PANELMEDICAL FACULTY

MUSLIM UNIVERSITY OF INDONESIA2015

GROUP 14 BY:

GROUP

14

Muh. Asy Shidiq 110 2015 0003A. Muh. Yasser Mukti110 2015 0022Andira Ratu Nurrasyid 110 2015 0030Andi Aisya Zealand 110 2015 0051Nur Zamzam Azizah 110 2015 0059Amaliah Hakim 110 2015 0070Rifqy Aditya 110 2015 0078Rindang Cahyani Abas110 2015 0101Elsa Shafira Prasetyati 110 2015 0117Cindy Purnamasari 110 2015 0136Atika Rahmah Mustapa 110 2015 0147

S C E N A R I O 2“ A Woman Who was Forced to offer her kidney”

This was a case of a woman of 22 years of age who came to donate a kidney for our patient who was supposedly her brother. She was a good match, but I strongly suspected that she was not related and was either being coerced or being paid to donate the kidney. We have a policy against doing transplants from unrelated donors. We make it very clear that we will consider a transplant only if the donor is related to the recipient and is not doing it for gain. I asked her several times but she said that she was his sister. I still had my suspicions, so I sent her to a psychiatrist for assessment. She was of subnormal intelligence and did not understand the procedure.

We could have refused to do the operation here, but they would have gone to some other center and had it done anyway. So, we carried out the operation. Much later, we learned that she was a paid, distantly related person who was possibly forced by her family. We are trying to avoid that this becomes a commercialized process of buying and selling goods in the market.

We have pioneered the process of renal transplantation in the country and we have found that our results are comparable to the advanced centers in the West. A very important cornerstone of our policy is that we do not accept unrelated donors. Many hospitals in our country allow unrelated donations. The demand for transplants is far greater than available donors can meet. We do not have a government-approved cadaver organ harvesting policy. So the patients have to rely on willing relatives or buy it in the market. It would cost the recipient a big sum of money and then there is the cost of life-long immunosuppression. Some people can afford this and they create a demand for kidneys from unrelated willing donors. The donors desperately need the money and the doctors tell them they can manage with one kidney. Innocent people, underprivileged, unrelated or distantly related, are coerced or even tricked into giving a kidney. Sometimes they don't even know it. They may not be given any money or less than what was promised. This is not new; we have had quite a few reports already. The implications are very serious as have been seen in many developing countries.

We had another case where the donor was clearly a first cousin of the patient and was apparently willing. We had some vague feeling about her and sent her for psychiatric assessment. They found that she had subnormal intelligence and had no clue about the issue, the procedure and what it meant for her. We refused. The patient and his family, and even the donors' parents were upset with us.

H A R D W O R D

TransplantationTo perform a medical operation in which an organ or other part that has been remove from the body of one person is put it into the body of another person.

ImmunosuppressionA weakning of the immune system that cause a decrease ability to fight infection and disease.

CommercializedTo use something as an opportunity to earn money; designed principally for financial gain; profit-oriented.

CONT…

CoercedPersuade (an unwilling person) to do something by using force or threats.

Source : Meriam-Webster Dictionary, Oxford dictionary

CadaverCorpse or a death body; especially : one intended for dissection. Subnormal

Lower or smaller than normal, un normal structure or function; having less of something and especially of intelligence than is normal.

ImplicationA possible future effect or result.

Analyze the

case based on the principles of:

Medical Humanity AspectHumanism is aimed at reviving a sense of the flow of humanitarian/aspire to a better association. There is also the opinion of humanism as an attitude /behavior regarding human attention with emphasis on compassion and the dignity of the individual

Source : The teaching in Medical Faculty of UMI 2007

“We make it very clear that we will consider a transplant only if the donor is related to the recipient and is not doing it for gain”

“Much later, we learned that she was a paid”

“We are trying to avoid that this becomes a commercialized process of buying and selling goods in the market”

“It would cost the recipient a big sum of money and then there is the cost of life-long immunosuppression”

“Distantly related person who was possibly forced by her (the girl) family”

“A woman of 22 years of age who came to donate a kidney for our patient who was supposedly her brother”

“She was of subnormal intelligence and did not understand the procedure”

T E X T U A L

She (the girl) shouldn’t donate because the doctor would be able to explain the effects and procedures to the donor.

