Organ transplantation has emerged as lifesaving treatment for medically suitable patients with end-stage organ failure. This study revealed the stipulations of the policy, practice and ethics of human organ transplantation procured from living donors in Bangladesh. Bangladesh’s policy and practice of living organ donation for transplantation is family-oriented: only a close relative is legally allowed to donate organs to a patient. In particular, I explored how Bangladeshis donate organs to their relatives and undergo transplantation. Does the family-oriented biomedical policy and practice successfully prevent organ trafficking in Bangladesh? What are the lived experiences of Bangladeshis who undergo organ transplantation? Are they morally obliged to donate to their relatives culturally or socially? And, do donors support or resist such family-oriented donations for transplantations after the post-operative period? These questions allowed me to examine the policy and ethics of procuring organs from the bodies of relatives and to illustrate why the family-oriented practice is necessary to prevent organ trafficking in Bangladesh.
This thesis therefore examines the following policy and ethical questions: what have the family-oriented biomedical policy and practice of living organ donation for transplantation in Bangladesh been and what are the people’s views on them? How have the Islamic cultural factors and socio-economic realities of the country shaped the family-oriented character of its biomedical policy and practice in the country? And what reforms are necessary for such policy and practice and how can such reforms be ethically justified? In addition to introduction and conclusion chapters, the thesis contains three main chapters to address these issues and provides substantive policy and ethical accounts and arguments.
Chapter two of the thesis presents the stipulations of the law as well as the views and narratives of 25 transplant physicians and nurses, health administrator, organ donors and recipients, and their family members that I interviewed in Bangladesh. A survey on 102 conveniently selected persons was also made to find broad opinions. These works revealed that the family-oriented character of the law has generally been endorsed and accepted in the country. Close relatives are always encouraged to donate organs for transplantation in practice for their patients, and saving the lives of close relatives by donating organs to them is understood as a moral injunction and obligation. Many view that saving the life of a close relative by donating one’s organs is equivalent to saving one’s own life. However, it has also been discovered that potential donors may not always be available from inside families because some patients may not have close relatives or even if they do, those relatives are not medically suitable for transplantation. This indicates that a legal reform allowing non-close relatives to donate organs is necessary and should be considered.
Chapter three examines the Islamic cultural roots of the family-oriented policy and practice of living organ donation for transplantation in Bangladesh. Although organ donation for transplantation are not explicitly discussed in the Qur’an or the Sunnah, scholars have followed the spirit of these classics to explore the issues. As the purpose of the Islamic law is to serve the betterment and common good of human society, a biomedical practice should be supported if it benefits rather than hinders the well-being of human life. While Muslims are sympathetic towards every human life, they are encouarged to assist and save the lives of their close relatives first. As the obligation to relatives is the second injunction of Allah, a Muslim always expects needed care and support from one’s close family members. Specific kinship terminology is used in Bangladeshi society that defines, strengthens and corelates close family relations into a network of mutual assistance. This cultural-social ethos encourages most Bangladeshis to live collectively and motivates them to be morally devout in aiding their close relatives. It is only cultural logical for the Bangladeshi government to maintain the family-oriented requirement of living organ donation for transplantation in the country. Moreover, it should be recognized that such assistance should not be limited to close relatives only. As the Qur’an states that Muslims who are bound by ties of blood are very close to one another (Qur’an, 8:75), certain non-close relatives are also related by blood ties.
Chapter four provides substantive policy and ethical arguments for a legal remedy and improvement. The family-oriented character of the policy and practice of living organ donation for transplantation is necessary in Bangladesh; otherwise organ selling will increase in the country where the majority of people still live on less than $2 a day.If Bangladesh extends the current biomedical policy beyond blood relatives, it may place poor Bangladeshis in markets as daily commodities. That would be an immoral practice that should not be permitted. However, the thesis argues that since non-close relatives such as first cousins are also blood relatives to patients, allowing them to donate organs will not cause an organ trafficking problem as long as proper regulations are implemented. The motivation of non-close blood relations and a suitable thank-you subsidy may encourage them to donate organs to patients. This chapter also explores what would be a suitable amount of reward that would be considered a moral appreciation for receiving an organ.
The thesis concludes that the family-oriented character of the policy and practice is morally defensible and that the proposed remedy is also necessary and justifiable as it will improve healthcare outcomes, promote altruism and solidarity of Bangladeshi families, and protect poor people from selling their organs