T
his is a three-part series on the issue of organ donation in Malaysia. The first part examines the factors contributing to the country’s low organ donation rate, particularly in cases involving patients declared brain dead.
A video showing a couple accompanying their son on his final journey to the operating theatre for an organ donation procedure at Hospital Sultanah Nur Zahirah in Kuala Terengganu, which went viral on social media earlier this year, revealed a deeply human side of a story rarely highlighted in this country.
Amirrul Mukminin Mohd Zain, 27, was declared brain dead after being involved in a motorcycle accident in January. From a clinical medical standpoint, he had already passed away – his heart continued to beat only with the aid of life support.
Known for his kind nature, Amirrul had registered as an organ donor several years earlier. His parents chose to honour his wish to donate his organs despite their immense grief.
It was reported that seven of his healthy organs and tissues were donated, including his heart, kidneys and corneas. His parents showed extraordinary courage in consenting to organ retrieval from a body that still appeared "alive."
In this country, this is something that rarely occurs, according to transplant specialists interviewed by Bernama, a view that underscores the ongoing debate surrounding the reality of actual organ donation in Malaysia, which remains low, particularly in cases involving brain-dead patients.
LEGACY
With the assistance of Universiti Malaya Medical Centre (UMMC) here, Bernama had the opportunity to conduct a written interview with another family who went through a similar experience, also earlier this year.
Requesting that their identities remain confidential, the parents, who are Chinese, made the difficult decision after their son, in his 30s, was declared brain dead following a stroke.
Organ donation is highly encouraged in most religions, as it can be considered 'charity' and a great act of charity, especially towards organ recipients and their families.
Their son suffered a stroke while in the bathroom and was rushed to UMMC. Despite various treatments, he was eventually pronounced brain dead and put on a ventilator.
After being informed by the hospital about their son’s situation and the potential for organ donation from patients in this category, the family made a difficult decision, even though they could see him still "breathing."
“While we were overwhelmed with grief, we also found a sense of acceptance. Learning that his organs and tissues could potentially save others brought us some comfort and gave us the strength to proceed with the process, ensuring that his legacy continues.”
The parents said their son, who was not registered as an organ donor, ran his own electrical goods business and was always cheerful and willing to help others.
Both his kidneys were transplanted to recipients through surgeries carried out on the same day he was declared brain dead. Two of his healthy tissues – bone and a heart valve – were also successfully donated.
The family expressed hope that society would view organ donation as a deeply noble humanitarian act. They also encouraged Malaysians to have early discussions with their families about their wishes to become organ and tissue donors so that clear decisions can be made when the time comes.
GIFT
The parents’ sacrifice was not in vain. A kidney of their son “lives on” in the body of a 49-year-old woman, who wishes to be known only as Saras.
When she was 34, Saras was diagnosed with Stage 2 chronic kidney disease. Since then, her condition steadily worsened, requiring close monitoring and continuous treatment. Her social life came to a standstill, and her future seemed uncertain.
She was no longer able to work and had to undergo regular dialysis at a cost of about RM230 per session. She also suffered a series of complications, including osteoporosis, numbness in her hands, dry skin, and high blood pressure, while also having to strictly limit her fluid intake.
“For nearly 15 years, I endured this suffering. Without organ donation, I wouldn’t have survived. It gave me a second chance at life. I want to thank the donor’s family for making such a difficult decision despite their grief. I promise to take care of myself and not waste this precious gift,” she said when contacted by Bernama.
More than two months after receiving her new kidney, her life has changed significantly. Where she once had to strictly control her fluid intake, she can now drink freely and urinate normally again—a blessing she is most grateful for.
“I hope my story will raise awareness about the importance of organ donation, especially in cases involving brain-dead patients. They may no longer be in this world, but they are saving lives, and their legacy lives on in the recipients,” she said.
WIDESPREAD MISUNDERSTANDING
Malaysians can register themselves as organ donors via dermaorgan.gov.my. While registering as a donor makes one’s intention clear, Malaysian law requires family consent for any organ donation at the time of death. Conversely, unregistered individuals can have their organs donated if their family authorises it after their death.