The girl should be honest to the doctor to get the best medical services

The transaction of human’s organ without a legal approve should be stop

The donor’s family shouldn’t forced her to do the transplantation without the girl’s permission

CONTEXTUAL

Medical Ethics AspectsMedical ethics in stedman’s medical dictionary tell that principles of correct professional conduct with regard to the rights of the physician himself, his patients, and his fellow practitioners. We can also tell that ethics in medical aspect is priciples of related professional behavior with the right as a doctor, the patients, and the rights of the colleague.

Source : Hanafiah, M.Jusuf.2007.Medical Ethics and Health Law. 4th Edition.Jakarta:EGC

“We could have refused to do the operation here, but they would have gone to some other center and had it done anyway”

“We do not have a goverment-approved cadaver organ harvesting policy”

“A very important cornerstone of our policy is that we do not accept unrelated donors”

T E X T U A L

The doctor want to save by doing the operation because they would do it in the other medical center anyways

The hospital have policy that the doctor shouldn’t accept unrelated donor

Autonomy:

The doctor already asked her several times about the relation between patient and donor. We still need permission from the donor to prove about the blood relation with the patient

Non-Maleficent:

The doctor did the operation and didn’t cause any bad effect to the patient or the donor

CONTEXTUAL

Medical Professional AspectsProfessionalism is reflection of the values and behavior of doctors in a daily with patients, family, colleagues and the society.

The essence of professionalism :

Our moral to run an ethics

Running an ethical the public profession

Negotiations between the value of the profession and the value of the society

Source : Dahlan, Sofwan. Setyo Trisnadi.2012.Medical ethic and professionalism.Medical Faculty in UNNISULA

“So, we carried out the operation”

“They found that she had subnormal intelligence and had no clue about the issue, the procedure and what it meant for her”

“I still had my suspicions, so I sent her to a psychiatrist for assessment”

“ We refused. The patient and his family, and even the donors' parents were upset with us”

T E X T U A L

The doctor do the right thing by sent her to psychiatrist to prove about her knowledge about the transplantation and her

relation with the patient

The doctor knew that she has a subnormal intelligence but still doing the operation

The doctor doesn’t have commitment or accountability because on the other case the doctor refused to do the

operation with subnormal intelligence donor

CONTEXTUAL

Caring, Compassion and Communication

Honor And Integrity

Responsibility and Accountability

How do you see the case in the perspective of Islam (All the Aspects in the view of Quran and Sunnah)

ر���� و�� ف��� غ��� غ��� غ��� ا��ل�� غ����� إ���ا � إ��� ي�� غ�� غ��� غ���� ي�� إ���ا ا غ���� غ���� د��� ا�� غ��� ا غ����� غ�� د�! ا�� غ�" غ���# ي��� غ��� غ����# ف����$ ي���% ا�� إ���& غ��' غ����ر� إ)� غ�

“….. But whoever is forced (by necessity), neither desiring (it) nor transgressing (its limit), there is no sin upon him. Indeed, Allah is Forgiving and Merciful”

Q.S Al-Baqarah ayat 173

Q.S Al-Maidah ayat 32

ي��� م إ���� د��� ا�� غ����* غ���� ي�� غ��+ا د�����, ي��� غ�- إ���# ي�� غ��. إ�" ا�� س����* ي��� غ�- غ���0 غ�1 غ���2 ي���& غ���3 ف��� غ��- غ��+ا غ���0 �� إ�4 ا�� غ���# ي����5 إ���ا ي��� إ�6 غ�" ى���7 غ�� غ��� ا�� غ�6 ي�9 غ��1 غ�: غ��; إ��ل ى��غ> إ���0 ي��= غ��+ا ي����ي��< غ��? غ��ل غ�� � ا�� س��@ �� إ��' غ��= Aغ����� ا�� غ��6 ا��ل�� ا�� غ�� ي��) غ��+ا ا�� غ��' غ��- غ��+ا Bغ� غ���� ا�� Cغ�� ا�� غ�� ي��) غ��+ا ي���& غ���3 غ�� ا�� س��@ �� إ��' غ��= Aغ����� ا�� غ��6 ا��ل�� غ���0 غ�1 غ���2 ا�� غ��' غ��- غ��+ا Bغ� غ���� Dإ����� غ+اي��� ي����� ا��

