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Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

1 

 

Religious, Cultural and Legal Barriers to Organ Donation: The Case of 

Bangladesh 

 

Md Shaikh Farid, Ph.D.1, Tahrima Binta Naim Mou2 

1. Associate Professor, Department of World Religions and Culture, Dhaka University, Dhaka- 1000, Bangladesh, 

Email: sfarid@du.ac.bd  

2. Adjunct Lecturer, Sonargaon University (SU), and M.Phil. Researcher, Department of World Religions and Culture, 

Dhaka University, E-mail: tahrima_mou@yahoo.com 

 

DOI: https://doi.org/10.3329/bioethics.v12i1.50654  

 

Abstract: There is a substantial shortage of organs available for transplantation in Bangladesh. This has 

resulted in the commodification of organs. This study analyzes the religious, cultural, and legal barriers to 

organ donation in Bangladesh. It is based on the examination of available literature and primary sources 

i.e. religious decrees and opinions of religious leaders of faith traditions, and the Bangladesh Organ 

Donation Act, 1999. The literature was retrieved from databases, such as PubMed, BioMed, and Google 

Scholar using the key words: organ donation in Islam, organ donation in Bangladesh, organ donation and 

religions. The study found that although many Islamic scholars accept organ donation, both living and 

cadaveric, under some conditions, some Bangladeshi Muslim clerics oppose donation. They argue that 

organ retrieval violates the sanctity of the human body and retrieval of organs may harm a living donor or 

lead to death, and organ donation may encourage the commercialization of body parts. Both 

commercialization and harming oneself are considered sins. Thus, the divergent views of Muslim clerics 

are a major barrier to organ donation among the Bangladeshi Muslims. Cultural and social factors also have 

a negative impact. Most people desire to be buried with their bodies intact. Although the Bangladesh 

government promulgated the Bangladesh Organ Donation Act, 1999, and amended it in 2018, it restricted 

donors and recipients to members of the extended family, which also reduced the donor pool. This study 

argues that the Muslim Orthodox clerics’ stand against organ donation and other cultural and legal issues 

are the major obstacles to organ donation in Bangladesh.   

 

Key words:  Organ donation, organ transplantation, cadaveric donation, Islamic bioethics 

 

Introduction: Organ donation is one of the 

major developments of medical sciences in 

the 21st century. Organ transplantation is a 

life-saving process for people who are 

suffering from organ failures. Although 

organ donation and transplantation can be a 

new hope to dying patients, the attitude and 

acceptability of organ donation and 

transplantation vary according to religious, 

cultural, and legal issues. These diversities in 

legal, cultural, religious, and traditional 

concepts regarding organ donation and 

transplantation restrain its acceptability and 

create a lack of willingness to organ donation 

among the people of Bangladesh. Therefore, 

comparing to other countries, Bangladesh 

lacks behind in organ donation and 

transplantation. Although organ donation is 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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increasing steadily in Bangladesh, still this 

medical practice is stuck in its primary stage 

of development 1. Thus, the question arises 

what are the reasons behind this situation 

even after knowing that saving a life is a 

virtuous act? Do people know the importance 

of organ donation? For what reasons 

Bangladeshi people are not willing to donate 

organs even to their family members? Why is 

the percentage of organ donation in the 

country very low? Is this because of religions 

or religious beliefs, cultural issues, 

educational, social prejudices, mistrust of 

medical professionals or hospitals? What are 

the opinions of religious leaders and religious 

scholars of the country regarding organ 

donation? How do the medical authority and 

the government act on this very crucial issue? 

In this paper, we discussed only religious, 

cultural, and legal barriers to organ donation 

in Bangladesh.  

 

Methodology and methods: This study 

discusses and analyzes the religious, cultural, 

and legal barriers to organ donation in 

Bangladesh. Thus, the article is descriptive 

and analytical. This article discusses the issue 

from four major religious perspectives, such 

as Islam, Hinduism, Buddhism, and 

Christianity in the context of Bangladesh. 

