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.

1. PANEL
MEDICAL FACULTY
MUSLIM UNIVERSITY OF INDONESIA
2015
GROUP 14
BY:

2. GROUP
14
Muh. Asy Shidiq 110 2015 0003
A. Muh.Yasser Mukti 110 2015 0022
Andira Ratu Nurrasyid 110 2015 0030
Andi Aisya Zealand 110 2015 0051
Nur Zamzam Azizah 110 2015 0059
Amaliah Hakim 110 2015 0070
Rifqy Aditya 110 2015 0078
Rindang Cahyani Abas 110 2015 0101
Elsa Shafira Prasetyati 110 2015 0117
Cindy Purnamasari 110 2015 0136
Atika Rahmah Mustapa 110 2015 0147

3. 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.

4. 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.

5. H A R D
W O R D
Transplantation
To 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.
Immunosuppression
A weakning of the immune system that cause a
decrease ability to fight infection and disease.
Commercialized
To use something as an opportunity to earn money;
designed principally for financial gain; profit-oriented.

6. CONT…
Coerced
Persuade (an unwilling person) to do something by
using force or threats.
Source : Meriam-Webster Dictionary, Oxford dictionary
Cadaver
Corpse 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.
Implication
A possible future effect or result.

7. Analyz
e the
case
based
on the
princi
ples
of:
Medical Humanity Aspect
Humanism 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

8. “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

9.  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

10. Medical Ethics Aspects
Medical 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

11. “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

12.  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

13. Medical Professional Aspects
Professionalism 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

14.  “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

15. 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

16. the case
in the
perspect
ive of
Islam
(All
the
Aspects
in the
view of
Quran
ِ‫ن‬َ‫م‬َ‫ف‬ِ‫إ‬ َ‫َل‬َ‫ف‬ ٍ‫د‬‫ا‬َ‫ع‬ َ‫َل‬ َ‫و‬ ٍ‫اغ‬َ‫ب‬ َ‫ْر‬‫ي‬َ‫غ‬ َّ‫ر‬ُ‫ط‬ْ‫ض‬‫ا‬َ‫غ‬ َ َّ‫اَّل‬ ََّّ ِ‫إ‬ ِِْ‫ي‬َََ‫ع‬ ََْ‫ْث‬ٌَ‫ي‬ ِ‫ح‬َ‫ر‬ ٌ‫ور‬ُ‫ف‬
“….. 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

17. Q.SAl-Maidah
ayat32
‫م‬َّْ َ‫ن‬ َ‫ل‬َ‫ت‬َ‫ق‬ ْ‫ن‬َ‫م‬ َُِّ‫ن‬َ‫أ‬ َ‫ل‬‫ي‬ِ‫ئ‬‫ا‬َ‫ر‬ْ‫س‬ِ‫إ‬ ‫ي‬ِ‫ن‬َ‫ب‬ َٰ‫ى‬َََ‫ع‬ ‫َا‬‫ن‬ْ‫ب‬َ‫ت‬َ‫ك‬ َ‫ك‬ِ‫ل‬ََٰ‫ذ‬ ِ‫ل‬ْ‫ج‬َ‫أ‬َ‫ف‬ ِ‫ض‬ ْ‫ر‬َ ْ‫اْل‬ ‫ي‬ِ‫ف‬ ٍ‫د‬‫ا‬َ‫س‬َ‫ف‬ ْ‫و‬َ‫أ‬ ٍ‫س‬ْ‫ف‬َ‫ن‬ ِ‫ْر‬‫ي‬َ‫غ‬ِ‫ب‬ ‫ا‬ً‫س‬ْ‫ف‬َ‫أ‬َ‫ك‬َ‫ل‬َ‫ت‬َ‫ق‬ ‫ا‬َ‫م‬َّ‫ن‬
َ‫ل‬ َ‫و‬ ‫ا‬ً‫ع‬‫ي‬ِ‫م‬َ‫ج‬ َ‫اس‬َّ‫ن‬‫ال‬ ‫ا‬َ‫ي‬ْ‫ح‬َ‫أ‬ ‫ا‬َ‫م‬َّ‫ن‬َ‫أ‬َ‫ك‬َ‫ف‬ ‫ا‬َ‫ه‬‫ا‬َ‫ي‬ْ‫ح‬َ‫أ‬ ْ‫ن‬َ‫م‬ َ‫و‬ ‫ا‬ً‫ع‬‫ي‬ِ‫م‬َ‫ج‬ َ‫اس‬َّ‫ن‬‫ال‬ََُّ‫ْث‬ ِ‫ت‬‫َا‬‫ن‬ِ‫ي‬َ‫ب‬ْ‫ال‬ِ‫ب‬ ‫َا‬‫ن‬َُُ‫س‬ُ‫ر‬ َُْ‫ه‬ْ‫ت‬َ‫ء‬‫ا‬َ‫ج‬ ْ‫د‬َ‫ق‬ََّّ ِ‫إ‬َ‫د‬ْ‫ع‬َ‫ب‬ َُْ‫ه‬ْ‫ن‬ِ‫م‬ ‫ا‬ً‫ير‬ِ‫ث‬َ‫ك‬
ِ‫ض‬ ْ‫ر‬َ ْ‫اْل‬ ‫ي‬ِ‫ف‬ َ‫ك‬ِ‫ل‬ََٰ‫ذ‬َّ ‫و‬ُ‫ف‬ ِ‫ر‬ْ‫س‬ُ‫م‬َ‫ل‬
“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.”

