process. When organ is received by a donor, the
patient is required to conIirm a seat in a Ilight and he must come to IJN as soon as
possible. Once arrived, the IJN staII will check the patient once again and then the
IJN will state its approval that the respected patient is eligible to receive the newly
acquired organ.
58

The experts involve in the process oI removing and transIerring an organ
typically consist oI an aesthetician, 2 nurses, 2 surgeons and other related experts.
In overall it normally requires 8 to 10 people altogether. The specialists groups will
be divided into two groups knows as the organ retrieval group at the related
hospital and organ transplant group who will standby at the operating theater
together with the patient who will receive the organ.
59

2. Forming Coordinator Agency

6
In organ transplantation process, coordination is carried out Ior time saving
purposes. Coordination exists in all organ transplantation processes. Each and
every hospital is instructed to coordinate to ensure smooth operation oI organ
transplantation. II a patient who passed away is an organ donor and his relatives
agree to donate the deceased organ aIter being inIormed by the hospital staII, the
hospital where the deceased had been treated will inIorm the coordinator center
about the organs that can be used, including heart. Specialists Ior each organ will
come to veriIy that all organs are in good condition. Usually the criteria related to
organs and donors medical record will be compiled by the hospital that provides
the treatment.
60

In heart transplantation, Ior instance, the heart will only be used iI the
criteria oI the disease suIIered by a patient matched with the criteria oI the donor.
The waiting patient is required to stay at the hospital area in 4 hours.
61

In liver transplantation, coordinator team is also needed as in heart
transplantation. The specialist doctors groups will be divided into two groups. One
group Iocuses on the tasks required to preserve the organ aIter it was removed
Irom a body. The organ will be brought to the operating theater in shortest time
possible to be implanted into the recipients body.
Surgeons will determine which part to be removed. Once identiIied, these
experts will careIully cut 20 oI the part without disturbing other parts. Removing
part oI a liver does not aIIect other part because the liver parts consist oI their own
nerves.
62
The wound caused by such surgery does not require treatment like the
treatment needed Ior a wound on the outer part oI the body. The liver will heal
itselI and will be back to normal aIter a Iew weeks. This is due to a liver is capable
oI renewing itselI and the removed part will regenerate, even though the size may
not be the same as the original size prior to surgery. AIter the liver grows to its
original state, the donor is Iree Irom any harmIul risk.
63
Coordinators are also
needed in kidney transplantation as well as other organs transplantation.

7
3. Organ Delivery
While the doctors and medical specialists group perIorms the surgery to remove an
organ, the receiving patient and the related specialists are already in standby
position in the operating theater. Organ obtained will be sent by a speciIic
coordinator as soon as possible to the hospital where the patient is waiting to
enable prompt surgery Ior organ transplantation. This delivery is done using
hospital transportation or sometime using helicopter, in distant location case. The
removed organ will be kept in a special box that is Iilled with ice to prevent the
organ Irom being damaged.
64

A heart, Ior example will be kept in a plastic bag with a speciIic medicine to
prevent it Irom being damaged by germs attack. Air is pumped out oI the plastic
bag and the box will be Iilled with ice to ensure that the heart is in an extremely
cold level.
65
The organ delivery time depends on the place on where the organ is
obtained. II the organ is Irom a nearby hospital, it may take 10 to 15 minutes but iI
the organ is Irom Iar away, it may take 45 minutes or more.
4. Duration of Organ Transplantation
The long and the short oI an organ transplantation surgery perIormed by the
surgeons really depend on the type oI organ being transplanted. The longest organ
transplant surgery is the transplantation involving liver. The surgery typically
consume between 12 to 18 hours.
66

This is due to the Iact that liver transplantation involves more complicated
procedures compared to heart transplantation. Liver transplantation is even more
complicated iI it involves a live donor. On the other hand, heart transplantation
surgery takes about 4 hours and kidney transplantation surgery takes about 1 to 1
hours to be transIerred into the needing patient.
According to Yahya Awang, a Iairly complicated heart transplantation surgery
sometimes can take up to 6 hours as was the case oI Aizai Awang Abd Rahman, a

8
surgeon at IJN. In tissue transplantation, the time consumed is entirely diIIerent
than those oI organ transplantation because tissue can be kept Ior a long time.
67