The article is based on examining available 

literature and primary sources i.e. religious 

decrees and opinion of religious leaders of 

faith traditions, and the Bangladesh Organ 

Donation Act (1999). The literature was 

retrieved from databases, such as PubMed, 

BioMed, and Google Scholar using the key 

words: organ donation in Islam, organ 

donation in Bangladesh, organ donation in 

religious scriptures.  

 

Organ donation scenario in Bangladesh 

and around the world: Both living and 

cadaveric organ donation and transplantation 

are very common medical practices 

worldwide. However, in Bangladesh, these 

life-saving medical procedures are not well 

established yet. Even, there are no actual 

estimates regarding life-threatening diseases 

and the need for organ transplantation. It is 

estimated that around 20 million people are 

suffering from kidney diseases which are 

about 9 percent of the country's total 

population, and half a million people are 

suffering from corneal diseases. More than 

35,000 people die because of kidney failure. 

The yearly need for kidney transplantation is 

estimated at roughly 5000 2. However, only 

around 100 people can have kidney 

transplants with kidneys donated from their 

relatives 2, 3. In 1982, the first-ever successful 

kidney transplantation was conducted at 

Bangabandhu Sheikh Mujib Medical 

University (then Institute of Postgraduate 

Medicine & Research). After that, on a 

limited scale, regular kidney transplantations 

have been continued as kidney donation 

continues to come from living donors, who 

are believed to be close relatives of kidney 

recipients 1. The initiative of cornea 

transplantation began in 1974 and the 

successful cornea transplantation was 

conducted in 1984 4. To promote cornea 

donation challenging false perceptions and 

fear of donation in the society, a public 

awareness campaign had been extended over 

three decades. This has resulted in more 

cornea donations and transplantations in 

recent years 2.  

 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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Concerning liver disease, one in three 

Bangladeshi suffers from liver disease. 

Compare to kidney transplants, liver 

transplants are a recent development and are 

rare. The first-ever successful liver 

transplantation of the country was conducted 

in 2010 at BIRDEM Hospital 1. Although 

liver transplantation was started in 2010, it 

happens rarely because of a shortage of 

donations and a lack of trust of people in 

medical and transplant procedures. There are 

ten transplant centers both in the public and 

private sectors. Some private hospitals and 

charity centers such as Kidney Foundation 

and Centre for Kidney Disease and Urology 

Hospital, Square and Evercare Hospital 

conduct transplantation from living donors. 

However, mainly, in public hospitals, 

transplantations are performed. These centers 

mainly implant kidney and cornea, and bone 

marrow that has been introduced recently 5. 

This picture shows the capacity of organ 

donation and transplantation in the country.   

 

Because of the shortage of organ donation 

and capacity for organ transplantation, each 

year thousands of Bangladeshis die while 

waiting for an organ donor and possible 

transplantation. This is because of an acute 

imbalance between the number of people 

waiting for transplantation and the number of 

organs donated. The unavailability of 

potential donors makes the situation worse. 

Although the need for organ transplantation 

is growing over time, the practice of organ 

donation is not enough in the country. In 

Bangladesh, laws regarding organ donation 

and transplantation are still confined to close 

family members 6. Although the cadaveric 

transplantation is permitted in the amended 

Bangladesh Organ Donation Act (1999), the 

donation and transplantation are limited to 

living donors only 7. This has resulted also in 

the commodification of organs 8. 

 

Compare to Bangladesh, organ 

transplantation has become a normal and 

familiar strategy for treating organ failure 

largely in developed countries. In 1984, the 

United States constituted the National Organ 

Transplant Act (NOTA) which forms a 

legitimate structure for organ transplantation. 

It assures the Organ Procurement and 

Transplantation Network (OPTN) as a 

private, non-benefit organization under 

government supervision, which keeps up an 

automated review of potential organ donors 

and recipients. These organ banks are formed 

to obtain organs and supply them for 

transplantation when it is needed 5. In 

developed countries, such as the UK, a 

healthy adult citizen can donate organs at his 

or her consent at any age. In the USA, a 

healthy person aged between 18-70 years can 

donate a kidney. In Canada, a healthy person 

can donate a kidney, a lobe of the lungs, and 

a part of his or her liver if he or she wishes. 

