XVI. Case: Post-mortem organ donation – cultural aspects of death and burial traditions

Mr. H.I. is a 56-year-old Muslim man, married and has three children, all under the age of ten. He is without any significant past medical history. Mr. H.I. is motor biking across the country when he is involved in a high speed accident with an oncoming vehicle. Though wearing a helmet, he sustains severe injuries to his head, neck and cervical spine.

He is rushed to a local Emergency Department and is stabilized on a respirator, although in an unresponsive coma. Consultation by three different neurologists on separate days results in a consensus diagnosis of brain death.

His wife and children are identified and contacted. They arrive days later from another state and are informed of his diagnosis. Although the physicians explain the definition of brain death and how it is confirmed, the family refuses to accept that he is dead because he seems to be breathing and his hands occasionally twitch.

The wife expresses a fear to a social worker that the hospital wants to take her husband’s organs. After speaking with relatives who are physicians, she is somewhat persuaded that her husband is no longer alive. However, she expresses concern about how his body will be handled and whether it will be kept in the hospital too long for a proper burial.

Omar Sultan Haque, Harold Bursztajn and Abi Gopal, USA

Please discuss the alternatives and justify your answer!
How should the physicians proceed?

  1. The physicians again invite the wife for consulting and referring to medical literature explain to her that her husband is dead – and a quick decision about organ donation has to be made.
  2. The physicians respect the fears and concerns of the family and wife and stop asking her about organ donation. They suggest stopping the heart-lung-machine to quickly allow for a proper burial.
  3. The physicians consult a local Muslim authority who is in favor of organ transplantation and try to convince the wife that organ donation is in accordance with Islamic rules for burial.