18. Q.SAn-Nisa ayat29
“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.”
ُ‫ك‬َ‫ن‬ْ‫ي‬َ‫ب‬ َُْ‫ك‬َ‫ل‬‫ا‬ َ‫و‬ْ‫م‬َ‫أ‬ ‫وا‬َُُ‫ك‬ْ‫أ‬َ‫ت‬ َ‫َل‬ ‫وا‬ُ‫ن‬َ‫م‬َ‫آ‬ َ‫ين‬ِ‫ذ‬َّ‫ال‬ ‫ا‬َ‫ه‬ُّ‫ي‬َ‫أ‬ ‫ا‬َ‫ي‬ْ‫ن‬َ‫ع‬ ً‫ة‬ َ‫ار‬َ‫ج‬ِ‫ت‬ ََّ ‫و‬ُ‫ك‬َ‫ت‬ َّْ َ‫أ‬ َّ‫َل‬ِ‫إ‬ ِ‫ل‬ِ‫اط‬َ‫ب‬ْ‫ال‬ِ‫ب‬ ٍَْ‫اض‬َ‫ر‬َ‫ت‬
َُْ‫ك‬ِ‫ب‬ ََّ ‫ا‬َ‫ك‬ َ َّ‫اَّل‬ ََّّ ِ‫إ‬ َُْ‫ك‬َ‫س‬ُ‫ف‬ْ‫ن‬َ‫أ‬ ‫وا‬َُُ‫ت‬ْ‫ق‬َ‫ت‬ َ‫َل‬ َ‫و‬ َُْ‫ك‬ْ‫ن‬ِ‫م‬‫ا‬ً‫م‬‫ي‬ ِ‫ح‬َ‫ر‬

19. Q.SAl-Maidah ayat2
َ‫ر‬َ‫ح‬ْ‫ال‬ َ‫ر‬ْ‫ه‬َّ‫ش‬‫ال‬ َ‫َل‬ َ‫و‬ ِ‫اَّل‬ َ‫ر‬ِ‫ئ‬‫آ‬َ‫ع‬َ‫ش‬ ْ‫ا‬‫و‬َُّ ِ‫ح‬ُ‫ت‬ َ‫َل‬ ْ‫ا‬‫و‬ُ‫ن‬َ‫م‬‫آ‬ َ‫ين‬ِ‫ذ‬َّ‫ال‬ ‫ا‬َ‫ه‬ُّ‫ي‬َ‫أ‬ ‫ا‬َ‫ي‬‫َل‬ َ‫و‬ َ‫د‬ِ‫ئ‬‫آل‬َ‫ق‬ْ‫ال‬ َ‫َل‬ َ‫و‬ َ‫ي‬ْ‫د‬َ‫ه‬ْ‫ال‬ َ‫َل‬ َ‫و‬ َ‫ام‬‫ا‬ َ‫ْت‬‫ي‬َ‫ب‬ْ‫ال‬ َ‫ين‬ِ‫آم‬َ‫ام‬َ‫ر‬َ‫ح‬ْ‫ل‬
ُ‫د‬‫ا‬َ‫ط‬ْ‫ص‬‫ا‬َ‫ف‬ َُْ‫ت‬ََََْ‫ح‬ ‫ا‬َ‫ذ‬ِ‫إ‬ َ‫و‬ ً‫ا‬‫ان‬ َ‫ْو‬‫ض‬ ِ‫ر‬ َ‫و‬ َِْ‫ه‬ِ‫ب‬َّ‫ر‬ ‫ن‬ِ‫م‬ ً‫َل‬ْ‫ض‬َ‫ف‬ ََّ ‫و‬ُ‫غ‬َ‫ت‬ْ‫ب‬َ‫ي‬ُّ‫د‬َ‫ص‬ َّ َ‫أ‬ ٍ‫م‬ ْ‫و‬َ‫ق‬ َُّ ‫َآ‬‫ن‬َ‫ش‬ َُْ‫ك‬َّ‫ن‬َ‫م‬ ِ‫ر‬ْ‫ج‬َ‫ي‬ َ‫َل‬ َ‫و‬ ْ‫ا‬‫و‬َ‫ع‬ َُْ‫ك‬‫و‬ِ‫د‬ ِ‫ج‬ْ‫س‬َ‫م‬ْ‫ال‬ ِ‫ن‬
ُ‫ن‬ َ‫او‬َ‫ع‬َ‫ت‬ َ‫َل‬ َ‫و‬ ‫ى‬ َ‫و‬ْ‫ق‬َّ‫ت‬‫ال‬ َ‫و‬ ِ‫بر‬ْ‫ال‬ ‫ى‬َََ‫ع‬ ْ‫ا‬‫و‬ُ‫ن‬ َ‫او‬َ‫ع‬َ‫ت‬ َ‫و‬ ْ‫ا‬‫ُو‬‫د‬َ‫ت‬ْ‫ع‬َ‫ت‬ َّ َ‫أ‬ ِ‫ام‬َ‫ر‬َ‫ح‬ْ‫ال‬ْ‫ا‬‫و‬ُ‫ق‬َّ‫ت‬‫ا‬ َ‫و‬ َِّ ‫ا‬ َ‫و‬ْ‫د‬ُ‫ع‬ْ‫ال‬ َ‫و‬ َِْ‫ْث‬ِ‫اإل‬ ‫ى‬َََ‫ع‬ ْ‫ا‬‫و‬‫ا‬ ََّّ ِ‫إ‬ َ‫اَّل‬ُ‫د‬‫ي‬ِ‫د‬َ‫ش‬ َ‫َّل‬
ِ‫ب‬‫ا‬َ‫ق‬ِ‫ع‬ْ‫ال‬
“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.”