Concerning neighboring countries, such as 

India a relative donor can donate an organ to 

the patient whenever it is required. A 

nonrelative donor can donate organs by 

informing the State Authorization Committee 

at least 24 hours before. In Sri Lanka, any 

healthy person can donate an organ to the 

patient with the consent of the Ethical 

Committee of the Health Ministry 9. In 

Pakistan, if the required organ cannot be 

collected from the first-degree relative, an 

organ can be collected from a cadaveric or 

living non-relative donor with the approval of 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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the Human Organ Transplant Authority 

under the observation of the National 

Monitoring Authority 10.  

 

Many Muslim countries have formulated and 

enacted laws and regulations on organ 

donation from living and cadaveric donors. 

For example, Egypt is the only Muslim 

country where no objection is recorded from 

Islamic scholars regarding organ donation 

and transplantation 11. In Saudi Arabia, both 

living and cadaveric donation are allowed for 

organ transplantation 12. Among the Muslim 

Middle East countries, Iran has the best 

model for organ donation and transplantation 

as there is no prohibition of relative and 

nonrelative, and living and cadaveric donors 
13. Moreover, any healthy nonrelative organ 

donor is rewarded with a special monetary 

award. That’s why there is no waiting list for 

kidney transplantation in Iran 14.  

 

Religious issues of organ donation in 

Bangladesh: We discussed the issue from 

four major religious perspectives, such as 

Islam, Hinduism, Christianity, and Buddhism 

in the context of Bangladesh. 

 

Organ donation in Bangladesh: an Islamic 

perspective: For organ donation and 

transplantation, religions and religious 

sentiments play an important role throughout 

the world including Bangladesh 15. No 

religion formally forbids organ donation and 

transplantation both from living and 

cadaveric, except some orthodox Jews 

Rabbis, some Muslims and Christian scholars 
16. Many Muslim countries, such as Saudi 

Arabia, Malaysia, Indonesia, Turkey, Oman, 

Egypt declared religious decrees (fatwas) 

permitting organ donations from both living 

and cadaveric donors 17. These countries have 

brain death laws and organ transplant acts, 

and most importantly, in these countries, the 

concept of brain death and organ donations 

are supported and approved by Islamic 

scholars and religious leaders of different 

faith traditions 18. However, some South Asia 

Muslim clerics (scholars) and muftis (jurists) 

oppose organ donation — living and 

cadaveric — because according to them, the 

human body is an “amanat” (trusteeship) 

from Allah and it must not be dissected 19.  

 

Similar to other South Asian countries, there 

are opinions for and against organ donation 

among the Islamic scholars in Bangladesh. 

The cultural and social norms are blended 

with Islamic Religious Tradition in 

Bangladesh. Therefore, it is difficult to make 

the Bangladeshi Muslims understand 

religious issues and any other issues which 

are not directly discussed in the Quran and 

the Sunnah (the traditions of the Prophet). 

The problem arises because, despite many 

religious decrees (fatwas) from religious 

scholars around the world supporting organ 

donation and transplantation, there is a lack 

of agreement among Muslim scholars 

concerning whether organ donation is 

compatible with Islam 20. The literature on 

organ donation and transplantation also 

demonstrates that Muslims are more likely 

than people of other religions to have a 

negative view on organ donation 19. Studies 

also demonstrate two main concerns: first; 

Muslims are often uncertain whether organ 

donation is permissible or forbidden in Islam, 

and second; even in cases where Muslims 

believe organ donation is permissible in 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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Islam, this attitude does not often lead them 

to organ donation through actions, such as 

having donor cards 21.  

 

Those who don’t believe that organ donation 

is permissible they argue that human beings 

are not the owner of their bodies rather they 

are the caretaker only 20. Referring to the 

Quran they argue that after being buried, 

human bodies will decay, but during the 

process of resurrection, human bodies will be 

resurrected with all their memories and 

deeds. Human organs and skin will thus bear 

witness against one’s actions on the Day of 

Judgment 22. The Qur’an prescribes, “And 

you did not veil yourselves lest your ears, 

your eyes, and your skin should bear witness 

against you, but you thought that Allah did 

not know most of what you did” (Qur’an, 

41:22).    