و������� ف���� إ���# ي����* ف��' غ��ل Dإ����� غ+اي��� ي����� ا�� ي��� إ���� غ��; إ��ل ى��غ> غ��< ي��@ غ�" ي���� Eف� ي�6 إ���3 ا�� س���# �� Fإ� غ�: غ����� إ���ا غ����� ف�� Gإ��� ا�� غ�6 ي�� غ�9 ي��ل ا�� إ�" ا�� غ�6 ف�� ف����5 ف��� ي���� Eف� Iي� Jغ�� ا�� غ��=“Because of that, We decreed upon the Children of Israel that whoever kills a soul unless for a soul or for corruption [done] in the land - it is as if he had slain mankind entirely. And whoever saves one - it is as if he had saved mankind entirely. And our messengers had certainly come to them with clear proofs. Then indeed many of them, [even] after that, throughout the land, were transgressors.”

Q.S An-Nisa ayat 29

“O you who have believed, do not consume one another's wealth unjustly but only [in lawful] business by mutual consent. And do not kill yourselves [or one another]. Indeed, Allah is to you ever Merciful.”

غ����� ف�Bو�� Iغ� ي���� غ��+ا ا غ������ إ���ا إ���0 Kإ���� ا�� غ�9 ي��ل ا�� إ�" ي���� Bف� غ�6 ي�� غ�" ي���� Bف� غ��ل ا�� غ��و ي���3 غ��+ا و��ا�� ف�� ف�: ي��+ا Iغ� ا غ����� و��ا�� ف�6 غ���3 آ��غا غ���& ي� Nإ�� غ���ل ا�� ا�� Eغ� ف��ي غ��+ا ا�� غ�يا�� س��' �� إ��) غ��� ي���� Bف� إ�" غ���� غ�:ا�� غ��� غ��� ا��ل�� غ����� إ���ا ي���� Bف� غ����* ف��� ي�- غ��+ا و��ا�� ف�� ف�1 ي��? Iغ� ا غ����� غ�� ي���� Bف� ي�6 إ���3 Dد���� ا�� غ���# Iغ� ي���& غ��� Oس��� غ��� ا�� Pغ�� Iإ�  

Q.S Al-Maidah ayat 2

�����ا غ�� غ��< آاإ�4 ���� غ��? ي��ل ا�� غا ����� غ�� Qغ�� ي��< Eغ� ي��ل ا�� غا ����� غ�� Rغ��� ا�� غ���# Sغ�� ي��ل ا�� غ���# Eي� T�غ���� ا��ل�� غا ����� غ�� إ��� ��� ا��ل�� غ���# إ�4 آ��ا غ��@ Uغ���� ي��ا و�� ف��� Sإ�� Iف� غا ي��ا����� و�� ف�6 غ���3 آ��ا غ���& ي� Nإ�� غ���ل ا�� ا�� Eغ� ف��ي غ��+ا ا�� غ�يغا ����� غ�� ي��ا ف��� �� ا�� غ����$ Vي��� ا�� غ���� ي���� ف�1 ي�� غ�� غ��) ا�� غ��> إ��ا غ�� س�ا ا��-� غ��و ي���% إ��� غ�� ي���� Eإ� ي�" غ���� ���& ي���3 سا ���� Wي��� غ���� غ����� و�� ف��. غ�1 ي��9 غ�ي Rغ��� ا�� غ���# Sغ�� ي��ل ا�� Xغ��� ي�� غ�9 ي��ل ا�� غ���& ��� ي���3 آ��ا

