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do no harm. And third, it must be understandable and supported by the individual within his or her cultural and belief context. Judaism is not the only religion in which uncertainty over denitions of death and the lack of a unied interpretation make people hesitate to become organ donors. Michael Olivier and colleagues described in a paper last October in Nephrol Dial Transplant how a recent case of a Muslim patient on their renal transplant list made them realise how doctors are often completely ignorant about religious beliefs in the context of organ transplantation. In Islam, there is also a debate about the concept and denition of brain death, and it is forbidden to violate the human body whether living or dead. However, as in Judaism, altruism is also very important and saving a life is regarded very highly in the Quran. The UK Muslim Law Council ruled in 1996 that organ transplantation is entirely compatible with Islamic beliefs. Yet, in Singapore, which has a presumed consent system, Muslims are automatically exempt from it, and Islamic countries generally have a low rate of carriage of organ donor cards. In Tibetan Buddhism the belief is that, while preserving physical integrity of the dead body is not seen as crucial, spiritual consciousness may remain in the body for several days after breathing has stopped and any interference might disturb the persons next rebirth. Jehovahs Witnesses have since the 1980s taken the stance that organ donation and transplantation is an individual choice under the assumption that no blood is transfused. Sikhism and Hinduism are generally supportive of transplantation because the physical integrity of the dead body is not seen as an important concept. With increasingly multicultural nations it is very important that doctors discuss and are educated about the meaning of death and the cultural sensitivities of dierent religions. Only a well-informed and knowledgeable workforce that understands and respects dierent beliefs and anxieties will be trusted at a time when dicult conversations need to be handled sensitively. Faith leaders and doctors need to work together to avoid sowing distrust and confusion. Religious doctrine needs to be interpreted with deep understanding, humane wisdom, and humility. The Lancet
For the paper by Michael Oliver and colleagues see Nephrol Dial Transplant 2010; published online October 20. DOI:10.1093/ndt/gfq628
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