 

Thus, they argue that donation or 

transplantation of organs is not allowed in 

Islam as it is considered an alteration to 

Allah’s creation 22. It is also stated in the 

Quran that “Verily we have honored the 

children of Adam. We carry them on the land 

and the sea, and have made provision of good 

things for them, and have preferred them 

above many of those whom We created with 

a marked preferment” (Qur’an, 17:70). They 

also argue referring to a statement of Prophet 

Muhammad (PBUH), where he stated, 

“breaking the bone of a dead person is like 

breaking it alive”. Therefore, human bodies 

should be preserved as much as possible 

because the sanctity of the human body is 

very much important in Islam 14, 23. Thus, 

Muslims must bury dead bodies as soon as 

possible. 

Moreover, they argue that modern medical 

facilities, equipment, and treatments are not 

available to transplant patients in many 

Muslim countries including Bangladesh. 

Therefore, they are critics of the western 

biomedical practices. They believe that the 

main purpose of the western biomedical 

practices is nothing but another way of 

money-making 22. That’s why Muslim 

scholars are against organ donation and 

transplantation. These divergent views create 

a dilemma among Muslims who wish to 

donate their organs for transplantation and 

medical researches.  

 

While some scholars deny the importance of 

organ donation and transplantation, many 

Islamic scholars welcome it wholeheartedly. 

There are different interpretations by 

different religious leaders, ‘and 

‘Ulemas’(Scholars), but many of them 

support living organ donations under the 

following conditions 24: 

1. Donation should not cause a 

major loss to the donor’s health. 

2. A person receiving an organ 

should be beneficial for his/her 

health. 

3. Donation should not be for 

money. 

 

Scholars argue that if any question is not 

directly answered in the Quran and Hadith, 

Muslims should look for an answer in Ijma 

(consensus) and Qiyas (analogy). As there is 

no direct statement regarding organ donation 

in Islam, therefore, Muslims should follow 

secondary and subsidiary sources of Islamic 

Shariah. Regarding the enhancement of 

public welfare and the common good 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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(Maslahah), it is asserted by one of the 

significant rules of the Shariah that despite 

Islam forbidding the violation of the human 

body, necessity makes prohibited things 

permissible 18, 24. Thus, they argue that organ 

donation and transplantation are permissible 

based on the principle of the necessity and 

welfare of the community or human beings. 

Even, there is evidence that Prophet 

Mohammed (PBUH) himself replanted the 

eye of Qatada Ibn Noman, the arm of 

Muawith Ibn Afra, and the hand of Habib Ibn 

Yasaf which were amputated in the battle of 

Ohood 12, 24. Regarding blood transfusions, 

the principle of necessity allows blood 

transfusions from non-Muslims according to 

the Hanafi, Shafi, and Hanbali schools, while 

the Maliki school allows it if a Muslim donor 

is not available 22. Similarly, a verse from the 

Quran can be cited in support of this position. 

The Quran says, “He has explained to you in 

detail what is forbidden to you, except under 

compulsion or necessity” (Qur’an, 16:89). 

This implies that ‘necessity overrides 

prohibition’. In Islam, it is argued that one 

can treat oneself legally without doing any 

harm to human dignity and honor. That is 

why every legal treatment and life-saving 

method is permissible in Islam. The concept 

of altruism is encouraged in Islam. To save 

one’s life or do well to others selflessly is 

always appreciated in Islam 25. In the Quran, 

it is stated that “Whosoever saves the life of 

one person it would be as if he saved the life 

of all mankind” (Quran 5:32). 

 

In 1992, during the Third International 

Congress of the Middle East Society on organ 

transplantation, the Grand Mufti of the 

Republic of Tunisia, Shaikh M. M. Sellami 

said, “According to Islam a human being is 

not the owner of a part of his body or the 

whole body. In any case, organs should not 

be traded, but donated” and later, he added 

on, “I am afraid that these drug gangs could 

use their network overseas to start trading in 

human organs” 16. 

 

Maulana Abdullah Al-Maruf, a Bangladeshi 

Islamic scholar, referred to the decision of the 

OIC's Islamic Council which declared that 

one can donate his or her organs before or 

after his or her death for the welfare of the 

mankind. He stated that “A man, however, 

cannot sell his organs according to Islamic 

principles but he can donate…This is because 

human organs are highly precious in the eyes 

of Islam and they cannot be regarded as 

commercially tradable objects” 26. 

