AWARENESS FOR AFRICANS & ETHNIC MINORITY.
DR STEPHEN E.O. OGBONMWAN MBBS, M.MED, FMCOG, FRCOG. CONSULTANT OBSTETRICIAN & GYNAECOLOGIST. 25TH SEPTEMBER 2010.INTRODUCTION & HISTORY OF ORGAN
DONATION & TRANSPLANTATION.
• What is organ donation?
• The scale of the problem.
• History of organ donation
• Religious, Ethical, Cultural, Medical issues
• Promoting organ donation
• HISTORY OF ORGAN DONATION
• Scientist thought of replacing diseased organs by transplantation
• Human body is not receptive to foreign tissue due to ‘immune
system’ hence problem with rejection.
• Successful transplantation in identical twins Joseph Murray 1954
• Discovery of immuno-suppressive drugs like cyclosporinSCALE OF THE PROBLEM
• 10,000 people in UK are in need of organ
transplant to save or enhance their lives.
• Organ donation rates are low amongst Africans
• The African is 3 times more likely to need a
• 23% of the people who are waiting for an organ
transplant are Africans.
• Only 3% of organ donors come from African
• The huge disparity between need and organ
donation is very apparent.SCALE OF THE PROBLEM
• Africans do badly in all health Indices.
• Mothers of African ethnic origin are 2.3 times more likely
to have a stillbirth at parturition.
• They are 2.3 times more likely to have a neonatal death
• Research has shown that non-Caucasians women are
one and half times more at risk of experiencing severe
pregnancy-related complications than Caucasian women.
• This risk doubles for African women especially African-
Caribbean womenSCALE OF THE PROBLEM
• The overall estimated risk of severe complications is 89
cases per 100,000 maternities in the UK.
• For Caucasian women this risk is around 80 cases per
• It is 126 cases for non-Caucasian women as a whole,
• But it is 188 cases of severe complication per 100,000
maternities for the African women.
• Worse still is 196/100,000 maternities for African
Caribbean women.Religious aspects of Organ
Donation & Transplant:
• BUDDHISM & ORGAN DONATION:
• There are no injunctions in Buddhism for or
against organ donation.
• . The needs and wishes of the dying person
must not be compromised by the wish to save a
• Central to Buddhism is a wish to relieve suffering
• “Whoever would care for me, let him care for
those who are sick”. Buddha.Christianity and Organ
Donation & Transplant:
The Christian faith is based upon the revelation of God in the life of
• Jesus taught people to love one another and He proved His love for
the world when He died upon the cross for our sins.
• Sacrifice and helping others are consistent themes in Christianity,
• “…freely you have received, freely give” Matthew, chapter 10:8
• Christians should be encouraged to help others in need. Discussing
organ donation with family and friends is a responsible and
• The teaching of Christ can be summarised in thus, ‘Love your
neighbour as you love yourself’Hindu & Organ Donation
• There are many references that support the concept of organ
donation in Hindu scriptures.
• Daan is the original word in Sanskrit for donation meaning selfless
giving. In the list of the ten Niyamas (virtuous acts) Daan comes
• Life after death is a strong belief of Hindus and is an ongoing
process of rebirth. The law of karma decides which way the soul will
go in the next life.
• Organ donation is an integral part of the Hindu way of life, as
guided by the Vedas. That which sustains is accepted and promoted
as Dharma (righteous living).
• “…it is said that the soul is invisible…knowing this you should not
grieve for the body.”
• Bhagavad Gita, chapter 2:25Islam and Organ Donation &
• In 1996 the Muslim Law (Shariah) Council UK issued a fatwa on organ donation
• The council resolved that:
• The council supports organ transplantation as a means of alleviating pain or saving
life so Muslims may carry donor cards.
• The next of kin of a dead person, in the absence of a donor card or expressed wish,
may give permission to obtain organs from the body to save other lives.
• The fatwa is based on the Islamic principle of necessities overrule prohibition.
Normally, violating the human body, whether living or dead, is forbidden in Islam –
but the Shariah believes this can be overruled when saving another person’s life.
• Some Muslim scholars who believe that organ donation is not permissible and hold
the view that this does not fall under the criteria of the Islamic principle of necessities
overrule prohibition due to other overriding Islamic principles.
• The Muslim Law Council UK fatwa draws on one of the basic aims of the Muslim faith:
saving life.“Whosoever saves the life of one person it would be as if he saved the life
of all mankind.” Holy Qur’an, chapter 5:32Judaism & Organ Donation
• In principle, Judaism supports and encourages organ
donation in order to save lives (Pikuach Nefesh).
• This principle can sometimes override the strong
objections to any unnecessary interference with the
body after death, and the requirement for immediate
burial of the complete body.
• As all cases are different, Jewish law requires
consultation with a competent Rabbinic authority before
consent is granted.
• “One who saves a single life – it is as if he has saved an
• Pirke D’Rav Eliezer, chapter 48Sikh and Organ Donation
• Sikh philosophy and teachings place great emphasis on
the importance of giving and putting others before
• It also stresses the importance of performing noble
deeds and there are many examples of selfless giving
and sacrifice in Sikh teachings by the ten Gurus and
• Sikhs believe life after death is a continuous cycle of
rebirth but the physical body is not needed in this cycle
– a person’s soul is their real essence.
• “The dead sustain their bond with the living through
virtuous deed.”Medical Aspects of Organ Donation and
• Surgical risks to the organ donor.
• Surgical risks to the recipient.
• Living donors better than cadaver donors due to
• Need for consent for operation.
• 5 donor deaths per 19,368 procedure (USA
• Urological, vascular risks as in any surgeryLegal Aspects of Organ Donation
• Opting-out system, every human being is considered a possible
donor after death unless he/she has officially expressed a contrary
option. It is also known as presumed consent.