5. The Process of Organ Transplantation
Organ and tissue transplantation process is a clean and sterile surgery. Surgery is
perIormed in an operating theater by experienced surgeons. Acquisition oI organ or
tissue Irom a deceased donor will not aIIect the Iace and body Iorm oI the deceased
donor.
68

The same applies to a donor who is alive. Researchers had watched the original
video on organ transplantation perIormed on Wan Mohd HaIizam. The surgery
was perIormed in an extremely delicate manner in a special room in Subang Jaya
Medical Center by skilled specialists. The surgery did not harm the donor and did
not change his physical Iorm. The body part being cut open in the surgery was the
body part opposite to his heart. Other parts were not touched.
69

Recipients organ that has Iailed to Iunction is taken out. BeIore the heart is
taken out however, the patients body is connected to a ventilator machine, a
machine mechanically designed to help breathing mechanism, while waiting Ior
the new heart Irom a donor arrives. AIter the original heart is removed, a new heart
is connected at the exact same place where the old heart was previously connected
to.
70

The leIt heart vessel is the Iirst part to be sutured Iollowed by the right heart
vessel and then other related parts. In a kidney transplant surgery, the Iirst part to
be sutured is its blood vessel.
71

Upon completion oI the stitching, the ventilator machine which acts as the
temporary heart is switched oII. AIter that the new heart will start beating as
normal. The surgical wound is given a special medicine. The recipients chest
cavity is closed and stitched and the patient will be transIerred to the ICU ward.
72

9
In liver transplantation, the part taken is the leIt side because it poses less
risk to the donor. The amount taken is 20.
73

In kidney surgical transplant, the original kidney oI the patient is not
removed because its existence is not detrimental to the patient. This original kidney
will contract by itselI. A new kidney is attached next to the Iailed kidney. In
addition, iI the Iailed kidney is removed, it will take longer time Ior a patient to
recover Irom such surgery.
74

Usually, the kidney transplant surgery only switches the blood vessel Irom
old kidney to the new one. For a patient who suIIers Iailure oI both kidneys, he
will only receive one kidney Irom a donor and it is up to specialist doctors to
decide whether to place the new kidney on the leIt side or right side.
75

AIter organ was removed, the body oI a deceased donor will be cleaned.
Each organ such as heart, liver and kidney is taken by its own specialist group.
They did not remove the organs simultaneously. Instead, it is done by turn. For
instance, aIter the heart was removed, liver was removed Iollowed by kidney.
76

In short these experts work hand in hand with each other when taking the
organs. Time is monitored to avoid damaging the organs especially iI the donor
donates all organs or tissues oI his body. The team that removes the organ is not
involved with the team that implants the organ into a patients body.
77

Their Iunction is solely to remove organ. The same applies Ior the team that
perIorms the implant; they only involve in the implantation and have nothing to do
with the team that removes organ.
6. Rehabilitation Treatment
AIter receiving a new organ, the patient is required to be in the Intensive Care Unit
(ICU) ward Ior 1 or 2 days. AIter that, the patient will be removed to normal ward
Ior 1 or 2 weeks. At the end oI this period, the patient is allowed to go home. A
patient must undergo post-surgery rehabilitation or Iollow-up treatment. The


treatment can be divided into two types; speciIic rehabilitation treatment and
general rehabilitation treatment.
78

SpeciIic rehabilitation treatment involves a medicine called
immunosuppressant. This medicine acts as a deIend mechanism Irom a patients
antibody towards the newly received organ. This is due to the Iact that even though
the donor and the patient are oI the same blood type, organ rejection still can occur
either when the heart rejects the patients body or the patients body rejects the
heart. Immunosuppressant is given to control rejection so both sides can accept the
existence oI each other.
79

Other than that there is also general Iollow-up treatment in terms oI weekly,
biweekly, bimonthly, and so on and so Iorth schedule. Tissue sample is taken to
monitor the development oI the received organ such as heart and as research
material to detect should any rejection occurs. II rejection still occurs, the treating
doctor will increase the dosage oI the medicine or modiIy the medicine to stop the
rejection.
80

7. Post Organ Transplantation Surgery
AIter an organ or a tissue is acquired, the surgical wound will be sutured Ilawlessly
and the body oI the deceased donor will not have any physical deIormity. The
hospital guarantees that the whole organ transplantation process is done in Iully
respectable and the best manner as in other normal surgeries perIormed on living
patients.
81

8. Rejection Upon the Received Organ
It was highlighted above in rehabilitation treatment about the patients need to a
medicine that deIends Irom antibody attack or immunosuppressant to prevent
rejection on the newly received organ. This is due to the undeniable Iact that there
is a probability oI organ transplantation Iailure when the patients body tries to
reject the organ it just received.