 

These positive views on organ donation by 

Muslims scholars are not reflected in an 

actual donation, because many Bangladeshi 

Muslims are still reluctant and hesitant to 

organ donation. Therefore, compared to 

Bangladesh with other Muslim countries, 

such as Saudi Arabia, Turkey, Iran, Lebanon, 

and Kuwait have more organ donation and 

transplant 27. Moreover, the percentage of 

living kidney and liver donors in Bangladesh 

is less than any other neighboring country. 

The reasons behind these are nothing but lack 

of knowledge about organ donation, its 

process, misinterpretations of religious 

decrees (fatwas) of Islamic scholars by local 

religious leaders (imams). Moreover, this 

divergent view of Islamic scholars regarding 

organ donation is creating a dilemma among 

the Bangladeshi Muslims who wish to donate 

their organs. 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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Organ donation in Bangladesh: a Hindu, 

Buddhist and Christian perspectives: 

Hinduism supports organ donation and 

transplantation. The concept of daan or 

selfless activities has always been 

appreciated in Hinduism. There are many 

verses found in Hindu scriptures that 

indirectly support organ donation (18). The 

Bhagavad Gita notes, “...it is said that the soul 

is invisible...knowing this you should not 

grieve for the body” (Chapter 2:25). 

Similarly, the Manusmruti says, “Of all the 

things that it is possible to donate, to donate 

your own body is infinitely more 

worthwhile”. 

 

Interestingly, the practice of organ donation 

is also found in Hindu mythology. The 

xenotransplantation of head and neck on 

Hindu god Ganesha, Lord Shiva's consort, is 

considered a classic example of organ 

donation 18. Although Ganesha's elephant-

head may be a mythological figure, still it 

makes for an intuitive concept, considering 

the period when Shiva Purana was inked. 

Moreover, in Puranic Hindu texts, dating 

back to 2500-3000 B.C., a vivid description 

of the reconstruction of mutilated noses using 

skin homograft is also found 28. Therefore, 

many Hindu scholars have publicly 

supported organ donation for the benefits of 

other people. Organ donation is regarded as 

an integral part of living 18. 

 

In Buddhism, the process of death is 

considered a very important time and is 

treated with the utmost care and respect 19. 

However, preserving the physical integrity of 

a dead body is not considered important in 

Buddhism. According to some Buddhist 

scholars, the concept of brain death is seen to 

be problematic. In Tibetan Buddhism, it is 

believed that spiritual consciousness can stay 

in the body even after one’s death. The 

departure of this spiritual consciousness is 

regarded as the actual moment of one’s death 

and till then the body must be kept 

undisturbed. As Buddhism believes in 

rebirth, therefore, if any disturbance occurred 

to the dead body, the next rebirth can face 

adverse effects 19, 29. However, this concept 

creates conflicts with the concept of 

generosity (Daana) or selfless giving which 

is one of the core beliefs in Buddhism. Thus, 

in this dilemma, Buddhist scholars have 

different opinions on organ donation. Some 

scholars entirely oppose cadaveric donation 

while others leave it to individual choices 18. 

In other words, in Buddhism, the donation is 

viewed as a matter of individual choices 30. 

 

Those who support organ donation consider 

it a valuable opportunity of generosity on 

several levels. First, to donate one’s body or 

body parts for research or organ 

transplantation is a unique way to detachment 

to one’s own body. Second, to give priority 

to another person’s welfare above one’s 

interest is an excellent expression of the 

bodhisattva ethics of compassion or love. 

Third, to donate one’s organs with an 

intention to benefit others will bring huge 

benefits in future lives, enabling one to obtain 

a blessed rebirth and future opportunities for 

Dharma practice; if donations are dedicated 

to the enlightenment of all living beings, the 

merits are immeasurable 31. 

