Abstract
This paper critically re-evaluates the modern construct of “brain death” and argues that its rationale would become obsolete in a future where human organs can be laboratory-grown grown with complete genetic compatibility and zero graft rejection or advancements in xenotransplantation. In such a context, brainstem testing would revert to its original medical role, a prognostic indicator guiding the withdrawal of life support, while the declaration of death would return to the traditional cardio-respiratory standard. The concept of “brain death,” introduced as a
legal fiction to facilitate organ procurement, would thus lose its ethical justification. From an Islamic bioethical perspective, this development resolves longstanding debates amongst Muslim jurists about whether “brain death” constitutes mawtḥaqīqī (real death) or mawtḥukmī (legal death) or neither. The paper argues that brain death is a time-bound construct born out of necessity, not theology, and that the era of biotechnological organ synthesis would reaffirm death as an event decreed solely by Allah not by man.
Introduction
The question “When does a human being truly die?” has
challenged medicine, philosophy, and theology for
centuries. Before the late twentieth century, death was
universally defined by the irreversible cessation of
heartbeat and breathing, the cardio-respiratory definition
However, with the advent of mechanical ventilation and
the first successful human heart transplant in 1967, a
crisis emerged: organs suitable for transplantation could
only be harvested from bodies that were biologically
alive.
In 1968, the Harvard Ad Hoc Committee proposed a
new criterion for the definition of death based on
irreversible cessation of all brain function. This
innovation allowed organ retrieval from ventilated
patients without violating homicide laws, providing an
ethical and legal foundation for modern transplantation.
medicine.However, as Hussain (2022) agues this
“solution” introduced a moral paradox: “The main reason
for introducing the concept of brain death was to increase
the number of organs available for transplantation.”
Historical and medical background:
Irreversible cessation of all brain functions. Infact no organ in a patient declared brain dead is actually dead
the term “brain death” is itself a misnomer, a legal fictioniv. Patients declared brain dead still maintain circulation, endocrine function, the ability to absorb food the ability to grow, fight infection, and even gestational capacity. The persistence of integrated bodily functions
contradicts the idea that the organism as a whole has
ceased to exist.
Subsequent revisions from “whole brain death” to
“brainstem death” further weakened the coherence of the
definition. The UK Conference of Medical Royal Colleges (1979)vi reinterpreted brainstem testing from a
prognostic guideline to a declaration of death itself. The
modification was later criticised as “conceptually suspect
and clinically dangerous” by the U.S. President’s Council
on Bioethics (2008)vii.
Thus, “brain death” is not a natural nor a scientific truth
but a time-bound societal construct, developed to meet
transplantation demands and legislatively enforced to
harmonise medical practice.
Brain Death as a Social and Legal Construct
Hussain (2023)viii parallels brain death with gender
identity theory, both being postmodern redefinitions
detached from biological reality. In his words: “The brain
death criterion for death is nothing other than a
convenient fiction.”
Like gender identity, brain death depends on legal and
cultural consensus rather than objective physiology. One
may be “dead” in one jurisdiction but “alive” in another,
illustrating its artificiality.
The ethical justification for brain death rests on
utilitarian reasoning, that organ transplantation saves
lives and thus society redefines death to serve that good.
However, this pragmatic utilitarianism cannot override
metaphysical truths, particularly in religions where death
signifies the divine separation of soul and body (khuruj
al-rūḥ).
Defining Deaths in the Era of Laboratory Grown Organs And Xenotransplantation
The rapid development of tissue engineering,
xenotransplantationix, and lab-grown organs introduces a
transformative ethical paradigm. If organs can be
synthesised in laboratories from a patient’s own stem
cells, achieving 100% immunological compatibility, or
by advancements in xenotransplantation, then
1. The need for brain-dead organ donors disappears.
2. Brain death loses its functional necessity.
3. Brainstem testing reverts to a prognostic tool,
used only to predict recovery potential.
In this framework, death will once again be determined
by the traditional cardio-respiratory standard, the irreversible cessation of heart and breathing, the very
signs recognised by Islamic and classical medical
traditions for over a millennium.
Patients who fail brainstem reflexes but maintain
circulation would be reclassified as having “brainsteam
failure”, analogous to end-stage organ failure. Decisions
about ventilator withdrawal would be medical, not
ontological, guided by prognosis, not by an artificial
declaration of death.
Islamic Jurisprudential Analysis
Islamic scholars have long debated whether brain death
constitutes mawtḥaqīqī (actual death) or mawthukmi
(legal death) or neither. The OIC International Fiqh
Academy (1986)x allowed brain death-based declarations under strict conditions, which are not fulfilled in curren
clinical practice in the U.K., while other authorities such
as the Fiqh Council of North America, the European
Council on Fatwa and Research and the Indian Fiqh
Academyxiiirejected brain death as Islamic death.