The recipients body can recognize that the new organ is a Ioreign organ. To
tackle this rejection problem, a patient usually will be given to weaken the
rejection, among them are immunosuppressant. Most rejection cases can be treated
successIully.
82

In addition to taking the prescribed medicine, a patient is also advised to
avoid Irom consuming high cholesterol Iood and to stop smoking habit.
83

The usage oI immunosuppressant may prolong the liIe oI a patient who
suIIers organ Iailure at critical stage. Indeed, with the use oI this medicine, organ
transplantation achieves prominent success in todays modern medical world.
Today there exist new type oI agents that strengthen immunity such as
cyclosporine and rapamycin. The combination oI these two immunity strengthener
agents has successIully reduced rejection cases at the rate oI 85-90.
84

9. The Success of Organ Transplantation
The success percentage relies on the procedures oI the perIormed surgery. II the
transplantation surgery is done correctly, it will result in excellent success without
any negative impact. Rejection towards the newly received organ can be tackled as
explained above. The success oI organ transplantation in Malaysia so Iar has
achieved more than 90 level. Transplantation oI heart, kidney and liver are great
success that can be proud oI.
85

According to Abu Bakar Sulaiman, in 1980s the decision to kidney
transplantation treatment increased signiIicantly as a result oI a new medicine that
successIully reIrain human body Irom rejecting the new organ. Besides, research
shows that in reality, the lives oI the patient who receive new kidneys are better
than those patients who undergo dialysis
86
which usually involve high cost and
barely aIIordable Ior the poor.
10. Cost of Surgery


The cost oI surgery is very expensive and is diIIerent Irom one organ to another.
For a kidney transplantation surgery which takes 4 hours, the cost is RM26000 at
the government hospital.
87
For one heart transplantation surgery starting Irom
acquiring the heart to implanting it inside a patients body, the cost is in between
RM100000 to RM110000. The payment oI surgery cost is born by IJN. The patient
is asked to pay based on only what they can aIIord.
88

Anyhow organ transplantation cost in Malaysia is still relatively low which
is in between RM150000 to RM200000 Ior the Iirst time and RM40000 to
RM50000 Ior subsequent surgeries. From 1992 to 1997, the Malaysian health
authority allocated RM309 million to bear the cost Ior 187,836 patients who cannot
aIIord to pay the treatment cost in IJN.
89

11. Handling of the Deceased
Organ transplantation does not aIIect handling oI remains oI the deceased and the
burial process. The burial process can be done as normal. AIter organs and tissues
are acquired Irom the donors body, the remains will be washed, wrapped and then
returned to the donors relative as soon as possible. The process oI acquiring the
organs does not interIere with the burial procedures such as paying respect to the
deceased.
90

Example of Successful Organ Transplantation
An example oI the success oI organ transplantation perIormed in Malaysia is the
case oI kidney transplantation to a patient named Ahmad Kamal Mohd Noor, a 39-
year-old grocery shop owner, who received a kidney donated by a 43-year-old
gentleman. The true identity oI the man is not known because it is hospitals
conIidential. Ahmad Kamal actually suIIered Irom a chronic kidney Iailure. The
disease weakened him and he lost many job opportunities including oIIers Ior a
military course and a skill course. All oI these oIIers had to be rejected by him
because oI the illness he suIIered.