 

Christianity generally supports organ 

donation and transplantation. Most Anglican, 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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Catholic, and Protestant scholars find organ 

donation as an act of selflessness, thus, they 

approve organ donation and transplantation 
29. In the New Testament, several instances of 

homologous transplantation are found that go 

back to the 1st century A.D.. For example, 

Jesus Christ restored a servant's ear which 

was severed by Simon Peter's sword in a 

battle. Besides, it is also mentioned in the 

New Testament that tortured and mutilated 

Saint Agatha’s breast had been implanted 

again by Saint Peter, and Saint Mark had 

fixed a soldier’s battle-amputated hand 28. 

 

Pope John Paul II also supports organ 

donation publicly 18. Former Pope Benedict 

XVI always carried his donor card. 

Regarding organ donation, Pope Benedict 

XVI viewed that an organ donation is an act 

of compassion that is morally permissible if 

it is free and voluntary. He also said that 

organ transplantation is ethically acceptable 

with the consent of the donor and without 

undue risk of the donor. For cadaveric 

donation, the death of the donor must be fully 

confirmed 16. He noted: 

I offer my organs to help whoever is 

in need; it is simply an act of love. 

But, above all, it means - I repeat - to 

carry out an act of love toward 

someone in need, toward a brother in 

difficulty. It is a free act of love, of 

availability, that every person of 

goodwill can do at any time and for 

any brother. That is all. In my 

capacity, I do not allow myself to 

judge the law of any State. I do not 

judge laws. I only say that to give 

one’s organs spontaneously for 

transplants, in full awareness and full 

knowledge means to give expression 

to a true, deep act of love for one’s 

neighbor. 16  

 

Organ donation in Bangladesh: social and 

cultural barriers: The shortage of organs for 

transplantation makes it important to 

understand why some people are reluctant to 

donate their organs. There are many causes 

why certain groups are less likely to give 

consent to organ donation. Among these 

causes, both social and cultural issues play an 

important role, especially in developing and 

least developed countries, such as 

Bangladesh 32. There are some social 

obstacles and prejudices among the 

Bangladeshi regarding organ donation, which 

hamper organ donation. Firstly, most 

Bangladeshi desire to be buried with their 

bodies intact, thus they are not willing to 

donate organs posthumously. This belief is 

partly associated with religious conviction as 

they believe that their bodies belong to Allah, 

therefore, they cannot support to dissect 

human bodies 3.     

 

Secondly, most people fear that they may die 

during surgeries or after surgeries if they go 

under surgery for organ retrieval for donation 

as they lack knowledge on the process of 

organ donation 3. Thirdly, fear of mutilation 

is another misconception concerning organ 

donation as they believe that if a person wants 

to donate an organ, other organs might also 

be taken. This misconception can be 

corrected by informing donors or relatives of 

cadaveric donors that only organs identified 

for donation will be retrieved from donors 29. 

Fourth, family pressure plays a negative 

impact on the donation, particularly on its 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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earning members. In most cases, families do 

not allow an earning member of a family for 

donations because they are afraid that the 

person might not be able to earn livelihood if 

he or she donates an organ 33. Also, married 

women are always discouraged by in-law’s 

families to donate organs to members of their 

paternal families. Fifth, they fear that organs 

will be sold or used by rich people if they 

donate organs. Studies claim that the system 

of organ allocation to waiting list patients is 

not fair all the time. Wealthy patients are 

moved up the waiting list faster than poor 

patients during the transplantation of organs 
34. Sixth, organ trafficking is another fear that 

forbids people from organ donation as it 

includes unethical doctors, medical staff, and 

the rich people of Bangladesh. Seventh, 

commercial dealings with organs are also a 

major barrier to organ donation 8. Eighth, 

people’s mistrust of hospitals and health care 

professionals play also a negative role in 

donation especially when it comes to 

overseeing sick patients in hospitals, and 

declaring brain death in Bangladesh. Ninth, 

the cost of the transplantation process and 

medicines is so high therefore poor people 

cannot afford it. As the whole process is very 

costly, that is why most of the families avoid 

organ transplantation in the country. Lastly, 

there is also a scarcity of transplantation 

centers with minimal cost and modern 

facilities in Bangladesh, which is another 

major barrier to organ donation 1.   