20. “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
ِ‫إ‬ َُْ‫ك‬‫ي‬ِ‫د‬ْ‫ي‬َ‫أ‬ِ‫ب‬ ‫وا‬ُ‫ق‬َُْ‫ت‬ َ‫َل‬ َ‫و‬ ِ َّ‫اَّل‬ ِ‫ل‬‫ي‬ِ‫ب‬َ‫س‬ ‫ي‬ِ‫ف‬ ‫وا‬ُ‫ق‬ِ‫ف‬ْ‫ن‬َ‫أ‬ َ‫و‬ُ‫ي‬ َ َّ‫اَّل‬ ََّّ ِ‫إ‬ ۛ ‫وا‬ُ‫ن‬ِ‫س‬ْ‫ح‬َ‫أ‬ َ‫و‬ ۛ ِ‫ة‬َ‫ك‬َُْ‫ه‬َّ‫ت‬‫ال‬ ‫ى‬َ‫ل‬ْ‫ح‬ُ‫م‬ْ‫ال‬ ُُّّ ِ‫ح‬َ‫ين‬ِ‫ن‬ِ‫س‬

21. “Rasulillah said ‘ Allah wont send disease
without the cured”
HR Abu Hurairah
ً‫ء‬‫ا‬َ‫ف‬َ‫ش‬ َُِ‫ل‬ َ‫ل‬َ‫ز‬ْ‫ن‬َ‫أ‬ َّ‫َل‬ِ‫إ‬ ً‫ء‬‫ا‬َ‫د‬ ُ‫هللا‬ َ‫ل‬َ‫ز‬ْ‫ن‬َ‫أ‬ ‫ا‬َ‫م‬
َ‫ذ‬ِ‫إ‬َ‫ف‬ ،ٌ‫ء‬‫ا‬ َ‫و‬َ‫د‬ ٍ‫اء‬َ‫د‬ ِ‫ل‬ُ‫ك‬ِ‫ل‬ُ‫ء‬‫ا‬ َ‫و‬َّ‫د‬‫ال‬ َ‫اب‬َ‫ص‬َ‫أ‬ ‫ا‬
ِ‫هللا‬ َِّ ْ‫ذ‬ِ‫إ‬ِ‫ب‬ َ‫أ‬َ‫ر‬َ‫ب‬ ،َ‫ء‬‫ا‬َّ‫د‬‫ال‬َّ‫ل‬َ‫ج‬ َ‫و‬ َّ‫ز‬َ‫ع‬
"Every disease has definitely drug. When a drug in
accordance with illness then he will recover with the
permission of Allah Subhanahu wa Ta'ala. "(HR.
Muslim)
HR Muslim

22. CONCLUSI
ON
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.

23. 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.

24. THANKYOU
Seeyou inthe next panel