Organ Transplants in China Face Similar Controversies as in Egypt

- Regarding the Book,?Our Bodies Belong to God

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With the advancement of modern medicine and technology, organ transplants have become more and more popular in Western countries. However, more and more ethical issues have been raised, particularly in countries with traditional beliefs. In the book?Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt, Sherine Hamdy addresses issues regarding organ transplants in Egypt. Through examining the work conducted in Cairo,?Mansoura, and Tanta?from 2001 to 2007, Sherine?Hamdy?(2012, p. 10) “examines the layers of social networks that have shaped and been shaped by Egypt’s organ transplant debate” through engagements with a variety of groups of people in Egypt. China is also an ancient country with a long history. Though biotechnology is well developed in China, there are still debates about organ transplants regarding the biomedical versus the traditional ideologies, the definition of death, and consents from the family. "Similar to Egypt, some 'unknown'?market in China is also well-developed. China is also facing?some?controversies regarding organ transplants as in Egypt."

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Biomedicine versus Tradition

"Biomedical authority remains the national medicine of Egypt (Hamdy, 2012, p. 43)," but it is unable to build a definitive position on organ transplants. The highest moral, religious authority, Islam, does not agree with the biomedical authority. From the Islam framework, "our body belongs to God," as Shaykh Sha'rawi stated, "the human body is the exclusive property of God (Hamdy, 2012, p. 122)." From this traditional perspective, organ transplants should be forbidden because people?do not have the right to give away human body parts; the right comes from God. Though biomedicine takes up the authority of health in Egypt, the traditional thought is still deep in mind and hard to change. People who believe in biomedical authority may still concern about the tradition; an example is that "doctors poked fun at patients' fears that they might need all their body parts in the afterlife and simultaneously felt uncomfortable with the idea of parting with their own organs (Hamdy, 2012, p. 44)."

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However, anything that serves the greater social community can be allowed in Islam (Hamdy, 2012, p. 42). While?the purpose of organ transplants is to benefit the greater society, so it should be accepted by the tradition. Hamdy (2012, p. 131) argues that “differing positions on a practice such as an organ transplantation may have less to do with their different approaches to Islamic legal tenets than with their views of the practice at hand and its relationship to state institutions.” The statement “our body belongs to God” does not simply prohibit all the organ transplants, but?it?is subject to be modified through individual experiences and interpretations. That said, though it is hard to establish an Islamic consensus with the biomedical authority regarding organ transplants, it had become possible for people to accept biomedicine?through time as ideology changes.

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In China, though most people consider themselves as “non-religious,” "Certain Traditional idea" has become an “invisible rule.” In family education, children are asked to read Three-Character Canon, Standards for being a Good Pupil and Child, and other Confucianism-promoting books. The education system, job market, institutions are all under the rule of Confucianism, which promotes the idea of “being controlled under the Sky.” The main idea of Confucianism is to assign authority powers in the family, institutions, and society. Like traditional Egypt, Chinese people are unwilling to donate body parts because of the Confucianism?idea: “the body is given by the Sky that cannot be modified.” China remained to be a culture-closed country from hundred years ago until the last decades. "Through globalization in recent years the young Chinese people start challenging the traditional ideas."?That said, like Egypt, China is now accepting organ transplants. More and more young Chinese people and their relatives decide to sign the Voluntary Letter for Donation of Human Organs. However, as China has a huge population with different kinds of people living in different regions with different education levels, it is impossible for China to accept organ transplants immediately.

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Definition of Death & Family Consents

Unlike some Western countries, brain-death is not legally recognized in Egypt and China. "Medical practitioners in these (brain-dead defined) countries are not being deceitful about the patients being ‘actually’?dead because, in their terms, patients are dead. (Hamdy, 2012, p. 65)" In Egypt, legislators make decisions based on muftis, but the disagreement between fatwas and physicians impact muftis' final decision. "Fatwas and medical opinions (about the brain-death) swirled in circuits of doubt (Hamdy, 2012, p. 48)." The only common agreement is that a family member can donate a body part but cannot sell it, though the death definition remains controversial. Hamdy (2012, p. 75) argues that the current fatwa-physician system cannot legalize the brain-death, as the agreement cannot be met. In China, this idea of brain-death is widely accepted by the public; but in practice, family members cannot accept brain-death as the final death because these family members think the use of a mechanical ventilator can still keep the patient "alive." Besides, many Chinese people consider brain-death as the same as PVS (Persistent vegetative state) because of the promotion from social media, so many Chinese people would think there is a possibility that the patient will become PVS and even awake after the brain-death. The practical use of brain-death limits the source of organ donations in Egypt and China as many organ transplant processes require brain-dead. China has similar situations as Egypt regarding the definition of death.

