The science of xenotransplantation is close to solving the problem of organ donor shortages — but it has put Muslims in a tight spot.
A first-of-its-kind experiment in which a kidney from a genetically modified pig was successfully attached to a human has reignited a decades-old debate among the faithful about the religious permissibility of utilising swine parts.
Islam and Judaism prohibit the consumption of pork under normal circumstances; however, porcine products have been widely used in medicines ranging from insulin to measles vaccines.
Beyond that, pig valves have aided many a Muslim's heart ever since the first graft surgery was performed in the 1960s. The process is called ¨xenotransplantation¨— the science of moving a tissue or a functioning organ from one species to another.
“I can say that the mainstream view of religious scholars is that it’s possible to use pig parts as long as we don’t have any alternative available,” says Dr. Mohammed Ghaly, a professor of Islam and biomedical ethics at Qatar’s Hamad Bin Khalifa University.
“We have an Islamic ruling that says something forbidden can become permissible if there’s a medical necessity. After all, saving a human life is viewed as a very noble gesture in Islam,” he tells TRT World.
Organ transplantation is typically the last option for thousands of critically-ill patients. In the United States alone, more than 100,000 people are waiting for a donor organ. Many of them will die due to a shortage of donor kidneys and livers.
Despite the demand, successful xenotransplantation has proved an elusive goal for researchers in the over 40 years since the first scientific attempt to transplant an entire animal organ into humans.
A big hurdle to overcome has been the strong immune response, which is triggered when the human body comes in contact with foreign tissue, often rejecting it immediately.
In the recent experiment, surgeons at New York University Langone Health, an academic medical centre, were able to make a pig kidney perform its normal functions for three days after attaching it to the abdomen of a brain-dead patient.
That study, which has yet to be published in a peer-reviewed medical journal, is being hailed as a breakthrough.
Why not a goat or a sheep?
Pig has become the preferred subject for xenotransplant research almost by default.
“Being a Muslim, we might have a problem with pig. But for the rest of the world, it’s already consumed as food,” says Dr. Muhammad Mansoor Mohiuddin, the Director of Cardiac Xenotransplantation Programme at the University of Maryland School of Medicine.
Mohiuddin, a practising Muslim of Pakistani origin, is among the pioneers in the field of xenotransplantation. He and his colleagues at the National Institutes of Health successfully attached pig hearts to several baboons in 2014. One of the hearts survived for almost 3 years.
“We have completely mapped the genome of a pig,” he says, referring to the set of genetic information that forms the basis of living organisms.
“We know how a pig differs from a human and what changes are needed to make its organs acceptable in our bodies. We don’t know much about goats or cows.”
Non-human primates such as gorillas are the most ideal candidates to harvest donor organs.
Genetically speaking, they are much closer to humans — that’s one reason most advanced xenotransplant tests are still performed on monkeys.
The problem is that baboons, gorillas and chimpanzees are considered endangered species. There are also concerns that some zoonotic viruses, much like the coronavirus, can jump from monkeys to humans.
Pigs have become the preferred animal of choice for researchers for multiple reasons. They grow up fast, reproduce frequently and in abundance, and the size of their organs is similar to that of humans.
The loathsome khanzir
Transplanting a pig heart valve or using medicines made from a pig pancreas is one thing; implanting a pig organ in humans is another. It has great potential to stir controversy.
The genetic modifications, which involve replacing some of the pig genes with human genetic material, don’t change the fact that it's essentially a pig organ.
It’s highly unlikely that the wider Muslim community will eagerly accept the use of pig organs for human transplant, even if someone’s life is at stake.
Last month, just days after New York University surgeons announced their kidney experiment, scholars at the famed Al-Azhar University condemned it, arguing the use of pig organs is prohibited.
For some Muslims, even the colloquial mention of a pig (Khanzir in Arabic) can trigger a feeling of disgust.
The 1857 mutiny of Indian soldiers in the British colonial army partly resulted from Muslim infantrymen refusing to bite off cartridges of their Lee-Enfield rifles. The cartridges were sealed with pig fat.
Even the animated children’s cartoon Peppa Pig has become a controversial subject for some Muslim parents.
“There is no question that the Quran says pigs are rijss, which means it's filthy. The debate occurs on the question of when it’s okay to use it. But the base condition is that it’s haraam,” says Dr Aasim Padela, an internationally-recognised expert on Muslim health disparities and Islamic bioethics.
“It’s like wine. You can drink it if you are dying of starvation. But that’s an exception.”
Islamic scholars have long debated the exceptions, which allow for using porcine-derived products.
Egypt’s Dar Al-Ifta Al-Missriyah, the country’s highest religious body, issued a decree saying a pig’s heart valve can be transplanted into a human if it is chemically processed and has gone through sufficient transformation to the point the valve’s basic properties are altered.
Elaborating on its reasoning, the decree cites the process of turning wine, which is prohibited in Islam, into vinegar, which is permissible .
But if a patient’s life depends on a pig heart valve and there’s no alternative available, then he or she need not worry about the valve’s purity because “Allah the Almighty knows best,” it says.
Blame the Ummah
Experts say the pig has become the animal of choice for organ donation because xenotransplantation research is common in western countries such as the US and Germany, where pork consumption is not a taboo.
“If I am not a Jew or a Muslim and I am carrying out my scientific research, do you think I have any reason not to use the pig?” says Ghaly of Hamad Bin Khalifa University.
“I can imagine if this science was born and raised in the golden age of Islamic civilisation then we would have seen other options than a pig.”
Muslim countries spend a miniscule part of their national revenue on research and development despite some enjoying per capita incomes that rival those of developed countries.
Even as a necessity, using raw material that comes from a pig is not an ideal situation for a Muslim, says Padela.
“The Muslim world and scholars are reacting to developments in the west because they are the ones researching the pig model. We don’t invest and so we don’t have halal models.”
The innovators of modern medical techniques often take the beliefs of different religious communities into consideration - provided they are able to exert their influence.
Padela cites the case of Jehovah’s Witnesses, a Christian sect with a few million followers. Because the Jehovah’s Witness faith doesn’t allow blood transfusions, an entire procedure of bloodless surgery was created.
“We just spend petrodollars on new buildings and high minarets. We have a huge healthcare system in need. Why don’t we align it with our values?”