 

The problem of biopiracy, a form of bio-

violence where developed countries collect 

cells or tissues illegally from the 

marginalized populations or developing 

countries without any consent or fair 

compensation or agreement, is another major 

barrier to organ donation. These illegal acts 

are done for many scientific research studies, 

such as AIDS, Polio, Cancer, Gene mapping 

and so on, and Bangladesh is a good market 

place in this regard 8. 

 

These social and cultural barriers and 

prejudices and the shortage of modern 

transplant technologies are causing damage 

to this life-saving procedure in Bangladesh. 

Therefore, the percentage of living organ 

donation, and cadaveric donation, which is 

yet to start in Bangladesh, is very low 

compare to many other Muslim countries and 

its neighboring countries. 

 

Organ donation in Bangladesh: legal 

issues: Bangladesh Organ Donation Act, the 

first laws on organ donation and 

transplantation, was passed in 1999 where the 

government of Bangladesh ensured legal 

procedures for the collection, preservation, 

and legal use of human organs and 

transplantation. Although this act allows two 

types of donors, living and cadaveric, the 

cadaveric donation was not in practice in all 

these years. Besides, the donor lists in 1999’s 

Act were confined only to legal successors, 

such as husband, wife, father, mother, sister, 

brother, adult son, daughter and blood-related 

uncle, aunt as prospective donors 7, 35. 

However, in 2018, the amendment of this Act 

allowed grandparents, grandchildren, and 

first cousins as potential donors. In this 

amendment, a national cadaveric panel is 

proposed to be established to monitor the 

transplantation process along with providing 

facilities to doctors for the transplantation 

process. If any accusation is found regarding 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

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organ donors and recipients, then the 

individual will be punished with two years of 

detainment or a Taka of 5 lakh fine or both. 

If any specialist is found to be involved with 

the damage of the law his or her enlistment 

will be dismissed from the Bangladesh 

Medical and Dental Council. Again, if any 

institution is found denying the law, its 

registration of the transplantation center will 

be canceled by the authority and will be fined 
7. This amendment is truly welcomed and 

also is praised by the medical authority of 

Bangladesh 5.  

 

However, the Act of 1999 is amended in 

2018, its scope is still limited. The age limit 

is decided from 65-70 years both for donors 

and recipients, although the average life 

expectancy in Bangladesh is higher than this 

age limit 5. 

 

Although the volunteer donors are allowed 

for kidney transplantation, for other 

transplantations, the donor list is still 

restricted within a family and close relatives 
7. Therefore, in 2019, the High Court of 

Bangladesh gave a verdict regarding this 

issue where volunteer donors, who are not 

relatives to patients, are permitted to organ 

donation. The verdict was announced by the 

High Court of Bangladesh when a petition is 

filed regarding kidney transplantation where 

it clearly said not only the proposed 28 

members from the patient’s family but also 

voluntary donors, non-relatives of patients, 

can also donate his or her kidney willingly for 

transplantation. It also added that a thorough 

check-up of both the physical and mental 

health of the volunteer is required before 

donation. Regarding the verdict, the 

petitioner’s counsel, Barrister Rashna Imam 

said that sometimes family members do not 

want to be a donor and sometimes they 

unmatched with the patient and in that 

situation, a volunteer donor is a must for 

saving one’s life, under a monitoring process 
36.  

 

However, for cornea, skin, tissue, and bone 

marrow donation close relatives are not 

required. The law allows the donation and 

retrieval of major transplantable organs. The 

infrastructure of the ICU, brain death 

committee, transplant coordinator, and the 

national committee for cadaveric organ 

transplantation are well defined in the law. 

However, there is no central monetary 

transaction rules and no clear guidelines on 

organ allocation system according to the law. 

Voluntary donation during one’s lifetime 

(opt-in) has also not been discussed in the 

law. Organ procurement organization and 

audit system for transplantation are not 

mentioned. Moreover, there is no system for 

compulsory referral of all possible cases of 

brain death in hospitals 7. Besides, it is 

needed to introduce presumed consent which 

has been effective in many countries 

including some Muslim countries 5.  