ي���# �9 ي��ل ا�� ���7 غ�� غ��� ي��ا و�� ف�- غ�� ا�� غ��@ Iغ� غ�� ي��ا ف��< �� غ�1 ي��@ Iغ� ���� غ��+ا Rإ��� ا�� غ���# Sغ�� ي��ل ا�� إ��< Pإ�� ي����* غ��' ي��ل ا�� إ���& غ��� ي���� ف��: ف���< �� Vغ��� ���� غ��+ا Rد���� ي��و غ���2 ف���� آ��ا غ�6 Uغ���� ي���� Bف� غ���6 غ���3 إ���# Pي�� غ�ي Yإ��� ا�� غ��? إ��@ ي��ل ا�� ف��< ي� إ��< Uغ���� غ��� ��� ا��ل�� غ����� إ���ا غ��� ��� ا��ل�� ي��ا و�� ف��? I�غ� ا�� غ�� إ���� ا�� غ�� ي��< ف��@ ي��ل ا�� غ�� إ���� إ�اي�� ا������� ���7 غ�� غ��� ي��ا و�� ف�- غ�� ا�� غ��@ Iغ� غا ����� غ�� ى��� غ��و ي��? غ��1 ا��ل�� غ��

“O you who have believed, do not violate the rites of Allah or [the sanctity of] the sacred month or [neglect the marking of] the sacrificial animals and garlanding [them] or [violate the safety of] those coming to the Sacred House seeking bounty from their Lord and [His] approval. But when you come out of ihram, then [you may] hunt. And do not let the hatred of a people for having obstructed you from al-Masjid al-Haram lead you to transgress. And cooperate in righteousness and piety, but do not cooperate in sin and aggression. And fear Allah ; indeed, Allah is severe in penalty.”

 “And spend in the way of Allah and do not throw [yourselves] with your [own] hands into destruction [by refraining]. And do good; indeed, Allah loves the doers of good”

Q.S Al-Baqarah ayat 195

غ& إ�6 إ* Sي ف' يل ا ف�] Sإ في غ � غ ال غ�� إ�ا � ف6وا إ* ي) غ+ا غ � إ[ Bغ ف Eي 1� غ ال غل7 إ�ا ي� Bف إ<ي يي غ+ا إ" ف?وا ي Iف غ�ا غ إ � غ ال إ0 إ�9 غ5 إ�ي ف?وا إ� ي- غ+ا غ

“Rasulillah said ‘ Allah wont send disease without the cured”

HR Abu Hurairah

Jس غ�ا Uغ ف غل غ غ_ ي- غ+ا ��ا غ إ�ا Jس غ�ا ف ال غ غ_ ي- غ+ا غ3ا

Yغ��� ا�� Vغ��� غ��+ا ا�� غ��> إ���ا غ���� �، Jر�� ا�� غ�� غ��� Jد�� ا�� غ��� ي���0 Bف� إ��ل

إ��� ��ا��ل�� إ���� ي��> إ���ا إ�" غ��+ا غ���# غ�" �، Jغ�� ا�� غ���< ا��ل�� Jف�� ا�� غ�� غ���< ا��ل��

غ����0 غ��= غ�� غ����_ Every disease has definitely drug. When a"غ���drug in accordance with illness then he will

recover with the permission of Allah Subhanahu wa Ta'ala. "(HR. Muslim)

HR Muslim

CONCLUSION

 

Based on the scenario we know that the doctor is inconsistent in his decisions as we compare the first and second cases. On the first case, though the doctor knew about the donor’s subnormal intelligence and had his suspicions on donor-recipient relationships, he conducted the operation anyway. However, on the second case, he also knew but tried to prevent the operation by proving that the donor and recipient are not related. The doctor hesitated to do the operation on the first case at the beginning, and considered the health risks and the possibility for them to do it in another hospital anyway if he rejected. He then chose to do the renal transplant.

In our opinion, he shouldn’t have done the operation. If only the donor knew about the procedure she undergoes, she might rejected. It is the doctor’s job to explain the procedure to the donor in a way that the donor can understand. The family of the donor is also at fault. They forces her to donate her kidney regeardless her opinion. In Al-Quran, it is written that this cannot be done without mutual consent, and there is no clear indication that she consented.

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