In recent years, Kazakhstanis have rejected cadaveric donation on religious grounds. However, religious authorities of the country speak about no prohibition of cadaveric organ donation in Islam and Christianity.
Life after death
The first Kazakhstani to receive a heart transplant from the cadaveric donor was the resident of Astana Zhanibek Uspanov. In August 2012, he received a heart transplant from a woman who became brain dead after massive stroke. Her son gave consent to removal of organs. The surgery went well. Zhanibek has children. According to him, he started to value life after he felt the breath of death.
Zhanibek was infinitely lucky that the deceased person’s relatives permitted to use the organs. Now Kazakhstan has a decline in transplant surgeries using organs from deceased donors. The point is that the Code of People’s Health was amended in 2020 to introduce live consent or rejection of Kazakhstanis or their relatives of cadaveric organ donation. It was one of the main reasons why the number of transplantations from deceased donors has declined from 86 to 5-7 per year, according to ‘Vlast’ with reference to the ministry of health.
Now, according to ‘Vlast’, the ministry analyses laws and regulations based on the international experience to change the situation because there are 3,961 recipients in need of organ transplantation, including 104 children, on the waiting list. As of January 22, 2024, only 5,456 persons gave consent to live donation via one of legal instruments, on the electronic government portal eGov, and 35,725 rejected.
“Last year, we had 49 [potential] donors, and 90 per cent of them rejected. Relatives of seven deceased donors gave consent. Those seven people saved lives of 19 Kazakhstanis,” said Aidar Sitkazinov, director of the Republican Centre for Transplantation Coordination. “If we speak about people who have problems with kidneys, these people have a chance – dialysis, and they live for a certain period of time. Those who have problems with liver and heart have no chance. Live transplantation is impossible for them; they can only be saved by cadaveric donation.”
According to Zhanibek Uspanov, chances are low to become a donor even with live consent.
“By the time [of death], almost all organs could be damaged. We speak more about the desire of a person to be useful to other people even after death. This is the point of voluntary organ donation,” said Uspanov, who became an active promoter of the organ donation idea after organ transplantation.
According to Zhanibek Uspanov, Kazakhstanis usually reject cadaveric organ donation on religious grounds. Karaganda resident Irina Polezhayeva’s attitude is being an example of it. She is a religious person and is strongly opposed to the cadaveric organ donation.
“Many religious people believe that a human body should be maintained as it is to be resurrected on the Judgement Day. And this is the key argument among the believers,” Polezhayeva said.
According to her, organ recovery from a deceased person may take place only with consent of the relatives (it happens so in Kazakhstan now if no live consent of the donor is available). But Polezhayeva is worried about the fact that earlier this year Bolat Zhamishev, head of ‘Qazaqstan Halqyna’ foundation, declared the need to amend the law on cadaveric organ donation in order to recover organs without consent of the relatives. According to Zhamishev, this is the way to save lives of thousands of Kazakhstanis, who are on the transplant waiting lists. Most of them can hope only for organs from abroad – from the countries that do not require any permission from relatives.
Also Polezhayeva believes that the public health system of Kazakhstan is not ready for such a serious measure. The high profile case of illegal organ transplantation, when transplant surgeon Gani Kuttymuratov was a defendant, is still fresh in memory. It turned out that the relatives’ consent form for cadaveric organ donation was forged. However, the court found that the transplant surgeon was not aware of forgery. Nevertheless, the doctor was sentenced to 2.5 years in prison for improper exercise of professional duties because one of the patients was infected with HIV.
“Corruption is thriving in Kazakhstan at all levels and in all spheres. I think no good will come of it,” said Irina Polezhayeva.
Good deed
Archpriest Dmitry Baidek said that there are no religious bans on cadaveric donation. However, people should be prepared for such a sensitive issue.
“Just imagine,” said the clergyman. “A doctor comes to you and says that a person has died and his/her organs may be transplanted to other people. At the moment, the family is in grief and they are not always taking the reality adequately.”
Baidek reminded that the deceased person does not care what happens to his/her body.
“We come from dust and we will return back to it,” Baidek specified the orthodox attitude to the organ donation issue. “It is another matter that the choice must be informed, and a person should make it when alive. Presumed consent, which is practised in many countries, is a debatable question, but it cannot be deemed either good or bad.”
The Spiritual Administration of Muslims of Kazakhstan (DUMK) in reply to CABAR.asia sent a link to the article, which explains the attitude of Islam to organ donation. The article clearly says that ‘organ transplantation, i.e. transplantation of some organs from one person (live or dead) to another one, is allowed.” The explanation provides passages from the Quran, which prove that transplantation is allowed.
“However, this practice is allowed only if certain conditions are observed to the extent that does not humiliate the person,” according to the article. You can see the conditions in detail here.
Sensitive issue
Prominent public figure, chair of the Council of Mothers of the Assembly of People of Kazakhstan, Nazipa Shanai, has studied the issue of cadaveric organ donation from different perspectives and made an informed decision: she has given living donor consent for cadaveric organ donation. She notified her children and generally accepts death calmly. According to her, she tries to complete all tasks when leaving office not to leave things unfinished.
“Islamic religious leaders are not opposed to organ transplantation. Moreover, they think it is a benefaction. There is a special book ‘Petualar zhinagy’ (A collection of fatwas), which contains DUMK decisions on some unusual phenomena. When the society has some questions, our scholars read the Quran and make a relevant decision. The book has decree No. 8, which tells about permission of organ transplantation. It is written here that organ transplantation is permitted for the sake of saving life,” said Nazipa Shanai.
Aidos Sarym, member of the lower house of parliament, political analyst, does not consider himself as a deeply religious person and is willing to donate his organs after death.
“I am willing to sign the consent form next time when I visit a policlinic,” Aidos Sarym said. “I am a contemporary man and if something happens to me, you can use it. I do not consider the cadaveric organ donation as something mystical or deeply religious.”
This attitude of a public figure can change someone’s opinion about the cadaveric organ donation. Member of Parliament Askhat Aimagambetov believes that the opinion of people who reject cadaveric donation on religious or other grounds will always be affected by those around them.
“This is a sensitive issue and it is up to every citizen,” Aimagambetov said.
Therefore, this issue, according to Member of Parliament Sergei Ponomarev, requires awareness-raising work, “To make people aware of the issue.”
He said that four thousand Kazakhstanis wait for kidney transplantation, i.e. the cadaveric donation issue is really relevant for the country.
“All progressive people should make good deeds,” Ponomarev said.
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