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An Islamic perspective on pig-to-human heart transplant

A prominent religious scholar sheds light on the issue of xenotransplantation according to Islam

By Hammad Sarfraz |
In this September 25, 2021, image courtesy of NYU Langone Health, the surgical team examines the genetically engineered pig kidney for signs of rejection. PHOTO: AFP
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PUBLISHED January 30, 2022

The first transplant of a genetically-modified pig heart into a terminally ill human patient has triggered intense debate among Muslims the world over. On social media and off it, many have wondered aloud what an Islamic perspective on the procedure would be given the forbidden status of the pig.

In this regard, The Express Tribune reached out to Mufti Dr Irshad Ahmad Aijaz to shed light on the development. Mufti Aijaz is a prominent Shariah scholar who also specialises in Islamic Jurisprudence and Fatwa.

Speaking on the matter, Mufti Aijaz said there are two to three basic points which, if understood, allow us to answer such questions. “First, the things that are forbidden in our religion, [and] in the Abrahamic religions, include pig. Therefore, as this question has surfaced, some classical or orthodox Jews and orthodox Christians have also raised question. They have also raised objections over the use of a pig’s organ,” he pointed out. According to him, Islam has a clear concept of things that have been categorized haram or forbidden. “But in the Holy Quran, Allah has said that if a person is in a state of iztirar (exigency) and he does not commit any rebellion or goes beyond the limits, then there is no sin upon him,” he explained.

Mufti Aijaz said experts of the Islamic law (fuqaha) and interpreters of the Holy Quran (mufassireen) have three concepts relating to this. “Firstly, a forbidden thing becomes permitted (jaiz) in state of iztirar according to its need. In the state of iztirar, the use of haram things becomes permissible be it alcohol or the pork,” he noted. “In fact, in some situations scholars have even said it is wajib or obligatory. For example, if a person who is very thirsty and needs some kind of liquid finds only a haram liquid available, in such a situation, he should save his life by using that liquid in the quantity necessary to save his life. It can be alcohol, or milk of a haram animal or any other impure thing.”

According to the religious scholar, the concept of iztirar in Islam “clearly tells us what can be done in this state.” Another offshoot of this concept that is found in classical fiqah in books in detail in all schools of thought is called tadaweh fil muharrm or medication with the help of something which is not permissible. Scholars have also provided us details that if there is such a thing that we need to use in treatment, Mufti Aijaz said.

He also pointed out that there are two types of treatments. “One is that we eat something; consume or intake something. Another is that you do not eat or intake, you use it on your body. Like in old times, what if you used the bone of a haram animal in curing some bone of a person,

The summary of my discussion is that these three or four concepts are not new in our fiqah, rather in classical fiqah we have these concepts. That if something is haram what is the guidance for consuming that thing, using that thing in treatment, and the detail about that is also found in the state of iztirar or compulsion.”

Using these principles, Mufti Aijaz said we should re-evaluate the question of treating heart disease in a man, who would perhaps die without a new heart, by implanting a genetically modified heart from a pig. “I have read in a newspaper interview of that doctor that they had been trying for about fifteen years or more to find heart of an animal or instrument that could match to the human heart. It was contemplated that such a heart could be mechanically developed or an animal’s heart is used. Several attempts have been made in this regard, but they have been unsuccessful. So the first thing that appears to the Ulemas is to assess whether there was a point of necessity in the instance or not,” the scholar explained. “It must be clarified whether there was a dire need. The answer to this is ‘Yes’. We know that not doing so would take the patient’s life. If we make use of such a thing to save his life, then it must be ascertained whether the state of Iztirar, or compulsion, is established. The answer to this is ‘Yes’.”

He added that the second question we faced is whether a pig’s heart could be used, or whether there is a possibility of using the heart of any Halal animal, or heart of any other Haram animal such as that of monkey or a dog or a goat or a sheep. “This is a possibility which only medical professionals can explain. We are talking here from the religious point of view. The first point that occurred to us was whether was a dire need? The answer is yes, as it pertains to a matter of life. The second concern was whether any other animal’s heart could be used. The assumption to this is that it is not possible to transform or transplant the heart of every other animal.”

“It must be seen here that it is an experiment that has turned out successful today. But it may be possible that in the next 50 years, more experiments turn successful. So the thing which is established is that the heart is medically a good to fit to a human body and supports adequate function. Based on such, the heart of a pig (that too of a certain age) is the most viable option amongst all. The other experiments had failed so it is clear that they tried to exercise other options but only the pig’s heart worked,” the scholar further explained.

Mufti Aijaz also noted that the surgeons did not transplant the heart as it is. “Rather they genetically modified it to sync it to human body. I don’t have access all the medical details, but what I understand is that a genetically modified heart has been used. There is a point of Sharia here. In the instance when a thing has undergone genetic change, whether its state also changes. This concept is frequently talked about by scholars, especially when they ponder over Halal and Haram matters. The concept of state-change pertains to changes in the material changes in anything. When such a thing occurs, the law of Shariah also changes.”

The scholar cited examples of this principle from classical fiqah. “One instance pertained to the use of donkeys in salt mines. Sometimes, the donkeys used would fall into deep pits and miners who searched for them found nothing but salt. It was later understood that anything buried under salt will change its state and turn into salt after some months due to chemical processes,” he pointed out.

“This instance explains the phenomena of ‘tabdeel-e-maniat’ and istehala (change of state), an issue discussed in all schools of Islamic jurisprudence. Debate on this attempts to determine rules governing the permissibility of anything upon change of its original state. Another example of this are fossils, which are made from dead animals and insects dating back thousands of years. Now that they have turned into a state of rock, the question that arises for scholars is whether rules pertaining to animals will be applied or whether these objects will be considered as rocks. The consensus answer to this is that after change of state, the rules applied will be those for the transformed object not the original one,” he explained.

Considerations for state change are common in many industries, such as soap and chemicals, shared Mufti Aijaz. “The question we have right now is to see the genetic changes that have been applied at the pig’s heart. We must assess whether after changes it is still a pig’s heart or if it is not a pig’s heart anymore.”

Even after this debate ends one way or other, the scholar said the final conclusion as whether a heart transplant of this nature is permissible will span all points discussed. “If there is a dire need of something, as in the case of saving life, the preference would go to a Halal method. But if any Halal means is not available, a Haram object may be used. When no current treatment is appropriate except for the Haram means, Muslims would be advised to continue searching for Halal alternatives while counting on the compulsive Haram option,” he noted.

That said, Mufti Aijaz said that Muslims and Muslim states should be expected to fund research into Halal alternatives. “Ulemas have given their recommendations to Muslim countries, especially those with wealth worth billions. Even if it takes decades, fund research and support Muslim doctors seeking Halal alternatives,” he urged. “As for doctors, if they feel the Haram option is a patient’s only chance for life, then it is permissible.”