• By opting-in we mean a process by which people voluntarily sign
and submit a will saying that they want to become donors once they
are dead. If they do not do this, they will not be legally considered
• Required request law requires hospitals to ask the family of a
deceased patient for a donation of organs if the deceased is a
suitable candidate for organ donation
• Law prohibits trade in human organs and address the donor’s right
• .The law also protects supply of organs to the needy.Promotion of Organ Donation
• Donate Blood , Organs and Tissue for the sake
of Love of our fellow human being.
• Remember, when you freely give, you freely
• Organ donation may not interfere with body
• The need of our brothers and sisters supersede
any inhibition we may have to organ donation.Summary: Religion & Organ
Donation & Transplantation.
• No religion formally forbids donation or receipt of organs
or is against transplantation from living or deceased
• No religion formally obliges one to donate or refuse
• No religion formally obliges one to consider cadaver
organs “a societal resource” or considers organ donation
“a religious duty.
• No religion has a formal position on “bonus points,”
which is priority on the waiting list.
• No religion prefers cadaver over living donation.Social & Cultural Aspect of
• In Asian countries, it is more difficult to obtain cadaver kidneys for
renal transplantation because of certain socio-cultural beliefs and
customs. The issues affecting living related kidney donation are
more social than cultural. Important misconceptions and fears are:
• Fear of death,
• The belief that removal of organ violates sanctity of the deceased,
• Concern about being cut up after death,
• Desire to be buried whole,
• Dislike of idea of kidneys(organ)
inside another person,
• Wrong concept of brain death, and
• The idea of donation being against religious conviction.Cultural Aspect of Organ
• The Benin or Edo speaking people of Southern Nigeria, see the body as
sacred and not to be dismembered or violated. Liken that to the biblical
teaching which says the body is the temple of the Lord and should not be
dishonoured by dismembering it at donation.
• The Benin people believe in reincarnation that the body is only a vehicle for
the soul or human spirit. Hence they comfort the relatives of the deceased
that the deceased is not dead but has only transcended this life as his/her
soul has gone beyond human perception. ‘wa ghe vie ba mwen no wu’
• That transcended soul reincarnates 14 times to atone for perceived sins
before going into sublimation or eternity.
• It is believed that a dismembered part may be missing in subsequent
reincarnation which how the people explain birth defects.
• These ancient and traditional beliefs are gradually giving way to modern
thinking that organ donation saves and prolong the lives of the recipient
and as such should be encouraged. However the fear of the unknown keeps
holding people back from doing the needful in organ donation.Ethics of Organ Donation & Transplantation.
• Catholic Church holds that the virtue of charity is the norm for the justification of the cadaveric ,
and living organ donation and transplantation.
• John Paul II justifies organ donation and transplantation based on charity in general. He urged
Christians “to promote and encourage such a noble and meritorious act as donating your own
blood or an organ to those who have need of it.’’ as it is an act of love (Evangelium Vitae 86)
• This gift of organ donation is actually an authentic form of human and Christian solidarity.
• The death and resurrection of Jesus Christ establishes the supreme act of love.
• In Judaism, Bulka observes: “One may laud the donor who makes a heroic sacrifice, but it
certainly would not be proper to place pressure on individuals to be so altruistic.”
• Greek Orthodox Church, Stanley S. Harakas writes about the donation of a kidney. Organ
donation rescues “the life of another person as a loving act of mercy. The donor is to be
commended if he perceives his sacrifice not as a violation of his bodily integrity, but as a gracious
and loving unselfish act.”
• The Islamic Code of Medical Ethics (1981) upholds: “If the living are able to donate, then the
dead are even more so; no harm will afflict the cadaver if the heart, kidneys, eyes or arteries are
taken to be put to good use in a living person. This is indeed charity.”
• In the Buddhist tradition, organ donation is an act of helping another person in his/her extreme
need. It is an act of generosity and compassion. Organ donation and transplantation is acceptable
also in the Hindu tradition.Ethical Issues Connected With Donor
• From the medical perspective, the principle of totality would mean “all the parts of
the human body, as parts, are meant to exist and function for the good of the whole
body, and are thus naturally subordinated to the good of the whole body.”
• There should be a serious need faced by the patient, which can only be satisfied by
• Even if donation reduces “anatomical integrity, it should not diminish the “functional
integrity” of the person.
• The risk in donation as “an act of charity is [to be] proportionate to the good
resulting for the recipient.”
• There should be “free and informed consent” by the donor. All these norms can be
seen in the principle of totality.
• The 1975 Ethical and Religious Directives for Catholic Health Care Facilities states
“[T] he transplantation of organs from living donors is morally permissible when the
anticipated benefit to the recipient is proportionate to the harm done to the donorTAKE HOME MESSAGE ON ORGAN
DONATION & TRANSPLANTATION.
• There is a real scarcity of human organs even though organ transplantation facilities
are widely available. In this context, both living and cadaveric organ donation and
transplantation should be promoted.
• African and ethnic minority should be encouraged to be involved in organ donation to
ease the waiting list of their kin men and women on the organ donation programme.
• Africans should do their best to be exposed to all available resources in the
environment in which they live so that they can utilise these resources to their fullest
advantage as well as contribute to it to make it successful for mutual benefit.
• Africans and other ethnic minority should not socially exclude themselves from
community activities like organ donation because when they do so it is to their
detriment because if you do not give, you will not receive and when you freely give,
you also freely receive.
• The bible says that for lack of knowledge our people perish, Africans must do
everything possible to acquire knowledge and good education because there is power
in knowledge and education.TAKE HOME MESSAGE ON ORGAN