3
The disease had also taken its toll on Ahmad Kamal relationship when he
had to break up his engagement because he did not want other people to share his
suIIerings. Ahmad Kamal was conIirmed to suIIer kidney disease in 1980 aIter
both oI his kidneys Iailed. He Iaced Irequent urinary infection disease, had no
energy and had to lay down all the time. Things got worse when he was also
conIirmed to suIIer high blood pressure and bones TB disease. The condition
caused him to be under unconscious state until he had to be admitted into the
Intensive Care Unit (ICU).
The specialist who treated him told him that his chance to live is short and
that its just his time to die. In eIIort to cure his illness, he had to undergo 27
operations. His mother, Ms Rokiah Mat Jahrah donated one side oI the kidney to
him, but it was later Iound out that that kidney was not suitable Ior Ahmad
Kamals body, causing him to Iace many diIIiculties and his suIIering got worse
until he was unable to live a normal liIe. He could not urinate and his body became
swollen and Iat.
A year later, he was inIormed that there was a donor Irom a 43-year-old guy.
The donated kidney, however, had to be Irozen Iirst because it came Irom Ipoh
hospital while Ahmad Kamal at that time was in Kuala Lumpur Hospital (HKL).
The kidney transplant surgical technique perIormed on Ahmad Kamal was
the Iirst oI its kind perIormed in HKL. It costs RM100000. AIter the surgery, he
was able to lead a normal liIe like other people without having to rely on the
dialysis machine to remove toxic substances Irom his blood. The surgery
perIormed on Ahmad Kamal was carried out in 1989, 9 years aIter he was
diagnosed with kidney Iailure on both kidneys. AIter the surgery he got married
and was blessed with one child.
91

SUMMARY
Organ transplantation is deIined as removing certain organs such as heart, liver,
kidney and such that is donated by a donor and placing or planting it into a needing


patient. The organ transplantation practice in Malaysia is done very careIully and
because oI this careIulness, until today the authority has never reported any case oI
organ abuse or organ mishandling caused by careless medical specialist. The
practice oI organ transplantation conIorms to the rule outlined in Organ
Transplantation Etiquette 1991 produced by World Health Organization.
Based on explanation Irom three specialists; Mohd Zaki Morad Zaher and
Harjit Singh Irom Kuala Lumpur Hospital and Yahya Awang Irom IJN, it is
undeniable that all rules related to organ transplantation Irom either alive or
cadaveric donor outlined in Organ Transplantation Etiquette 1991 is in practice.
However, to ensure one hundred percent success in organ transplantation donated
by donor is impossible. All three specialists consulted by the researcher made it
clear that at most, the only thing they can do is to assume that organ transplantation
will be successIul based on past experience. Apparently, these specialists are doing
their best but the success depends on Allah (swt), truly. II it is strongly believed
that the organ transplantation will danger the lives oI the donor and the patient, the
transplantation will not be recommended because it will not only aIIect the organ
donor but also the organ transplantation Iield itselI in Malaysia.
92
For a living
donor without blood ties with a patient is required to pass the etiquette, medical
and psychiatric criteria when making decision to donate organ.
Almost all rules outlined in Islam are adhered to. Only two aspects are not
practiced by the authority, Iirstly, Ior the doctors involved in the transplantation,
priority must be given Ior Muslim doctors and secondly, iI an organ is received
Irom a Muslim donor, a Muslim recipient should be given the priority. These
requirements are not complied because the Malaysian authority is tied with the
organ transplantation principal set in 1991 by the World Health Organization. In all
9 principals oI organ transplantation being discussed, it is not clearly stated about
the impact oI organ transplantation Irom religious view. In other words it is not
mentioned that only Muslim doctors can handle organ transplantation oI a Muslim
while non-Muslim doctors are not allowed to perIorm such operation. There is also


no statement that states believers oI other religions are not allowed to donate or
receive organs iI they are oI diIIerent religious belieIs.
The involvement oI non-Muslim doctors in treating Muslim patients in the
issue oI organ transplantation however, is allowed by certain ulama such as
HanaIi,
93
al-ShaIi
c
i
94
dan Hanbali
95
in a chronicle. This group reasoned, among
others, that getting treatment Irom non-Muslim is just worldly matter and hence it
is allowed. This is the same case as Muslims are allowed to live in a house,
purchase clothes and use weapons produced by non-Muslim and engage in daily
activities with them. The Messenger (pbuh) had once dealt with the Jews
community Irom Khaybar clan. The Messenger (pbuh) had once rented a navigator
and entrusted His liIe and possessions to the navigator when he migrated to
Madinah.
96
Al-Quran also acknowledged that among the musyrik (polytheist) and
ahl al-Kitab (Christians and Jews), there exist people who are reliable and thus it is
allowed to engage in matters with them. Allah (swt) said:
- , , ' ' ' -, - - - -' - - + - - = , ' - , , ' =- - - - -' - - ' - ' . -
' - -' , ' = - - ' - ' ' = , ' ....
97