Mufti Muhammad Zubair Butt’s NHS supported fatwa
(2019) concluded that:“From an Islamic perspective
neither donation after brain death nor donation after
controlled circulatory death fulfils the criteria of death.
If organs can be obtained without reliance on “brain
dead” donors, this entire theological controversy
becomes redundant. Muslim scholars would no longer
need to interpret metaphysical death through neurological
proxies. Death would again be determined by visible,
irreversible cardio-respiratory cessation, aligning medical
practice with the traditional concept of Islamic death.
Ethical and Theological Implications
Reverting to the cardio-respiratory criterion preserves
key Islamic ethical principles:
1. Sanctity of life (ḥurmat al-hayah), no organs are
removed from individuals who are not actually dead.
2. Truthfulness (ṣidq), Muslim doctors no longer need
to obscure the reality of biological life behind legal
fictions when trying to recruit organ donors.
3. Non-maleficence (lāḍararwa-ladirar) prevents
harm through premature dissection of patients to
remove their organs for transplantation
4.Future transplantation ethics must prioritise
informed consent, transparent public discourse, and
adherence to religious and moral values.
5.Divine Sovereignty, death returns to being the
moment ordained by Allah, not redefined by human
convenience.
The Qur’an states:“And do not kill the soul which Allah
has made sacred except by right.” (6:151) and “And it is
He who gives life and causes death.” (23:80)
Brain death, as a utilitarian invention to enable organ
procurement, undermines these divine principles by
redefining life for expediency.
Conclusion
The emergence of laboratory-grown organs and
advancements in xenotransplantation will represent not
merely a medical innovation but also perhaps a moral
correction.
The necessity that once justified brain death will
disappear when organ scarcity no longer exists.
Brainstem testing should then be reclaimed as a clinical
prognostic tool, as originally intendedxv, not a declaration
of ontological death.
For Muslims, this technological transition resolves one of
modern bioethics’ most persistent theological dilemmas
affirming that death occurs only when the soul departs,
signified outwardly by irreversible cessation of heart and
breath.
Ultimately, the brain death construct will be remembered
as a transient legal fictionxvi,xvii, a product of human
pragmatism during an era of medical scarcity. Its
disappearance will restore coherence to medical ethics
and harmony between modern medicine and the Qur’anic
understanding of life and death, a reality determined
solely by Allah, not by man.
References
Barnard CN. The operation. A human cardiac transplant:
an interim report of a successful operation performed at
Groote Schuur Hospital, Cape Town. S Afr Med J.
41(48):1271–1274.
Beecher HK. (1969) The “definition of irreversible
coma” N Engl J Med. 1969; Nov 6;281(19):1068
Hussain, A. (2022).“Is Brain Death Actual Death?”
“Absolutely not!” Journal of the British Islamic Medical
Association, Aug. 2022
https://www.jbima.com/article/is
death-absolutely-not/
Marquis D. Death as a legal fiction. The American
Journal of Bioethics, 14 no. 8(2014) 28
Shewmon DA. The brain and somatic integration:
insights into the standard biological rationale for equating
“brain death” with death., The Journal of medicine and
philosophy, 2001;26 (5), pp457
Conference of Medical Royal Colleges and their
Faculties in the UK. BMJ 1979; 1:332
Controversies in the Determination of Death: A White
Paper by the President’s Council on
Bioethicshttps://bioethicsarchive.georgetown.edu/pcbe/re
ports/death/
Hussain, A. (2023). Death and gender theories:
Implications for Muslim doctors and the Muslim public.
Journal of the British Islamic Medical Association
2023
https://www.jbima.com/article/death
theories-implications-for-muslim
muslim-public/
Gunkel J, Miller FG. Xenotransplantation: Injus
Harm, and Alternatives for Addressing the Organ Crisis.
Hastings Cent Rep. 2025 Sep
10.1002/hast.5021. PMID: 41091031; PMCID:
PMC12523979
MajallaMajmaʿ al-Fiqh al
Jeddah, Third Session, 1986; 2:809.
Fiqh Council of North America, On Organ Donation and
Transplantation. 2021; item no. 5
https://fiqhcouncil.org/on-organ
transplantation/
The 6th Ordinary Session of the European Council for
Fatwa and Research. 2000; Decision 2/6
cfr.org/blog/2017/11/04/sixth
council-fatwa-research/
Indian Fiqh Academy at the 16th Fiqhi Seminar, 2007;
Muhazzabpur, Azamgarh
Conference
ofMedicalRoyalCollegesandtheirFacultiesintheUnitedKi
ngdom, ‘Diagnosisofbrain
death’,BritishMedicalJournal2:11(1976),
Shah SK, Miller FG. Can we handle the truth? Legal
fictions in the determination of death. Am J Law Med.
2010;36(4):540-85