In Malaysia, the rate of cadaveric organ donation, particularly involving brain-dead patients, remains low, largely due to a lack of family consent. According to the National Transplant Resource Centre under the Ministry of Health, nearly 90 percent of potential donations do not proceed due to family refusal, even when the patient had pledged to donate their organs.
Urgent organ transplantation is necessary due to the short lifespan of the organ transplant process.
Transplant specialists note that brain-dead patients offer greater potential to ease the national transplant waiting list (patients waiting for organ transplants) as both their organs and tissues can be donated. In contrast, in cases of cardiac death, only tissues are typically viable for donation.
Unfortunately, in the case of brain death cases, one of the biggest misconceptions among the public concerns brain death itself. Many believe a brain-dead person is still alive because the heart continues to beat, the body remains warm and the chest rises and falls.
In reality, from a medical standpoint, brain death means the complete and irreversible cessation of all brain function, with no possibility of recovery.
According to the Guideline of the Malaysian Medical Council (MMC) Brain Death Version 2/2025, the concept and entity of Brain Death/Death by Neurological Criteria (BD/DNC) are recognised and accepted; and that BD/DNC means death.
Beyond the difficulty many face in accepting this reality, cultural and traditional beliefs also contribute to the low rate of organ donation involving brain-dead patients.
Lim, a Buddhist, said he believes brain death does not constitute complete death as other organs continue to function.
“Organ donation is strongly encouraged in our religion as it is considered an act of charity and great compassion.
“However, such donations should only take place after a person has fully died, not merely brain-dead. We fear that removing organs before death is complete could cause unrest in the hereafter,” he said in a WhatsApp interview.
He also noted that in Buddhism, parents hold ultimate authority over decisions involving their children as they (parents) are regarded as their “creators”. As such, even if a child has pledged to donate their organs, the final decision rests with the parents.
N. Kuvineswaren, a Hindu, said while his religion encourages charitable acts, including organ donation, emotional factors and family consent remain major challenges.
“In our culture, preserving the feelings and well-being of parents is a priority. Religious leaders, therefore, need to play a role in educating the community so that organ donation is better understood as a noble act that can greatly benefit people who have been waiting for years for organ transplantations,” he said.
N. Kuvineswaren.
Alex, a Christian, said his religion does not prohibit organ donation, but issues often arise within families.
“There is a misconception that the body must remain whole at burial. This is why it is difficult for family members to agree to organ retrieval,” said the university student.
PERMITTED IN ISLAM
Confusion surrounding brain death and organ donation also presents a dilemma within the Muslim community. In many cases, decisions are influenced not by complete medical understanding, but by emotions, personal beliefs and concerns over the condition of the body.
According to UMMC Islamic Affairs Department officer Sarah Aqilah Mazuki, brain death has long been recognised in Islamic jurisprudence in Malaysia, supported by international bodies such as the International Islamic Fiqh Academy and the National Fatwa Council Malaysia.
Sarah Aqilah Mazuki.
She explained that brain death is considered true death as it is confirmed by independent specialist doctors through strict and multi-layered procedures.
On the issue of withdrawing life support, she said Islam permits it if the patient has no chance of recovery and with the consent of next of kin, as continued treatment would no longer benefit the patient.
From the perspective of organ donation, she noted that it aligns with the principles of Maqasid Syariah, particularly hifz al-nafs (the preservation of human life). The concept of choosing the lesser harm to avoid greater harm also applies. Organ donation is permissible provided certain conditions are met, including the absence of any commercial element.
Addressing organ donation between Muslims and non-Muslims, she clarified that it is allowed as long as the intention is to benefit others and save lives.
Sarah Aqilah, meanwhile, also emphasised that patient care always remains the top priority in hospitals.
“Patients are fully treated first. Death is only declared after very strict procedures. There is no such thing as ‘harvesting organs prematurely’ in the medical system,” she added.