Among the People oI the Book are some who, iI entrusted with a hoard oI
gold, will (readily) pay it back; others, who, iI entrusted with a single silver
coin, will not repay it unless thou constantly stoodest demanding,
Allah (swt) said:
' + - , ' - - , -' , ' -' , - ' = '' .
98

Allah only Iorbids you, with regard to those who Iight you Ior
(your) Faith,
These Ayah explains the consent to give giIts to the non-Muslim whether that
person is related by Iamily ties or not. The Messenger (pbuh) used to receive giIts
Irom a Iew musyrik.
99

6
According to Sheikh Jd al-Haq, receiving treatment Irom non-Muslim
doctors is allowed even though in the existence oI Muslim doctors because the
aspect being considered is not religious aspect but the skills possessed by that
doctors. Non-Muslim doctors are not inIerior in terms oI skills compared to
Muslim doctors.
100
In Iact, some non-Muslim doctors have higher skills compared
to Muslim doctors. Sheikh Jd al-Haq statement carries the meaning that in organ
transplantation operation, not only it can be done by Muslim doctors, it can also be
done by non-Muslim doctors because it does not related to ibadah matters. The
important thing is to have high skills and wide experience.
So Iar the Malaysian authority sticks to the principal that can bring beneIits
not only to the Muslim citizens but also to the non-Muslim citizens. This matter
does not contradict with the holy Islamic teaching because in Islam, perIorming
deeds is not limited to Muslims only. Non-Muslims should also receive the same
treatment.
It is admitted that iI there is a Muslim organ donor, priority should be given
to a Muslim patient also to receive that donated organ. However, iI the patient in
the waiting list is not a Muslim, it is not reasonable to let that patient suIIer until he
dies just Ior the sake oI getting a Muslim patient even though that Muslim patient
maybe in the 10
th
person in the waiting list. This means violating the person who
should be given priority based on the list. Islam never teaches its Iollowers to
ignore a person, even iI he is not a Muslim, to die just like that without proper
treatment. Islam instructed its Iollowers to be Iair not only among the Muslims but
also Ior the non-Muslims. Allah (swt) said:
` _ ' = , ' - - - - = , ` =- - '' - - + - ' ' , - , , -, , - -' , - ' ' + , ' ,
, - -' ' , , ' - = , ' - - ..

O you who believe! Stand out Iirmly Ior Allh and be
just witnesses and let not the enmity and hatred oI others make you avoid justice.
Be just: that is nearer to piety,