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Acquiring organs from living donors is strictly opposed in Egypt; instead, cadaveric donors are more ethical. However, "the 1996 media scandal involving stolen eyes proved disastrous to the future of cornea grafting in Egypt (Hamdy, 2012, p. 110)." Therefore, to respect the cadavers and to avoid improper treatment of them, doctors are trying to resolve this issue by obtaining consent from the donors' families. In China, one's own willing to donate an organ is not really important in some cases: if one (alive or dead) is/was willing to donate organs, but the family (all legal relatives) does not want this person to do so, then the organ transplants would not be allowed; however, if one did not declare any unwillingness before death, the family can make a decision to donate organs, which is unlikely to happen. The questions in Egypt and China remain as: How to receive consent from the donor before death? Is that consent valuable? How does the family play a role in this process? These questions remain contentious, and the current consenting process really prevents the development of organ transplants in Egypt and China, as it largely limits organ source even the donor may be willing to donate organs. China has similar questions as Egypt regarding family consents.

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The Black Market

Hamdy argues that there are several factors for families against organ transplants, which include physical/environmental risks, iatrogenic risks, financial risks, and social relations (risks in kinship). However, these risks further increase the demand for organs from the black market. There is a simple principle: high demands, few supplies, so the black market develops. Hamdy argues against establishing an organization for organ transplants in Egypt. “Transplant proponents have failed to adequately address the vulnerabilities of the poor and the specific problems that arise when transplantation is practiced in a sharply stratified society (Hamdy, 2012, p. 245).”?Although a national organization will promote the development of organ transplants, it also makes vulnerable groups “bear the brunt of risks and uncertain outcomes of high-technological medical interventions (Hamdy, 2012, p. 245).”?That said, buying and selling organs are strictly prohibited in Egypt and China; therefore, because of the limited organ sources, most organ sources come from the black market.

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Instead of forbidding the monetary exchange of organs, which is the current governance in Egypt and China, Hamdy suggests in Egypt to create laws that ensure organ transactions are transparent, and every agent in this transaction is responsible for it (Hamdy, 2012, p. 236). However, this may not work well in China. China has a massive population of more than 1.4 billion people; Chinese people always consider their own benefit. Hospitals are always involved in the transaction with the black market. That said, making everything transparent will affect profits for many people and institutions involved. The presence of the dark market further leads to social inequality as poor people are unlikely to receive an organ, but are more likely to be forced (such as financial or violent situations) to donate an organ. However, the dark market promotes the development of organ transplants to some degree in both China and Egypt; organ transplants tend to become industrialized through black markets.

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Conclusion

Hamdy claims that the main controversy of organ transplants is who can benefit from the process at whose expense (Hamdy, 2012, p. 250). Different people and groups have different perspectives to consider costs and benefits, so given the traditional power and modern technological ideologies, it is impossible for Egypt and China to legislate a common agreement regarding organ transplants. In Egypt, biomedicine has been getting higher authority?in health?over Islam through time; therefore, as time passes, the majority of Egypt will accept organ transplants as well as the definition of brain-death. China is facing a similar situation as Egypt regarding organ transplants. Confucianism is being challenged since Reform and Open Up. Besides, brain-death in China has been widely accepted; through globalization and de-stigmatization, “time” would be the only factor preventing the legislation of the brain-death in China. In the case of the dark market, it indeed promotes the organ-transplant ideology. Although creating a transparent “white” black non-commercial market is over-ideal?in China and Egypt, it can be a goal to work on in the future?for both countries with similar situations regarding organ transplants.

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Reference [Reference Format not used due to Technical Issues]

Hamdy, S. (2012). Our bodies belong to God: Organ transplants, Islam, and the struggle for human?dignity in ?Egypt. Berkeley: University of California Press.

?(本篇引號(hào)部分內(nèi)容為過(guò)審有刪改)