 

As the Act is still very restrictive, therefore, 

when close relatives are not found for 

donation, the rich people buy organs from the 

poor donors introducing them as close 

relatives. And most of them often go to the 

neighboring countries for treatments and 

transplantations which are also a financial 

loss to the economy of Bangladesh 8. In an 

interview regarding the issue, Gonoshasthaya 

Kendra trustee, Dr. Zafrullah Chowdhury, 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

11 

 

said that in Iran and Canada, only regulatory 

bodies decide whether donors should donate 

organs to a patient or not. He also added that 

rich people were getting kidney transplanted 

in India, Sri Lanka, Singapore, and the US; 

thus, the Bangladesh government is losing 

foreign currencies worth of Taka 8,000 crore 

every year 37.  

 

Therefore, it is recommended that the 

government of Bangladesh should allow 

voluntary donation so that organ trafficking 

and organ commercialization can be 

restricted. However, it is argued that allowing 

nonrelative donors into the donor pool may 

cause more harm than benefits and it would 

be an unethical practice while more than 20% 

of people still live below the poverty line. 

Allowing unrelated donors to organ donation 

in Bangladesh will coerce the poor people 

into selling their organs to rich patients 6. 

However, the illegal commercialization of 

body parts is being practiced around the 

world, therefore the government must stop 

the commodification of organs by enforcing 

laws and introducing stern punishments 38.  

 

Organ donation in Bangladesh:  a way 

forward: Although Bangladesh has 

experienced significant improvement in 

cornea donation, the donation of other organs 

is still lacking. The following measures might 

be taken to increase organ donation and 

transplantation: 

1. There should be a comprehensive 

awareness program regarding the 

importance of organ donation. The 

government, non-government 

organizations, media, public 

representations, religious scholars, 

doctors, nurses, all stakeholders 

should work together to make the 

awareness campaign a success.  

2. A ‘National Coordination 

Committee’ should be introduced by 

the government comprising all 

concerned stakeholders to monitor 

organ donation and transplantation.  

3. Enactment of law against illegal 

organ trafficking.  

4. Transplant facilities should also be 

prioritized in government hospitals so 

that poor people can get the benefit of 

organ donation.  

5. Manpower training, subsidy for the 

organ donors for ensuring post-

operative care and needy recipients 

for transplantation, establishing a 

central organ registration system, 

introducing a “donor card” could be 

introduced.  

6. An organized training program is 

needed to prepare manpower for 

organ retrieval and transplantation. 

7. There should be a scope of organ 

donation by all healthy relatives or 

nonrelatives like those in developed 

countries. The age limit for healthy 

donors and sick recipients should be 

raised to a standard level.  

8. All organ donors should be given 

fixed compensation and proper 

treatment and other facilities on a 

priority basis if necessary.  

9. Physicians involved in organ 

donation and transplantation should 

be safeguarded, and if any physician 

does not make medical negligence in 



Bangladesh Journal of Bioethics 2021; 12 (1): 1-13 

 

12 

 

transplantation procedure should be 

not discharged.   

10. There should be required doctors, 

nurses, and technical supports for the 

smooth functioning of organ 

transplantation. 

 

Conclusion: Organ donation and 

transplantation are major parameters to the 

development of the health care system of a 

nation. Most nations are making progress in 

practices of organ donation and 

transplantation and are offering hope of new 

lives and survival benefits to their people. As 

Bangladesh cannot afford to lag in organ 

donation and transplantation, all the concern 

stakeholders, particularly the government, 

physicians, community, and religious leaders 

should take organ donation and transplant 

positively, and treat religious, cultural, and 

legal issues from positive perspectives for a 

life-saving opportunity and the betterment of 

human beings. Moreover, it is not people who 

do not want to donate their organs but lack of 

mechanisms to facilitate donation are major 

barriers to organ donation in Bangladesh. 

Therefore, the practice of organ donation in 

Bangladesh should be increased under proper 

guidelines and surveillance as soon as 

possible. 

 

 

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Author Contributions: The 1st author conceived the 

idea and wrote the manuscript and checked the 

manuscript meticulously. The 2nd author did the 

literature review, wrote a part of the manuscript. 

 

Conflict of interests: The authors declare that there is 

no conflict of interest in this study. 

 