7
The principal oI giving priority among the Muslims is not a principal that is
Iixed and not unchanged, even more in emergency situation. Furthermore there are
Muslim patients in this country who received organ Irom non-Muslim donors
because the patients were on the top list oI patients who need organ
transplantation. II by priority, the organ should be given to a patient oI the same
religious belieI. II there is none, then it can be given to a Muslim patient.
Truthfully, priority is given to Muslim doctors if organ transplantation is from a
Muslim donor to a Muslim recipient. If the donor is a Muslim, it is more suitable
to be related to a condition where the doctors involve have freedom to do so.
The authority in Malaysia and other Islam countries abide to the rules stated
in the organ transplantation principal that was set by the World Health
Organization.
In Malaysia, aIter all the needed organs and tissue were taken, the remains
will be returned to the relatives aIter being cleaned Irom all trace oI surgery and it
does not interIere with the handling oI the deceased at all. A donor who wishes to
pull back his intention to donate organ is not considered as a crime, even though
such an act is quite unethical. In Malaysia organ transplantation process is carried
out not only in the government hospitals but also private hospitals that possessed
the expertise.
It is hoped that this explanation will enhance the understanding among the
Muslim about the practice and procedures oI organ transplantation in Malaysia and
it is hoped that organ transplantation Ior the purpose oI helping the needing
patients will increase in terms oI the number oI donors in the Iuture.
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3
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1
Muhammad YusuI al-Kandahlawi, Hayah al-Sahabah, Dar al-Qalam, Dimashq, 1987M, vol. 3, p. 555.
Ahmad bin Muhammad al-Qastalani, Khususiyat al-Rasul, Majlis Ihya al-Kutub al-Turath al-Islami, al-
Qahirah, 1996M, ed. 3, p. 28.
2
Ahmad Shihab al-Din al-KhaIIaji, Nasim al-Riyad Fi Sharh al-Shifa al-Qadi
c
Iyad, Dar al-Fikr, n.d.
vol. 3, p. 111. Abu al-Fadl
c
Iyad bin Musa bin
c
Iyad al-Yahsubi, al-Shifa Bi Ta
c
aruf Haqaiq al-Mustafa,
Dar al-Kitab al-
c
Arabi, vol. 1, n.d. p. 451. Muhammad bin YusuI al-Salihi al-Shami, Subul al-Huda Wa
al-Rashad Fi Sirah Khayri al-
c
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c
Ala Li al-Shuun al-Islamiyyah, Cairo, 1990, vol. 4, p.
82. Sa
c
id Hawa, al-Asas Fi al-Sunnah Wa Fiqhuha, al-Sirah al-Nabawiyyah, Dar al-Salam, Cairo,
1989M, vol. 4, ed.1. 1, p. 2036.
3
Ijtihad membawa maksud mencurah segala daya Iikiran untuk mengetahui hukum-hukum syarak. ( Sa
c
di
Abu Jayb, al-Qamus al-Fiqhi, Dar al-Fikri, Dimashq, 1988, ed.2. p. 71 )
4
Muhammad Ali al-Bar, al-Tabib Adabuhu Wa Fiqqhuhu, Dar al-Qalam, Kuwait, 1993, p. 208.
5
YusuI al-Qaradawi, Fatawa Mu
c
asirah, Dar al-WaIa, al-Mansurah, Cairo, 1993, vol. 2, pp. 532-537.
6
Jad al-Haq, al-Fiqh al-Islami, Murunatuhu Wa Tatawwuruhu, Majma
c
Buhuth al-Islamiyyah, 1989, pp.
233, 247 and 248.
7
Akhbar al-Liwa al-Islami, 25 Sha
c
ban 1408H, p. 5.
8
Akhbar al-Liwa al-Islami, 7 Jamadil Akhir 1407, p. 5. Akhbar al-Liwa al-Islami, 20 Jamadil Akhir,
1410, p. 14.
9
Akhbar al-Nur, 21 SaIar 1408, p. 1.
10
Akhbar al-Liwa al-Islami, 19 Rabi
c
u Awwal 1409, p. 8.
11
Akhbar al-Liwa al-Islami, 23 Rajab 1406, p. 4.
12
Hasanayn Muhammad MakhluI, Fatawa Shar
c
iyyah, Dar al-I
c
tisam, Cairo, n.d. pp. 35 and 37 .
13
Muhammad
c
Ali al-Bar, Islamic Views On Organ Tranplant, Paper Work Islam And Organ
Transplant Seminar, Kuala Lumpur, IKIM, 20&30 Oktober 1996, p. 6.
14
Ibid.
15
Muhammad Rajab al-Bayyumi, Qadaya Islamiyyah, Munaqashat Wa Rudud, Dar al-WaIa, Cairo,
1985, p. 154.

16
al-Bar, op.cit., p. 6.
17
Ibid.
18
Ibid.
19
Muhammad
c
Ali al-Bar, al-Mawqif al-Fiqhi al-Akhlaqi Min Qadiyyah Zar
c
i al-A
c
da, Dar al-Qalam.
Dimashq, 1414H, p. 168.
20
Shabir Ahmad Wadee, Organ Transplantation And The Shariah ( Islamic Law ) A South African
Perspective, Paper Work International Seminar On Organ Transplantation And Health Care Management
From Islamic Perspective, Yarsi Universiti, Jakarta,29-30 July 1996, p. 7.
21
Ibid. p. 8 .
22
Hukum Pendermaan Ginjal, Warita Kita, Majlis Ugama Islam Singapura, Julai /Ogos, 2000, pp.8-9.

