Cassidy's Corner

Farhat Moazam is an American board-certified pediatric surgeon who practiced in both the US and Pakistan for over two decades. She was founding Chair of Surgery at Aga Khan University in Karachi before earning her MA in Bioethics and PhD in Religious Studies at the University of Virginia (2004). This book originated from her doctoral research.

She is now founding Chairperson of the Centre of Biomedical Ethics and Culture (CBEC) at SIUT — the first dedicated bioethics center in Pakistan. She received the 2022 Hastings Center Bioethics Founders' Award and is a Hastings Center Fellow.

A pioneering ethnographic study based on participant observation and interviews at the Sindh Institute of Urology and Transplantation (SIUT) in Karachi — the largest transplant center in South Asia, where all services are provided free. Moazam draws on her dual perspective as Pakistani surgeon and Western-trained bioethicist to challenge autonomy-centered bioethics frameworks.

Chapter structure:

• Ch. 1 — "The Stage" — Sets the scene at SIUT ("a medical oasis in a sea of privation") and its charismatic director "Dr. Ahmed" (Dr. Adeeb Rizvi)
• Ch. 2 — "Webs of Relationships" — Family structures, kinship networks (biradari), honor (izzat), and collective decision-making. The family — not the individual — is the primary moral unit
• Ch. 3 — "Giving and Receiving Kidneys" — Ethnographic case studies of patients and families. Documents the zero-sum dynamic (no deceased donors, no unrelated donation, no organ sales = intense pressure on family members). Women — especially unmarried women — face disproportionate pressure to donate, which reduces their marriage prospects
• Ch. 4 — "A Surgeon in the Field" — Moazam's reflexive account of her dual role. A pivotal moment: she believed she'd secured a transplant for a young woman, but later discovered the patient remained on dialysis. "I had obtained no more than a superficial glimpse into...darker, deeper currents."
• Conclusion — "Ethics and Pakistan" — Argues that Beauchamp & Childress's principlist model is inadequate for non-Western contexts; calls for culturally grounded bioethics

• Izzat (honor) — Central concept shaping who donates and why. Family honor creates obligations that override individual preferences
• Biradari (kinship network) — The relevant decision-making unit. Distributes responsibility but can also exert coercive pressure
• Women as donors — Pakistan's patriarchal structure channels pressure toward women. Men are "economically indispensable," so women bear disproportionate burden
• Medical paternalism — Doctors decide on behalf of patients; patients expect and prefer this. Moazam asks what ethical practice looks like within this framework rather than condemning it
• The "Georgetown mantra" — Autonomy, beneficence, non-maleficence, justice — Moazam argues these Western principles fail to capture non-Western moral landscapes

Moazam provides what reviewers call "a unique contribution to the literature on interpretations of organ donation within Islam":

• Permissibility principles: Necessity (darura), public interest (al-masalih al-mursalah), altruism (al-ithar)
• Body's sanctity vs. saving life: Fatawa prescribe both duties, creating genuine theological tension
• Brain death: OIC accepted it (1986) but no consensus, especially among Hanafi scholars in South Asia
• School variation: Indo-Pakistani (Hanafi) scholars lean impermissible; Middle Eastern/Shafi'i/Shia scholars more permissive
• Pakistan's Federal Shariat Court: Through 12 hearings, unanimously affirmed ethical transplantation as "a noble act fully condoned by Islam" while declaring organ sale impermissible

There is no monolithic "Islamic view" — rather ongoing jurisprudential debate (ijtihad).

• American Journal of Transplantation: "An exceptionally gifted and evocative writer... not only superb intellectual work, but literary artistic merit" — Benjamin Hippen
• Social History of Medicine: "A major contribution to the field of medical ethics" — Vardit Rispler-Chaim
• Renée C. Fox: "A wonderful book, based on her extraordinary first-hand study"
• New Scientist: "An insider's story of how modern medicine can be made to work successfully in traditional societies"

Widely cited across bioethics, transplant medicine, Islamic studies, and medical anthropology. Helped catalyze the 2007 Pakistan ordinance banning commercial organ trade.