33

23
al-Quran, al-Nisa : 59
24
Himpunan Fatwa Kebangsaan Malaysia ( 1970 an hingga 1990 an ) Bahagian Penyelidikan, Jabatan
Kemajuan Islam Malaysia, n.d, p. 35.
25
Muhammad Na
c
im Yasin, Abhath Fiqhiyyah Fi Qadaya Tibiyyah Mu
c
asirah, Dar al-NaIais, Jordan,
1996, p. 160.
26
Ibid.
27
Shawqi Abduh al-Sahi, al-Fikr al-Islami Wa al-Qadaya al-Tibbiyyah al-Mu
c
asirah, Maktabah al-
Nahdah al-Misriyyah, Cairo, p. 205.
28
Ibid., p. hlm. 204. Hajjah Zainab bt. Othman, Pemindahan Organ Manusia, Jurnal Penyelidikan Islam,
Jabatan Kemajuan Islam Malaysia, bil. 11 1998/1419H, p. 65.
29
Wahbah al-Zuhaili, Nazariyyah al-Darurah al-Shar
c
iyyah Muqaranah Ma
c
a al-Qanun al-Wad
c
i, Dar
al-Fikr al-Mu
c
asir, Beirut, 1997, p. 76.

30
Jad al-Haq, op.cit. p. 431.
31
al-Bar, op.cit., p. 209.
32
The World Health Organisations, Nine Guiding Principles On Human Organ Transplantation,
Malaysian Transplantation News, Malaysian Society Transplantation, September 1997, p. 2. Legislative
Responses To Organ Transplantation, Martinus NijhoII Publishers, Netherland, 1994, pp. 473-474.
33
Ibid.
34
Malaysian Transplantation News, p. 2. Legislative Responses To Organ Transplantion, pp. 473-474.
35
Zaki Morad Zaher, Rawatan Bagi Kegagalan Pemindahan Organ Dan Isu-isu Berkaitan, Paper Work
Islam And Organ Transplant Seminar, Kuala Lumpur, IKIM, 20&30 Oktober 1996, p. 5.
36
Fokus, al-Islam, January 1995, p. 10.
37
Lim Yam Ngo, Progress In Transplantation In Malaysia: Paediatric Renal Transplant, In. Progress In
Tranplantation, Malaysian Society Transplantation, 4
th
Annual ScientiIic Meeting, Grands Season Hotel,
Kuala Lumpur, 30& 31 Oktober 1999, p. 13.
38
Lim Yam Ngo, Progress In Transplantation In Malaysia: Paediatric Renal Transplant, In. Progress In
Tranplantation, Malaysian Society Transplantation, 4
th
Annual ScientiIic Meeting, Grands Season Hotel,
Kuala Lumpur, 30& 31 Oktober 1999, p. 13.
39
Abu Bakar Abdul Majeed, Organ Transplantation On Islamic Perspective. IKIM Journal,
July/Dicember 1996, p. 41.
40
Sirosis Berlaku Apabila Sel-sel hati Rosak, Mingguan Malaysia, 25 April 1999, p.25.
41
Abu Bakar Abdul Majeed, op.cit., p. 41.
42
IJN Memerlukan Ramai Penderma Jantung Ramai Pesakit Mati Menunggu, Mingguan Malaysia, 7
Mac 1999, p. 20.
43
2200 Tisu, Organ Manusia Diperlu Untuk Pembedahan, Berita Harian, 11 Febuari 1998, p. 4.
44
Yahya Awang, Department oI Cardiotorasic, National Heart Institute, Kuala Lumpur, Recorded
Interview, 9 July 1999, 3.30 pm.
45
Laws oI Malaysia, Act 130 Human Tissues Act 1974, The Commissioner oI Law Revision, 1995, p. 5.
46
Zamki bin Abdullah, National Transplant Resource Center, Kuala Lumpur, Recorded Interview, 18
May 1999, 11.00 am.
47
Malaysian Transplantation News, Malaysian Society oI Transplantation, September 1997,p. 4.
48
Zamki bin Abullah, op.cit.
49
Ibid.

3

50
C C Tan dan Doktor M Cardosa, Detection, Indentification And Selection of Donors, Malaysian
Transplantation News, Malaysian Transplantation Society, September 1997, p. 3
51
Ibid.
52
Ibid.
53
Dewan Kosmik, May, 1999, p. 12.
54
Abu Bakar Sulaiman, Prosedur Etika Dalam Pemindahan Organ, Paper Work Islam And Organ
Transplant Seminar, Kuala Lumpur, IKIM, 20&30 Oktober 1996, p. 6.
55
Yahya Awang, op.cit.
56
Dewan Kosmik, May 1999, p. 11.
57
Abu Bakar Sulaiman, op.cit., p. 6.
58
Yahya Awang, op.cit.
59
Aizai Awang Abd Rahman, Department oI Cardiology, National heart Institute, Recorded Interview,
13 September 1999, 10.30 am.
60
Muhammad Fauzi Yunus, Pemindahan Jantung Kejar Waktu, Media Kesihatan, September/Oktober
1998, p. 14.
61
Ibid, p. 15.
62
Hati Organ Hidup, Ibubapa, July 1999, p. 27.
63
Ibid.
64
Yahya bin Awang, op.cit.
65
Ibid.
66
Ibid.
67
Ibid.
68

69
Wan Mohd HaIizam bin Wan Ismail, Video Presentation On Lever Surgery, Universiti oI Malaya
InIormation Center, Kuala Lumpur, 9 March 2000, 10.00 am.
70

71
Ahmad Salehuddin, operation teater 0T 7, Malaysian National University Hospital, Kuala Lumpur,
recorded Interview, 9 March 2000, 10.00 am.
72
73
Wan Mohd HaIizam bin Wan Ismail, Universiti oI Malaya InIormatioan Center, Recorded Interview,
25 February 2000, 8.30 am.
74
Wan Azman bin Wan Ismail, Department oI Cardiology, Universiti Hospital Kuala Lumpur, Recorded
Interview, 17 April 2000, 4.30 pm.
75
Ibid.
76
Aizai Awang Abd Rahman, op.cit.
77
Ibid.
78
Muhammad Fauzi Yunus, p. 15.
79
Ibid.
80
Ibid.
81
82
Ibid.
83
Najibah Hasan, Pemindahan Jantung Bantu Menyelamatkan Nyawa, Mingguan Malaysia. 10 January
1999, p. 17.

3

84
S. Y. Tan, New Immunosuppresion Agents, In. Progress In Transplantation, Malaysian Society oI
Transplantation, 4 th Annual ScientiIic Meeting, Grand Seasons Hotel, Kuala Lumpur, 30&31 Oktober
1999, p. 23.
85
Malaysian Transplantation News, Malaysian Society oI Transplantation, p. 4.
86
Abu Bakar Sulaiman, op.cit., 3.
87
Mohd Zaki Morad Zaher, Deparment oI NeIrology, Kuala Lumpur Hospital, Recorded Interview, 10
July 1999, 3.00 pm.
88
89
2,200 Tisu Dan Organ Manusia Diperlu Untuk Pembedahan, Berita Harian, 11 Febuari 1998, p. 4.
90
Zamki bin Abullah, op.cit.
91
Nurul Adlina Kamarudin, Derma Organ Masih Asing Di Malaysia, Berita Minggu, 5 January 1998, p.
12.
92
Yahya bin Awang, op.cit. Mohd Zaki Morad Zaher, op.cit. Harjit Singh, Endoscopy Room, Kuala
Lumpur Hospital, Recorded Interview, 8 September 1999, 10.00 am.
93
Muhammad Amin Ibn
c
Abidin, Hashiyah Ibn Abidin, vol. 2, Dar Ihya al-Turath al-
c
Arabi, Beirut,
1984, p. 166.
94
Shihab al-Din Ahmad Qalyubi, Hashiyatan
c
Ala Minhaj al-Talibin, Dar al-Fikr, Beirut, vol. 3, n.d. p.
212. ibn Hajar al-
c
Asqalani, Fath al-Bari, Dar al-Matba
c
ah al-SalaIiyyah, Cairo, 1407H, vol. 10, p. 207.
95
Abu Muhammad Ibn MuIlih, al-Furu
c
,
c
Alam al-Kutub, Beirut, n.d,. vol. 2, pp. 462 and 479.
96
Ali Muhammad YusuI al-Muhamadi, Hukm al-Tadawi Fi al-Islam, Majallah Fiqh al-Islami, Jeddah,
1992, p. 619.
97
al-Quran, Ali
c
Imran : 75.
98
al-Quran, al-Mumtahanah : 9
99
Ibrahm Muhammad al-Jamal, Fiqh al-Muslim
c
Ala al-Mazahib al-Arba
c
ah, Dar al-Jil, Beirut, 1992,
vol. 3, pp. 151-152.
100
Jad al-Haq, op.cit., p. 432.
101
al-Quran, al-Maidah: 8.

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